NCC203117_NOI Application_20200915

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/21/2020 3:43:06 PM (NCG01 NOI Submission)
Approve by Clark, Paul 7/21/2020 3:58:18 PM (Review- Construction NOI 28599)
• The task was assigned to Clark, Paul by round robin distribution 7/21/2020 3:43 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: July 23, 2020 5:00 PM
7/21/2020 3:43 PM
Submit by Selkane, Aziza 9/15/2020 7:57:21 AM (Payment Verification for NCC203117)
* Robert R Stafford
• Selkane, Aziza assigned the task to Selkane, Aziza 9/15/2020 7:56 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 1, 2020 5:00
PM 7/21/2020 3:58 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting IT No
an NOI that was r Yes
rejected before?
1a. Project Name * Falls of the Cape Phase 3
1 b. Specific Lot This field any be used to list specifc lot numbers.
Numbers 70-88, 33-34, 89-93, 94-100, and 127-129
2. County* Harnett
3. Highway or Street E. Front Street
Address* Street narre only is acceptable if no address number assigned yet
4. City or Township* Lillington
5. State * NC
6. Zip Code * 27546
7. Latitude* Enter the latitude in decimal degrees
35.4016
8. Longitude* Enter the longitude in decimal degrees (M.JST be negative)
-78.8069
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*
07/02/2020
Estimated Construction Project Start Date
10. Date to End*
01/31/2021
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Classification for Developrrent
12. Acres to be
18.30
disturbed*
(including off -site borrow and waste areas)
13. Total site area 26.34
(acres) *

14. Post- 5.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-HARNE-2020-Falls of the Cape Phase 3
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 Cape Fear River
Waterbody* Nsrm of waterbody into which stornwater runoff will discharge
15b. Waterbody 18-(16.7)
Index No.* NCWaterbody Index Nunber
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. ^
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 Legally Pesponsible Entity
Name * Falls of The Cape
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * Robert
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Stafford
It Corporation, enter Pbegistered Agent Last %rre
3b. Title owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 19106929800
Telephone No.*
6. Permittee Mailing Street Address
Address* 246 Valleyfield Lane
Address Line 2
246 Valleyfield Lane
City
State / Frovince / Fbgion
Southern Pines
NC
Fbstal / Zip Code
Country
28387-6754
us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
246 Valleyfield Lane
Address Line 2
246 Valleyfield Lane
City
State / Frovince / Region
Southern Pines
NC
Fbstal / Zip Code
Country
28387-6754
us
8. Type of
Individual
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Information
..............................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Rob
Contact - First
Name *
2. Primary Site Stafford
Contact - Last
Name *
3. Title
4. Site Contact E- [e-mail]
mail Address*
5. Site Contact 9194223990
Telephone No.*
6. Organization
Name
7. Site Contact Street Address
Mailing Address* 246 Valleyfield Lane
Address Line 2
city
Southern Pines
Postal / Zip Code
28387
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 06/23/2020
Approved *
2. E&SC Plan Project HARNE-2020-022
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 * Fayetteville (FRO)
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
harne-2020-022apRev. pdf 785.01KB
Approval letter or
Mast beRDFformat
Grading Permit
6. Site Location Map
Helpful for linear project review
(Optional)
SHEET 2.pdf 837.1 KB
Mist be RDFformat. 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
NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form
887.31 KB
SW.pdf
Mast be R7Ffon-rat
This is an Express
r 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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the
Commission implementing this Atcle 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 * Robert R Stafford
Title owner
Organization Legally Plesponsible Entity
KRJ, Inc
Date * 07/21 /2020

F. Tracking and COC Info
NOI Tracking No. 28599
NC Reference No.
NCG01-2020-3117
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC203117
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3117
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. NCC203117-2020
Invoice Due Date 8/20/2020
Initial Fee $ 100.00
Invoice Status OPEN