NCC200961_NOI Application_20200312

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/10/2020 2:13:12 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 3/11/2020 11:02:33 AM (Review- Construction NOI 22953)
• The task was assigned to Garcia, Lauren V by round robin distribution 3/10/2020 2:13 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 12, 2020 5:00
PM 3/10/2020 2:13 PM
Submit by McCoy, Suzanne 3/12/2020 10:39:47 AM (Payment Verification for NCC200961)
* Bill Clark Homes
• McCoy, Suzanne assigned the task to McCoy, Suzanne 3/12/2020 10:39 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 22, 2020 5:00 PM
3/11/2020 11:02 AM

.• SThF� ';
1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
la. Project Name * Westhaven - Bill Clark Homes of Greenville
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers Lots 13 & 14
2. County* Pitt
3. Highway or Street Westhaven Road
Address* Street name only is acceptable if no address nunber assigned yet
4. CityorTownship* Greenville
5. State * NC
6. Zip Code* 27834
7. Latitude* Enter the latitude in decinal degrees
35.5633
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-77.3996
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*
10/15/2019
Estir ated Construction Project Start Rate
10. Date to End *
04/30/2020
Estinated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial Classification for Development
12. Acres to be
0.25
disturbed*
(including off -site borrow and waste areas)
13. Total site area 0.87
(acres)*

14. Post- 0.01
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-PITT-2019-Westhaven - Bill Clark Homes of Greenville
Tracking ID Assigned autorratically
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 Fork Swamp
Waterbody * %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 27-97-4
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Swift Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 27-97-(0.5)
Index No. NCWaterbody Index Nurrber
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index N nber
Index No.
16a. Is this project r Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B. ^
Flarnittee 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 Bill Clark Homes of Greenville, LLC
Name * If perrrittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name* Lance
It Corporation, enter Fbgistered Agent First Barre
3. Last Name* Clark
If Corporation, enter F3egistered Agent Last Wre
3b. Title Owner/Division Manager
4. Permitee E-mail [e-mail]
Address *
5. Permittee 2523555805
Telephone No.*
6. Permittee Mailing Street Address
Address* 200 E. Arlington Blvd.
Address Line 2
Suite A
City State / Ftovince / Region
Greenville North Carolina
Fbstal / Zip Code Country
27858 United States
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
200 E. Arlington Blvd.
Address Line 2
Suite A
City
State / Rovince / i egion
Greenville
North Carolina
Fbstal / Zip Code
Country
27858
United States
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Mindi
Contact - First
Name *
2. Primary Site
Stephens
Contact - Last
Name *
3. Title
Purchasing/Estimating
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
252-355-5805
Telephone No.
6. Organization
Bill Clark Homes of Greenville, LLC
Name
7. Site Contact
Street Address
Mailing Address*
200 E. Arlington Blvd.
Address Line 2
Suite A
city
Greenville
Postal / Zip Code
27858
8. Consultant Name
(Optional)
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.
State / Rovince / Region
North Carolina
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/01/2019
Approved *
2. E&SC Plan Project ESCP-2019-0057
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* City of Greenville
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. For linear projects, please also upload a site map showing the overall extent of the project or
include the beginning point and end point coordinates in the "Notes" box below.
5. E&SC Plan
ESCP-2019-0057 - Westhaven-Bill Clark Homes of
Approval letter or
208.33KB
Greenville Approval.pdf
Grading Permit
Mast be FL7Ffon-rat
Site Map (Optional)
Helpful for linear project review
Mast be FDFform3t
Notes (Optional)
Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies for linear projects if necessary.
6. NOI Certification
NCG01 Notice of Intent - Westhaven - Bill Clark
Form
518.37KB
Homes of Greenville.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:
Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other
document filed 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 under this 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 guilty ofa Class 2 misdemeanor which may include 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
rV,r,&` alt6
Type Name* Lance Clark
Title Owner/Division Manager
Organization Bill Clark Homes of Greenville, LLC
Date * 03/10/2020

F. Tracking and COC Info
NOI Tracking No. 22953
NC Reference No. NCG01-2020-0961
Uses 'count number' variable (incremrented by SP)
Certificate of NCC200961
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 961
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)