NCC201123_NOI Signed Certification_20200320

NORTH CAROLINA
Em4mnm&tral Qualrly
A. Project Information
Part A.
Proiect Location and Waterbodv Information
1a. Project Name * lot 106 Wexford Reserve
1 b. Specific Lot This field may be used to list specifc lot nun-bers.
Numbers 106
2. County* Wake
3. Highway or Street 2632 TRIFLE LN
Address* Street narre only is acceptable if no address nun-ber assigned yet
4. Cityor Township* Wake Forest
5. State * NC
6. Zip Code * 27587
7. Latitude* Enter the latitude in decimal degrees
36.0004
8. Longitude* Enter the longitude in decimal degrees (MJSTbe negative)
-78.5486
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*
03/16/2020
Estimated Construction Project Start Date
10. Date to End*
09/30/2020
Estimated Construction Project End Date
11. SIC (Primary) *
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial Classification for Developrrent
12. Acres to be
0.53
disturbed*
(including off -site borrow and waste areas)
13. Total site area 0.87
(acres) *
LJ

14. Post- 0.12
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-WAKE-2020-lot 106 Wexford Reserve
Assigned automatically
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 Horse Creek
Waterbody* �brre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-17-(0.7)
Index No.* NCWaterbody Index Nin-ber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Neuse River
Receiving Waterbody narre
Wate rbody
15d. Waterbody 27-(5.5)
Index No. NCWaterbody Index Ninter
15e. Additional Waterbody narre
Receiving
Wate rbody
15f. Waterbody NCWaterbody Index Ninter
Index No.
16a. Is this project r Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*
Note: Stormwater discharges from construction activities associated with oil and gas exploration, production,
processing, treatment, or transmission facilities are eligible for the exemption from NPDES permit coverage except
in very limited instances. Do not proceed with this application before consulting this EPA fact sheet and verifying a
permit applies.

B. Permittee Information
Part B.
Permittee Information - Legally Responsible 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
Name *
2. First Name*
3. Last Name*
3b. Title *
4. Permitee E-mail
Address*
5. Permittee
Telephone No.*
HJ Morris Construction Inc
IF permittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Hank
IF Corporation, enter Pegistered Agent First Ibrre
Morris
IF Corporation, enter Pegistered Agent Last Ibrre
President
[e-mail]
9193450514
6. Permittee Mailing Street Address
Address* PO Box99188
Address Line 2
PO Box 99188
aty
Raleigh
Postal / Zip Code
27624
Check box if the r Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 918 Albany Court
Address Line 2
State / Province / REgion
North Carolina
Country
United States
aty State / Province / Pegion
Raleigh NC
Postal / Zip Code Country
27615-5301 US
8. Type of Individual
Ownership*

C. Site Contact information
Part C.
Project Site Contact Information
................................................................................................................................................................................................................................................................................................................................
1. Primary Site Hank
Contact - First
Name *
2. Primary Site Morris
Contact - Last
Name *
3. Title President
4. Site Contact E- [e-mail]
mail Address* This person will be copied on all correspondence.
5. Site Contact 9193450514
Telephone No.*
6. Organization
HJ Morris Construction Inc.
Name
9. Site Contact
Street Address
Mailing Address*
PO Box99188
Address Line 2
aty
Raleigh
Postal / Zip Code
27624
10. Consultant Name (Optional)
HJ Morris Construction , Inc.
First and Last narre
11. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
12. Consultant 9193450514
Telephone No.
State / Province / Pegion
North Carolina
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (Esq Ran Approval Information
....................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 03/13/2020
Approved *
2. E&SC Plan Project SEC-034136-2020
Number/I D * Assigned by agency or local program
3. E&SC Plan r State DEQ Office
Approved by* r Local Program
4. Local Program* Wake County
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- SEConstruction Plan ReviewChecklist-SEC-
Approval letter or 317.72KB
034578-Wexford lot 106.pdf
Grading Permit* Mist beFDFformat
Site Map (Optional) R=lpfulfor linear project review
Lot 106 Wexford Reserve- Plot Plan.pdf 78.73KB
Mast be FDFformat
Notes (Optional) Provide any additional information that might help the reviewer better understand how uploaded documents support
the application. Include additional waterbodies for linear projects if necessary.
6. NOI Certification Lot 106 Wexford Reserve NOI Certification
Form* 606.69KB
Form_000017.pdf
Mast be FDFforrrat
YOU MUST MAIL THE ORIGINAL SIGNED NOI CERTIFICATION FORM (click on this link) to The Stormwater Program
at the address on the form for the application to fulfill federal application requirements. The Certification Form must be
signed by the person listed in Section B (Permittee Information) or by an authorized responsible person within the same
organization. NOTE: The person who signs the paper form must be the same person to electronically certify
and sign the eNO1.
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.613 (i) provides that:
Any person who knowingly makes anyfalse statement, representation, or certification in anyapplication, 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 Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyof a Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that
* rJ 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.
* rJ 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.
* rJ 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
r 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 *
�14.0 5Z 4�
Type Name*
Hank Morris
Title *
President
Organization *
HJ Morris Construction, Inc
Date *
03/16/2020