NCC205385_NOI Application_20201124

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/20/2020 12:22:06 PM (NCG01 NOI Submission)
Approve by Meloy, Michael 11/20/2020 1:09:27 PM (Review- Construction NOI 36766)
• Clark, Paul reassigned the task to Meloy, Michael 11/20/2020 12:31 PM
* thx
• The task was assigned to Clark, Paul by round robin distribution 11/20/2020 12:22 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 24, 2020 5:00
PM 11/20/2020 12:22 PM
Subnut by Selkane, Aziza 11/24/2020 2:00:56 PM (Payment Verification for NCC205385)
* Kelsey Rivera
• Selkane, Aziza assigned the task to Selkane, Aziza 11/24/2020 2:00 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 1, 2021 5:00 PM
11/20/2020 1:09 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 36683
NOI No.
Prior Reviewer Michael Meloy
Name
1a. Project Name * Sandy Springs - Lot 116
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Moore
3. Highway or Street Sandy Springs Road North
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Aberdeen
5. State * NC
6. Zip Code * 28315
7. Latitude * Enter the latitude in decimal degrees
35.1183
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-79.4084
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* 11/16/2020
Estimated Construction Project Start Date
10. Date to End* 11/15/2021
Estimated Construction Project End Cute
11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Developrrent

12. Acres to be 0.41
disturbed* (including off -site borrow and waste areas)
13. Total site area 0.41
(acres) *
14. Post- 0.41
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-MOORE-2020-Sandy Springs - Lot 116
Tracking ID Assignedautonatically
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 Devil Gut Branch
Wate rbody* %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 14-2-11-7
Index No.* NCWaterbody Index Nurrber
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 * McKee Homes, LLC
IF 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 * Kelsey
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Rivera
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Pre Con Coordinator
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-475-7100,727
Telephone No.*
6. Permittee Mailing Street Address
Address* 109 Hay St, Ste 301
Address Line 2
City
Fayetteville
Fbstal / Zip Code
28301
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 109 Hay St, Ste 301
Address Line 2
State / Frovince / Region
NC
Country
USA
City
State / Frovince / Region
Fayetteville
NC
Postal / Zip Code
Country
28301
USA
8. Type of Non -Government
Ownership *

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
_.....................................................................................................................................................................
1. Primary Site
Kelsey
Contact - First
Name *
2. Primary Site
Rivera
Contact - Last
Name *
3. Title
Pre Construction Coordinator
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
9104757100
Telephone No.
6. Organization
McKee Homes, LLC
Name
7. Site Contact
Street Address
Mailing Address*
109 Hay St, Ste 301
Address Line 2
city
Fayetteville
Fbstal / Zip Code
28301
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 / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/15/2019
Approved *
2. E&SC Plan Project MOORE-2020-025
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 Lot 116 SS Approval. pdf
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 20 NB)
Lot 116 SS Plan.pdf
Rease do not upload entire set of E&SC plans.
69.56KB
1.67MB
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 Lot 116 SS.pdf 701.04KB
Form Wst be RDFforrret
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
(�lfvf��,�Li"fr7
Type Name * Kelsey Rivera
Title Pre Construction Coordinator
Organization Legally Responsible Entity
McKee Homes, LLC
Date * 11/20/2020

F. Tracking and COC Info
NOI Tracking No. 36766
NC Reference No.
NCG01-2020-5385
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205385
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5385
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. NCC205385-2020
Invoice Due Date 12/20/2020
Initial Fee $ 100.00
Invoice Status OPEN