NCC202717_NOI Application_20200629

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/24/2020 12:18:31 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 6/26/2020 9:40:47 AM (Review- Construction NOI 27421)
• Farkas, Jim J reassigned the task to Garcia, Lauren V 6/24/2020 3:45 PM
• The task was assigned to Farkas, Jim J by round robin distribution 6/24/2020 12:19 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 26, 2020 5:00 PM
6/24/2020 12:19 PM
Submit by Selkane, Aziza 6/29/2020 8:33:21 AM (Payment Verification for NCC202717)
* Colin Webster
• Selkane, Aziza assigned the task to Selkane, Aziza 6/29/2020 8:32 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 7, 2020 5:00 PM
6/26/2020 9:41 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was r Yes
rejected before?
Previous Rejected 26925
NOI No.
Prior Reviewer Lauren Garcia
Name
1a. Project Name *
975 Sandavis Rd.
1 b. Specific Lot
This field may be used to list specifc lot nunbers.
Numbers
Lot 1
2. County*
Moore
3. Highway or Street 975 Sandavis Rd.
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Southern Pines
5. State * NC
6. Zip Code * 28387
7. Latitude * Enter the latitude in decirral degrees
35.1884
8. Longitude* Enter the longitude in decinal degrees (M. ST be negative)
-79.3858
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* 06/23/2020
Estimated Construction Project Start Date
10. Date to End* 10/11/2020
Estimated Construction Project End Cute
11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Developrrent

12. Acres to be 0.12
disturbed* (including off -site borrow and waste areas)
13. Total site area 0.48
(acres) *
14. Post- 0.05
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-MOORE-2020-975 Sandavis Rd.
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 McDeeds Creek
Wate rbody* %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 18-23-11-4
Index No.* NCWaterbody Index Nurrber
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. ^
Fl rnittee 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
Legally Pesponsible Entity
Name *
The Ascot Corporation, LLC
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name *
Colin
IF Corporation, enter Faegistered Agent First %rre
3. Last Name*
Webster
It Corporation, enter F;bgistered Agent Last %ne
3b. Title
Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-688-7361
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box 1872
Address Line 2
City State / Rovince / Pbegion
Southern Pines North Carolina
Fbstal / Zip Code Country
28388 United States
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
30 Country Club Boulevard
Address Line 2
City
State / Frovince / Region
Whispering Pines
NC
Fbstal / Zip Code
Country
28327
US
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Information
..............................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Lisette
Contact - First
Name *
2. Primary Site Ledesma
Contact - Last
Name *
3. Title Sales/Mktg Manager
4. Site Contact E- [e-mail]
mail Address*
5. Site Contact 910-688-7361
Telephone No.*
6. Organization The Ascot Corporation, LLC
Name
7. Site Contact Street Address
Mailing Address* PO Box 1872
Address Line 2
city
Southern Pines
Postal / Zip Code
28388
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 05/04/2020
Approved *
2. E&SC Plan Project 20-1186
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 Southern Pines
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 Lot 1 975 Sandavis Minor EC Approved.pdf 61.46KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) Lot 1 975 Sandavis site plan.pdf 247.56KB
Mast be RDFformat. Rease do not upload entire set of E&SCplans.
7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies for linear projects if necessary.
8. NOI Certification Lot 1 975 Sandavis NCG01 Signed Uploaded.PDF 220.67KB
Form Wst be RDFfornat
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
IT 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* Colin S. Webster
Title Manager
Organization Legally Iesponsible Entity
The Ascot Corporation, LLC
Date * 06/24/2020

F. Tracking and COC Info
NOI Tracking No. 27421
NC Reference No. NCG01-2020-2717
Uses 'count number' variable (incremrented by SP)
Certificate of NCC202717
Coverage (COC) Uses 'count number' variable (incremented by SF)
No.*
Count Number 2717
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.)
Initial Invoice No.
Invoice Due Date
Initial Fee $
Invoice Status