NCC203010_NOI Application_20200716

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 7/13/2020 3:55:13 PM(NCG01 NOI Submission)
Approve by Farkas,Jim J 7/15/2020 11:32:40 AM(Review-Construction NOI 28205)
• The task was assigned to Farkas,Jim J by round robin distribution 7/13/2020 3:55 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:July 15,2020 5:00 PM
7/13/2020 3:55 PM
Submit by Selkane,Aziza 7/16/2020 8:50:56 AM(Payment Verification for NCC203010)
* Chris Sanders
• Selkane,Aziza assigned the task to Selkane,Aziza 7/16/2020 8:50 AM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is:August 26, 2020 5:00 PM
7/15/2020 11:32 AM

�ThF1
1Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System 'D application for•• - .•-under NorthCarolina's
General Permit 1 1111:STORIMATER DISCHARGES associated with construction acti\Aties(or
NORTH CAROLINA
Enrlrnnmenfu�Qr�arlry
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting f•No
an NOI that was r Yes
rejected before?
1a. Project Name* Crescent Ridge Lot 10
1 b.Specific Lot This field any be used to list specifc lot numbers.
Numbers 10
2.County* Wake
3. Highway or Street 1929 lyra place
Address* Street nacre only is acceptable if no address number assigned yet
4.City or Township* wake forest
5.State* NC
6.Zip Code* 27587
7. Latitude* Enter the latitude in decimal degrees
36.0420
8. Longitude* Enter the longitude in decimal degrees(M.JST be negative)
-78.6160
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* 07/13/2020
Estimated Construction Project Start Date
10. Date to End* 01/30/2021
Estimated Construction Project End Date
11.SIC(Primary)* Residential, Single Family Houses(SFE)(1521)
Standard Industrial Classification for Development
12.Acres to be 0.54
disturbed* (including off-site borrow and waste areas)
13.Total site area 0.98
(acres)*

14. Post- 0.09
construction (Estirrated)
impervious area
(acres)*
NCC Project NCC-WAKE-2020-Crescent Ridge Lot 10
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 buckhorn creek
Waterbody* %rre of waterbody into which storrrwater runoff will discharge
15b.Waterbody 27-13-1-(1)
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs*
15c.Additional neuse River Falls Lake
Receiving Waterbody narre
Waterbody
15d.Waterbody 27-(5.5)
Index No. NCWaterbody Index Nurrber
15e.Additional Waterbody narre
Receiving
Waterbody
15f.Waterbody NCWaterbody Index Ninber
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. ^
Fternittee 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* Haven Homes LLC
It pernittee is an individual(i.e.,organization does not apply),enter first and last narre in this field.
2. First Name* Chris
If Corporation,enter Faegistered Agent First%rre
3. Last Name* Sanders
It Corporation,enter F;bgistered Agent Last Iona
3b.Title managing partner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 9193495598
Telephone No.*
6. Permittee Mailing Street Address
Address* 1116 HAWK HOLLOW LN
Address Line 2
aty State/Rovince/Fbgion
wake forest North Carolina
Flostal/Zip Code Country
27587 United States
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 1116 HAWK HOLLOW LN
Address Line 2
city State/Frovince/Region
wake forest North Carolina
Fbstal/Zip Code Country
27587 United States
8.Type of Non-Government
Ownership*

C. Site Contact Information
Part C. ^
Project Site Contact Inforrration
.......................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Chris
Contact-First
Name*
2. Primary Site Sanders
Contact-Last
Name*
3.Title managing partner
4.Site Contact E- [e-mail]
mail Address*
5.Site Contact 9193495598
Telephone No.*
6.Organization Haven Homes LLC
Name
7.Site Contact Street Address
Mailing Address* 1116 HAWK HOLLOW LN
Address Line 2
City State/Province/Region
WAKE FOREST NC
Postal/Zip Code Country
275875855 United States
8. Consultant Name (Optional)
Chris Sanders
First and Last narre
9. Consultant E-mail This person will be copied on all correspondence.
10. Consultant
Telephone No.

D. E&SC Plan
Part D. ^
Erosion&Sedirrent Control(E&SC)Ran Approval Inforrration
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 04/30/2020
Approved*
2. E&SC Plan Project SEC-036437-2020
Number/ID* Assigned by agency or local program
3. E&SC Plan f 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 200430 lot 10 crescent Approval-
Approval letter or S&EConstruction Plan ReviewChecklist-SEC-036437- 321.88KB
Grading Permit
2020 Crescent Ridge lot 10.pdf
Mast be RFforrrat
6.Site Location Map Helpful for linear project review
(Optional) Wst be FDFfornat.Rease do not upload entire set of E&SCplans.
7. Notes(Optional) Ffovide any additional inforrration that night help the reviewer better understand how uploaded documents support
the application.Include additional w aterbodies for linear projects if necessary.
8. NOI Certification 200713 NCG01-eNO1-Certification-Form-20190919-
Form 767.56KB
DEMLR-SW.pdf
Mast be FDFfornat
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* chris sanders
Title managing partner
Organization Legally Ibsponsible Entity
Haven Homes LLC
Date* 07/13/2020

F. Tracking and COC Info
NOI Tracking No. 28205
NC Reference No. NCG01-2020-3010
Uses'count_nurrber'variable(increrrented by SP)
Certificate of NCC203010
Coverage (COC) Uses'count number'variable(increrrented by SP)
No.*
Count Number 3010
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. NCC203010-2020
Invoice Due Date 8/14/2020
Initial Fee $ 100.00
Invoice Status OPEN