NCC202933_NOI Application_20200713

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 7/9/2020 8:36:02 PM(NCG01 NOI Submission)
Approve by Garcia, Lauren V 7/10/2020 4:40:14 PM(Review-Construction NOI 28073)
• The task was assigned to Garcia, Lauren V by round robin distribution 7/9/2020 8:36 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:July 13,2020 5:00 PM
7/9/2020 8:36 PM
Submit by Selkane,Aziza 7/13/2020 8:55:01 AM(Payment Verification for NCC202933)
* Jorge Ramos
• Selkane,Aziza assigned the task to Selkane,Aziza 7/13/2020 8:54 AM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is:August 21, 2020 5:00 PM
7/10/2020 4:41 PM

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1Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System 'D application for•• - .•-under NorthCarolina's
General Permit 1 1111:STORIVWATER DISCHARGES associated with construction activities(or
NORTH CAROLINA
Enrlrnnmenfu�Qr�arlry
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 27872
NOI No.
Prior Reviewer Jim Farkas
Name
1a. Project Name* Davencroft House lot 30
1 b.Specific Lot This field rray be used to list specifc lot nunbers.
Numbers Only one lot#30
2.County* Pitt
3. Highway or Street 4327 Dublin rd
Address* Street narre only is acceptable if no address nunber assigned yet
4. City or Township* Greenville
5.State* NC
6.Zip Code* 28590
7. Latitude* Enter the latitude in decimal degrees
35.5530
8. Longitude* Enter the longitude in decimal degrees(MJSTbe negative)
-77.4240
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* 07/20/2020
Estimated Construction Project Start Date
10. Date to End* 07/01/2022
Estirreted Construction Project End Cute
11.SIC(Primary)* Residential, Single Family Houses(SFE)(1521)
Standard Industrial Classification for Development

12.Acres to be 0.37
disturbed* (including off-site borrow and waste areas)
13.Total site area 0.37
(acres)*
14. Post- 0.20
construction (Estimated)
impervious area
(acres)*
NCC Project NCC-PITT-2020-Davencroft House lot 30
Tracking ID Assignedautorraticaly
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 Swift Creek
Waterbody* Barre of waterbody into which stormwater runoff will discharge
15b.Waterbody 27-97-(0.5)
Index No.* NCUVaterbody Index N r ber
Stormwater V No
discharges will flow r Yes
to additional
wate rs*
16a. Is this project F Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B. ^
Fbrnittee 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 Responsible Entity
Name* Jorge Ramos
It pernittee is an individual(i.e.,organization does not apply),enter first and last narre in this field.
2. First Name* Jorge
If Corporation,enter Registered Agent First%rre
3. Last Name* Ramos
It Corporation,enter Registered Agent Last Iona
3b.Title Owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 12527173644
Telephone No.*
6. Permittee Mailing Street Address
Address* 916 Abbott Farm Road
Address Line 2
916 ABBOTT FARM RD
City State/Frovince/Region
Ayden NC
Fbstal/Zip Code Country
28513 us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 916 Abbott Farm Road
Address Line 2
916 ABBOTT FARM RD
City State/Province/Region
Ayden NC
Postal/Zip Code Country
28513 us
8.Type of Individual
Ownership

C. Site Contact Information
Part C. ^
Roject Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Jorge
Contact-First
Name*
2. Primary Site Ramos
Contact-Last
Name*
3.Title Owner
4.Site Contact E- [e-mail]
mail Address*
5.Site Contact 12527173644
Telephone No.*
6.Organization JORGE RAMOS
Name
7.Site Contact Street Address
Mailing Address* 916 ABBOTT FARM RD
Address Line 2
city State/Rovince/Region
Ayden NC
Fbstal/Zip Code Country
28513 United States
8. Consultant Name (Optional)
Jorge Ramos
First and Last narre
9. Consultant E-mail [e-mail]
This person will be copied on all correspondence.
10. Consultant 252-717-3644
Telephone No.

D. E&SC Plan
Part D. ^
Erosion&Sediment Control(E&SC)Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 07/02/2020
Approved*
2. E&SC Plan Project ESCP-2020-0041
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 PROJECT ID ESCP-2020-0041.pdf 1.09MB
Approval letter or Mast beRFforml
Grading Permit
6.Site Location Map Helpful for linear project review
(Optional) SITE LOCATION MAP(1).pdf 1.02MB
Mast be RDFfornat.Rease do not upload entire set of E&SCplans.
7. Notes(Optional) Rovide 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 NOI CERTIFICATION FORM.pdf 873.87KB
Form Mast be RDFfornat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66(1) provides that:
Anyperson who knowinglymakes any false statement,representation,or certification in anyapplication,record,report,plan,or other
documentfiled 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 underthis 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 guiltyofa Class 2 misdemeanor which mayinclude 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
Type Name* Jorge Ramos
Title Owner
Organization Legally Ibsponsible Entity
Jorge Ramos
Date* 07/09/2020

F. Tracking and COC Info
NOI Tracking No. 28073
NC Reference No. NCG01-2020-2933
Uses'count_nurrber'variable(increrrented by SP)
Certificate of NCC202933
Coverage (COC) Uses'count_nurrber'variable(increrrented by SP)
No.*
Count Number 2933
Sequential nurrber for subrrittal 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. NCC202933-2020
Invoice Due Date 8/9/2020
Initial Fee $ 100.00
Invoice Status OPEN