NCC201201_NOI Application_20200325

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/24/2020 3:24:17 PM (NCG01 NOI Submission)
Approve by Clark, Paul 3/24/2020 3:31:40 PM (Review- Construction NOI 23460)
• The task was assigned to Clark, Paul by round robin distribution 3/24/2020 3:24 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 26, 2020 5:00 PM.
The priority is: High 3/24/2020 3:24 PM
Submit by McCoy, Suzanne 3/25/2020 8:07:44 AM (Payment Verification for NCC201201)
* Joseph Jacobus
• McCoy, Suzanne assigned the task to McCoy, Suzanne 3/25/2020 8:07 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 5, 2020 5:00 PM. The
priority is: High 3/24/2020 3:31 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
la. Project Name * CHR Properties LLC
1 b. Specific Lot This field may be used to list specifc lot nunbers.
Numbers
2. County* New Hanover
3. Highway or Street 2705 Castle Creek Lane
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Wilmington
5. State * NC
6. Zip Code* 28401
7. Latitude* Enter the latitude in decimal degrees
34.2850
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-77.9210
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*
10/16/2019
Estirrated Construction Project Start Date
10. Date to End*
11/18/2019
Estinated Construction Project End Date
11. SIC (Primary)*
Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be
13.20
disturbed*
(including off -site borrow and waste areas)
13. Total site area 14.81
(acres)*
14. Post- 0.00
construction (Estirrated)
impervious area
(acres) *

NCC Project NCC-NEW H-2019-CHR Properties LLC
Tracking ID Assignedautonatically
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 Northeast Cape Fear River
Waterbody* N3rreof waterbody into which stornwater runoff will discharge
15b. Waterbody 18-74-(61)
Index No. * NCWaterbody Index Nunber
Stormwater r- No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Waterbody name
Receiving
Waterbody
15d. Waterbody NCWaterbody Index Narrber
Index No.
15e. Additional Waterbody name
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Nunber
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. ^
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 CHR Properties LLC
Name * If pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name* Joseph
IF Corporation, enter Fbgistered Agent First Barre
3. Last Name* Jacobus
If Corporation, enter Pegistered Agent Last %rre
3b. Title Managing Partner
4. Permitee E-mail [e-mail]
Address *
5. Permittee 910-620-1437
Telephone No.*
6. Permittee Mailing Street Address
Address* 2705 Castle Creek Lane
Address Line 2
city State / Ftovince / Region
Wilmington NC
Flostal / Zip Code Country
28401 USA
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
2705 Castle Creek Lane
Address Line 2
City
State / Ffovince / Fbgion
Wilmington
NC
Flostal / Zip Code
Country
28401
USA
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Joseph
Contact - First
Name *
2. Primary Site
Jacobus
Contact - Last
Name *
3. Title
Managing Partner
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-620-1437
Telephone No.
6. Organization
Name
7. Site Contact
Street Address
Mailing Address*
2705 Castle Creek Lane
Address Line 2
City
Wilmington
Fbstal / Zip Code
28401
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
NC
Country
USA

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/10/2019
Approved *
2. E&SC Plan Project GP 38-19
Number/ID * Assigned by agency or local program
3. E&SC Plan r State DEQ Office
Approved by* r Local Program
4. State DEQ Office * Wilmington (WiRO)
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 Land Disb Permit GP 38-19.pdf 635.64KB
Approval letter or Mast beRDFforml
Grading Permit
Site Map (Optional) Helpful for linear project review
Mast be R7Fform3t
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 20191011155145883 - 17106.pdf 145.52KB
Form Mast be FDFfon-rat
This is an Express f No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E (i) 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 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 *
Joseph Jacobus
Title
Managing Partner
Organization
CHR Properties LLC
Date *
03/24/2020

F. Tracking and COC Info
NOI Tracking No. 23460
NC Reference No. NCG01-2020-1201
Uses 'count number' variable (incremrented by SP)
Certificate of NCC201201
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 1201
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.)