NCC205588_NOI Application_20201208

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/3/2020 10:50:08 AM (NCG01 NOI Submission)
Approve by Clark, Paul 12/3/2020 12:48:30 PM (Review- Construction NOI 38014)
• The task was assigned to Clark, Paul by round robin distribution 12/3/2020 10:50 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 7, 2020 5:00
PM 12/3/2020 10:50 AM
Submit by Selkane, Aziza 12/8/2020 11:11:32 AM (Payment Verification for NCC205588)
* Bradley A Haertling
• Selkane, Aziza assigned the task to Selkane, Aziza 12/8/2020 11:10 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 14, 2021 5:00 PM
12/3/2020 12:48 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 37243
NOI No.
Prior Reviewer Paul Clark
Name
1a. Project Name * Birchwood Grove Subdivision Phase 1 & 2
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers 96
2. County* Harnett
3. Highway or Street U.S. 401
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Hectors Creek Township
5. State * NC
6. Zip Code * 27526
7. Latitude * Enter the latitude in decimal degrees
35.4660
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-78.8290
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* 12/07/2020
Estimated Construction Project Start Cate
10. Date to End* 02/07/2022
Estimated Construction Project End Cute
11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial Classification for Developrrent

12. Acres to be 34.80
disturbed* (including off -site borrow and waste areas)
13. Total site area 80.70
(acres) *
14. Post- 25.65
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-HARNE-2020-Birchwood Grove Subdivision Phase 1 & 2
Tracking ID 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 Cape Fear River
Wate rbody* %rre of waterbody into which stormwater runoff will discharge
15b. Waterbody 18-(10.5)
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 Fa sponsible 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 Responsible Entity
Name * KB Home
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 * Jonathan
If Corporation, enter Registered Agent First %rre
3. Last Name* Hayward
It Corporation, enter Registered Agent Last %rre
3b. Title Vice President of Land Acquisition
4. Permitee E-mail [e-mail]
Address*
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 4506 South Miami Boulevard
Address Line 2
Suite 100
City
State / Frovince / Fegion
Durham
NC
Fbstal / Zip Code
Country
27703-8000
us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
4506 South Miami Boulevard
Address Line 2
Suite 100
City
State / Frovince / Region
Durham
NC
Fbstal / Zip Code
Country
27703-8000
us
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Jonathan
Contact - First
Name *
2. Primary Site
Hayward
Contact - Last
Name *
3. Title
Vice President of Land Acquisition
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
[phone]
Telephone No.
6. Organization
KB Home
Name
7. Site Contact
Street Address
Mailing Address*
4506 South Miami Boulevard
Address Line 2
Suite 100
city
Durham
Fbstal / Zip Code
27703-8000
8. Consultant Name
(Optional)
Brad Haertling
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
(919)-469-1101
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 05/01/2020
Approved *
2. E&SC Plan Project HARNE-2020-056
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 harne056apModRev.pdf
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 20 NB)
00. CVR-Cover.pdf
Rease do not upload entire set of E&SC plans.
96.94KB
511.35KB
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 NOI _Signed.pdf 75.33KB
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
Type Name * Jonathan Hayward
Title Vice President of Land Acquisition
Organization Legally Responsible Entity
KB Home
Date * 12/03/2020

F. Tracking and COC Info
NOI Tracking No. 38014
NC Reference No.
NCG01-2020-5588
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205588
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5588
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. NCC205588-2020
Invoice Due Date 1/2/2021
Initial Fee $ 100.00
Invoice Status OPEN