NCC201013_NOI Application_20200316

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/13/2020 12:18:58 PM (NCG01 NOI Submission)
Approve by Clark, Paul 3/13/2020 1:45:59 PM (Review- Construction NOI 23048)
• The task was assigned to Clark, Paul by round robin distribution 3/13/2020 12:19 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 17, 2020 5:00
PM 3/13/2020 12:19 PM
Submit by McCoy, Suzanne 3/16/2020 10:08:12 AM (Payment Verification for NCC201013)
* Reina Laws
• McCoy, Suzanne assigned the task to McCoy, Suzanne 3/16/2020 10:07 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 24, 2020 5:00 PM
3/13/2020 1:46 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
la. Project Name * Logans Manor -Capitol City Homes Lot EC Rev 3/5/20 Lots 1&35
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers 1
35
2. County* Wake
3. Highway or Street 104 Logans Manor Dr
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Holly Springs
5. State * NC
6. Zip Code * 27540
7. Latitude* Enter the latitude in decimal degrees
35.6450
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-78.8104
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*
03/20/2020
Estimated Construction Project Start Date
10. Date to End *
03/05/2021
Estinated Construction Project End Cate
11. SIC (Primary) *
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Leveloprrent
12. Acres to be
4.44
disturbed*
(including off -site borrow and waste areas)
13. Total site area 4.44
(acres)*

14. Post- 0.12
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-WAKE-2020-Logans Manor -Capitol City Homes Lot EC Rev
Tracking ID 3/5/20 Lots 1&35
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 Basal Creek(Bass Lake, Mills Pond)
WaterbodY * Ibrreofwaterbodyinto whichstornwaterrunoff will discharge
15b. Waterbody 27-43-15-3
Index No.* NCWaterbody Index Nunber
Stormwater rJ No
discharges will flow r- Yes
to additional
wate rs *
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. ^
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 Capitol City Homes LLC
Name * If perrrittee is an individual (i.e., organization does not apply), enter first and last nave in this field.
2. First Name* Jason
It Corporation, enter Fbgistered Agent First Barre
3. Last Name* Morrow
IF Corporation, enter F3egistered Agent Last Wre
3b. Title Managing Partner
4. Permitee E-mail [e-mail]
Address *
5. Permittee 919-872-0048
Telephone No.*
6. Permittee Mailing Street Address
Address* 5711 Six Forks Road
Address Line 2
Suite 200
city
Raleigh
Fostal / Zip Code
27609-3888
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
5711 Six Forks Road
Address Line 2
Suite 200
Cty
Raleigh
Fbstal / Zip Code
27609-3888
8. Type of Non -Government
Ownership*
State / Ftovince / Faegion
NC
Country
us
State / Ffovince / Fbgion
NC
Country
US

C. Site Contact Information
Part C.
Roject Site Contact Information
..............................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Kevin
Contact - First
Name *
2. Primary Site Cheek
Contact - Last
Name *
3. Title Project Manager
4. Site Contact E- [e-mail]
mail Address*
5. Site Contact 919-414-0360
Telephone No.*
6. Organization
Name
7. Site Contact Street Address
Mailing Address* 5711 Six Forks Rd. Suite 200
Address Line 2
city
Raleigh
Fbstal/ Zip Code
27609
8. Consultant Name (Optional)
First and Last nave
9. Consultant E-mail This person will be copied on all correspondence.
10. Consultant
Telephone No.
State / Frovince / Pegion
NC
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................................................................................................__
1. Date E&SC Plan 03/05/2020
Approved *
2. E&SC Plan Project 06-2017
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Town of Holly Springs
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 Approval Letter _Logans Manor —Capitol City Homes
Approval letter or 98.15KB
Lot EC_Rev3-5-20 Lots 1&35.pdf
Grading Permit
Mast be R7Fforrrat
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 Logans Manor Lots 1 & 35 NCGO1 NOI Certificate
Form 53.49KB
Form.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
01do.", KID t t," '
Type Name* Jason Morrow
Title Managing Partner
Organization Capitol City Homes LLC
Date * 03/13/2020

F. Tracking and COC Info
NOI Tracking No. 23048
NC Reference No. NCG01-2020-1013
Uses 'count number' variable (incremrented by SP)
Certificate of NCC201013
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 1013
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.)