NCC204093_NOI Application_20201106

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/15/2020 6:45:10 PM (NCG01 NOI Submission)
Approve by Clark, Paul 9/17/2020 3:19:54 PM (Review- Construction NOI 31486)
• The task was assigned to Clark, Paul by round robin distribution 9/15/2020 6:48 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 17, 2020 5:00
PM 9/15/2020 6:48 PM
Submit by Selkane, Aziza 11/6/2020 9:25:23 AM (Payment Verification for NCC204093)
* Keith Sears
• Selkane, Aziza assigned the task to Selkane, Aziza 11/6/2020 9:23 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 29, 2020 5:00 PM
9/17/2020 3:22 PM

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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 31433
NOI No.
Prior Reviewer Paul Clark
Name
1a. Project Name * Lot Clearing Plan for Lots 80 - 97 at Avery Pond S/D, Phase III C
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers 80 - 97
2. County* Harnett
3. Highway or Street 39, 63, 85, 105, 121, 137, 153, 169, 175, 176, 170, 152, 136, 118,
Address* 102, 84, 60, and 36 Old Head Way
Street narre only is acceptable if no address number assigned yet
4. City or Townsh i p * Hectors Creek
5. State * NC
6. Zip Code * 27526
7. Latitude * Enter the latitude in decimal degrees
35.4951
8. Longitude* Enter the longitude in decimal degrees (M.JST be negative)
-78.8173
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* 09/21/2020
Estimated Construction Project Start Date
10. Date to End* 12/22/2020
Estimated Construction Project End Cute
11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial Classification for Ceveloprrent

12. Acres to be 5.96
disturbed* (including off -site borrow and waste areas)
13. Total site area 8.77
(acres) *
14. Post- 1.18
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-HARNE-2020-Lot Clearing Plan for Lots 80 - 97 at Avery Pond
Tracking ID S/D, Phase III C
Assigned automatically
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* N larre of waterbody into which stormwater runoff will discharge
15b. Waterbody 18-15-1
Index No.* NCWaterbody Index Number
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 Drive, 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 Drive, 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 Drive, 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
USA

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 01/24/2020
Approved *
2. E&SC Plan Project HARNE-200-058 - 075
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 80.pdf
1.38MB
Approval letter or AVP Lot 81.pdf
1.39MB
Grading Permit
AVP Lot 82.pdf
1.38MB
AVP Lot 83.pdf
1.39MB
AVP Lot 84.pdf
1.39MB
AVP Lot 85.pdf
1.39MB
AVP Lot 86.pdf
1.39MB
AVP Lot 87.pdf
1.39MB
AVP Lot 88.pdf
1.39MB
AVP Lot 89.pdf
1.38MB
AVP Lot 90.pdf
1.39MB
AVP Lot 91.pdf
1.39MB
AVP Lot 92.pdf
1.38MB
AVP Lot 93.pdf
1.39MB
AVP Lot 94.pdf
1.39MB
AVP Lot 95.pdf
1.39MB
AVP Lot 96.pdf
1.39MB
AVP Lot 97.pdf
1.39MB
Mast be RDFfon-rat
6. Site Location Map Helpful for linear project review
(Optional) Mast be RDFfornat. 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 Signed NOI Avery 80- 97.pdf 1.47MB
Form Mist be RDFfornat
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 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 * 09/15/2020

F. Tracking and COC Info
NOI Tracking No. 31486
NC Reference No.
NCG01-2020-4093
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC204093
Coverage (COC)
Uses 'count number' variable (increrrented by SP)
No.*
Count Number 4093
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. NCC204093-2020
Invoice Due Date 10/17/2020
Initial Fee $ 100.00
Invoice Status OPEN