NCC204870_NOI Application_20201103

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/27/2020 7:12:30 PM (NCG01 NOI Submission)
Approve by Gamble, Aana C 10/28/2020 10:59:52 AM (Review- Construction NOI 34355)
• The task was assigned to Gamble, Aana C by round robin distribution 10/27/2020 7:12 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 29, 2020 5:00
PM 10/27/2020 7:12 PM
Submit by Selkane, Aziza 11/3/2020 10:46:29 AM (Payment Verification for NCC204870)
* Keith Sears
• Selkane, Aziza assigned the task to Selkane, Aziza 11/3/2020 10:45 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 9, 2020 5:00
PM 10/28/2020 11:00 AM

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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 * Lot Clearing Plan for Lot 136 and 138 - 153 at Avery Pond SD,
Phase III D
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers Lots 136 and 138 - 153
2. County* Harnett
3. Highway or Street 758, 784, 812, 828, 846, 860, 863, 878, 879, 882 Avery Pond Drive
Address* and 61, 62, 75, 76, 83, 86, 89 Waterville Way
Street name only is acceptable if no address number assigned yet
4. City or Township* Hectors Creek
5. State * NC
6. Zip Code* 27526
7. Latitude* Enter the latitude in decinal degrees
35.4935
8. Longitude * Enter the longitude in decimal degrees (MJST be negative)
-78.8209
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*
11/09/2020
Estinated Construction Project Start Date
10. Date to End *
02/08/2021
Estinated Construction Project End Date
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial C]assification for Development
12. Acres to be
5.71
disturbed*
(including off -site borrow and waste areas)
13. Total site area 9.97
(acres) *

14. Post- 1.10
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-HARNE-2020-Lot Clearing Plan for Lot 136 and 138 - 153 at
Tracking ID Avery Pond SD, Phase III D
Assigned autorratically
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 Coopers Branch
Wate rbody* %rre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 18-15-1
Index No.* NCWaterbody Index Nunber
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. ^
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 Pesponsible Entity
Name * LGI Homes - NC, LLC
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 * Keith
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Sears
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Regional Construction Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919 795 3922
Telephone No.*
6. Permittee Mailing Street Address
Address* 6500 Creedmoor Road, Suite 212
Address Line 2
City
Raleigh
Fbstal / Zip Code
27613
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 6500 Creedmoor Road, Suite 212
Address Line 2
State / Frovince / Fbgion
NC
Country
USA
City State / Frovince / Region
Raleigh NC
Fbstal / Zip Code Country
27613 USA
8. Type of Non -Government
Ownership *

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Keith
Contact - First
Name *
2. Primary Site
Sears
Contact - Last
Name *
3. Title
Regional Construction Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919 795 3922
Telephone No.
6. Organization
LGI Homes - NC, LLC
Name
7. Site Contact
Street Address
Mailing Address*
6500 Creedmoor Road, Suite 212
Address Line 2
city
Raleigh
Fbstal / Zip Code
27613
8. Consultant Name
(Optional)
Lee R. Hines, Jr., PE (Richie)
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919 422 8011
Telephone No.
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................................................................................................__
1. Date E&SC Plan 04/03/2020
Approved *
2. E&SC Plan Project HARNE-2020-105 to 121
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 AVP Lot 136.pdf
76.12KB
Approval letter or AVP Lot 138.pdf
76KB
Grading Permit
AVP Lot 139.pdf
76.25KB
AVP Lot 140.pdf
86.78KB
AVP Lot 141.pdf
75.65KB
AVP Lot 142.pdf
88.09KB
AVP Lot 143.pdf
76.09KB
AVP Lot 144.pdf
75.78KB
AVP Lot 145.pdf
75.53KB
AVP Lot 146.pdf
75.87KB
AVP Lot 147.pdf
75.5KB
AVP Lot 148.pdf
76KB
AVP Lot 149.pdf
75.37KB
AVP Lot 150.pdf
87.37KB
AVP Lot 151.pdf
76.09KB
AVP Lot 152.pdf
75.87KB
AVP Lot 153.pdf
75.87KB
Mist be FDFfornat
6. Site Location Map Helpful for linear project review
(Optional) Mist be FDFfornat. Rease do not upload entire set of E&SCplans.
7. Notes (Optional) Ffovide 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.
8. NOI Certification Signed NOI Avery 136 and 138 - 153.pdf 1.47MB
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
Kci# ha+e
Type Name * Keith Sears
Title Regional Construction Manager
Organization Legally Responsible Entity
LGI Homes - NC, LLC
Date * 10/27/2020

F. Tracking and COC Info
NOI Tracking No. 34355
NC Reference No.
NCG01-2020-4870
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC204870
Coverage (COC)
Uses 'count number' variable (increrrented by SP)
No.*
Count Number 4870
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. NCC204870-2020
Invoice Due Date 11/27/2020
Initial Fee $ 100.00
Invoice Status OPEN