NCC200505_NOI Application_20200210

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 2/7/2020 1:06:18 PM(NCG01 NOI Submission)
Approve by Clark, Paul 2/7/2020 2:02:14 PM(Review-Construction NOI 21663)
• Morman,Alaina reassigned the task to Clark, Paul 2/7/2020 1:38 PM
* Per your request.
• The task was assigned to McCoy,Suzanne by round robin distribution 2/7/2020 1:06 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: February 11,2020 5:00
PM 2/7/2020 1:06 PM
Submit by McCoy, Suzanne 2/10/2020 7:44:15 AM(Payment Verification for NCC200505)
* The Rexford Group
• McCoy,Suzanne assigned the task to McCoy, Suzanne 2/10/2020 7:43 AM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is: March 20,2020 5:00 PM
2/7/2020 2:02 PM

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1Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System 'D application for•• - .•-under NorthCarolina's
General Permit 1 1111:STORIMATER DISCHARGES associated with construction activities(or
NORTH CAROLINA
Enrlrnnmenfu�Qr�arlry
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name* Bennett Residence
2.County* Chatham
3. Highway or Street 227 Stoney Creek Way
Address* Street nacre only is acceptable if no address number assigned yet
4. City or Township* Chapel Hill
5.State* NC
6.Zip Code* 27517
7. Latitude* Enter the latitude in decimal degrees
35.7680
8. Longitude* Enter the longitude in decimal degrees(M.ST be negative)
-79.0590
If you do not know the latitude and longitude coordinates for this project,you can search the location on this map of
North Carolina. Look for the coordinates in the bottom left corner.
9. Date to Begin* 02/10/2020
Estimated Construction Project Start Date
10. Date to End* 01/01/2021
Estimated Construction Project End Cute
11.SIC(Primary)* Residential, Single
Family Houses(SFE)
(1521)
Standard Industrial aassification for Development
12.Acres to be 0.48
disturbed* (including off-site borrow and waste areas)
13.Total site area 0.78
(acres)*
14. Post- 0.26
construction (Estimated)
impervious area
(acres)*

NCC Project NCC-CHATH-2020-Bennett Residence
Tracking ID Assignedautorratically
Below you must enter waterbody information for surface waters affected by this project. Please consult
DWR's Surface Water Classifications Map Viewer to find waterbody name and corresponding index number. Please
enter only immediate receiving waterbodies-not waters downstream of those unless the project extends there. You
may enter up to 3 waterbodies if needed.
15a. Receiving New Hope River Arm of B. Everett Jordan
Waterbody* Lake(below normal pool elevation)
Nbrre of waterbody into w hich storrrwater runoff w ill discharge
15b.Waterbody 16-41-(3.5)
Index No.* NCWaterbody Index I inber
Stormwater V No
discharges will flow r Yes
to additional
wate rs*
16a. Is this project F Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B. ^
F2rnittee Inforrration-Legally Fbsponsible Entity and Individual
Important:The person who signs the NOI Certification Form and signs the Certification in Section E of this application
form should be the same person as listed in THIS SECTION, or an authorized responsible individual within the same
organization. That person must be a responsible corporate officer who owns or operates the construction activity, such
as a president,secretary,treasurer, or vice president,or a manager that is authorized in accordance with Part IV,
Section B, Item(6)of the NCG010000 General Permit. For more information on signatory requirements,see Part
IV,Section B, Item(6)of that permit.
1.Organization The Rexford Group, ltd.
Name*
2. First Name* Rexford
ff Corporation,enter Fbgistered Agent First Barre
3. Last Name* D'Aprix
If Corporation,enter Faegistered Agent Last%rre
3b.Title Contractor
4. Permitee E-mail [e-mail]
Address*
5. Permittee 3106211231
Telephone No.*
6. Permittee Mailing Street Address
Address* 362 Mountain Laurel
Address Line 2
city State/F rovince/Region
Chapel Hill NC
Fbstal/Zip Code Country
27517 us
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 362 Mountain Laurel
Address Line 2
City State/Frovince/Fbgion
Chapel Hill NC
Fbstal/Zip Code Country
27517 us
8.Type of Individual
Ownership*

C. Site Contact Information
Part C. ^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Rexford
Contact-First
Name*
2. Primary Site D'Aprix
Contact-Last
Name*
3.Title Contractor
4.Site Contact E- [e-mail]
mail Address*
5.Site Contact 3106211231
Telephone No.*
6.Organization The Rexford Group, ltd.
Name
7.Site Contact Street Address
Mailing Address* 362 Mountain Laurel
Address Line 2
City State/Province/Region
Chapel Hill NC
Postal/Zip Code Country
27517 us
8. Consultant Name (Optional)
Ford D'Aprix
First and Last narre
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant 3106211231
Telephone No.

D. E&SC Plan
Part D. ^
Erosion&Sedirrent Control(E&SC)Ran Approval Inforrration
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 02/05/2020
Approved*
2. E&SC Plan Project 2020-00989
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Chatham County
Documentation of E&SC Plan approval and the signed Notice of Intent(NOI)Certification Form is required for a
complete application.
5. E&SC Plan Bennett_Letter of Approval.pdf 288.76KB
Approval Wst be RDFforrrat
letter/documentation
Notes(Optional) Frovide any additional inforrration that night help the reviewer better understand how uploaded documents support
the application.
6. NOI Certification Bennett_NCG01-eNO1-Certification-Form-20190919-
Form 114.19KB
DEMLR-SW.pdf
Mist be FDFfornat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66(1) provides that:
Anyperson who knowinglymakes any false statement,representation,or certification in anyapplication,record,report,plan,or other
documentfiled or required to be maintained under this Article or a rule implementing this Article;or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Artcle;or who falsifies,tampers with,or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
Commission implementing this Artcle shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars($10,000).
Under penalty of law, I certify that:
17 I am the person responsible for the construction activities of this project,for
satisfying the requirements of this permit,and for any civil or criminal penalties
incurred due to violations of this permit.
rJ The information submitted in this NOI is,to the best of my knowledge and belief,
true,accurate, and complete based on my inquiry of the person or persons who
manage the system,or those persons directly responsible for gathering the
information.
* 17 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* rJ If the Erosion and Sediment Control Plan approved by the delegated program is
not compliant with Part II(Stormwater Pollution Prevention Plan)of the
NCG010000 General Permit, I will nonetheless ensure that all conditions of Part
II of the permit are met on the project at all times.
* 17 I hereby request coverage under the NCG010000 General Permit and
understand that coverage under this permit will constitute the permit
requirements for the discharge(s)and is enforceable in the same manner as an
individual permit.
Specify if you are:* r The Responsible Person named on this Notice of Intent
f Authorized Responsible Person*
Important:The person who electronically signs this Certification above must be the same person who signs the NOI
Certification Form. If that person is signing on behalf of the Permittee,that individual must be an authorized responsible
person within the same organization as the Permittee. *An authorized individual is a responsible corporate officer who
owns or operates the construction activity, such as a president, secretary,treasurer,or vice president, or a manager
that is authorized in accordance with Part IV, Section B, Item(6)of the NCG010000 General Permit. For more
information on signatory requirements,see Part IV,Section B, Item(6)of that permit.
Signature
Type Name* Rexford D'Aprix
Title Contractor
Organization The Rexford Group, ltd.
Date* 02/07/2020

F. Tracking and COC Info
NOI Tracking No. 21663
NC Reference No. NCG01-2020-0505
Uses'count_nurrber'variable(increrrented by SP)
Certificate of NCC200505
Coverage (COC) Uses'count number'variable(increrrented by SP)
No.*
Count Number 505
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed(used to assign YY digits after"NOC'in COCno.)