NCC205702_NOI Application_20201215

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/9/2020 10:25:40 AM (NCG01 NOI Submission)
Approve by Clark, Paul 12/9/2020 2:50:50 PM (Review- Construction NOI 38703)
• The task was assigned to Clark, Paul by round robin distribution 12/9/2020 10:25 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 11, 2020 5:00
PM 12/9/2020 10:25 AM
Submit by Selkane, Aziza 12/15/2020 3:42:07 PM (Payment Verification for NCC205702)
* Nags Head Construction and Development Inc
• Selkane, Aziza assigned the task to Selkane, Aziza 12/15/2020 3:41 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 20, 2021 5:00 PM
12/9/2020 2:51 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 *
Coastal Villas Subdivision
1 b. Specific Lot
This field Tray be used to list specifc lot numbers.
Numbers
1-17
1 c. Parcel ID List all RNs associated w ith this project.
Number(s) (PIN)
2. County* Dare
3. HighwayorStreet Croatan Hwy
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Nags Head
5. State * NC
6. Zip Code* 27959
7. Latitude* Enter the latitude in decimal degrees
35.9551
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-75.6253
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*
01/04/2021
Estimated Construction Project Start Rate
10. Date to End*
01/07/2022
Estimated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Oassification for Development
12. Acres to be
10.20
disturbed*
(including off -site borrow and waste areas)

13. Total site area 11.17
(acres) *
14. Post- 3.59
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-DARE-2021-Coastal Villas Subdivision
Tracking ID 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 Roanoke Sound
Waterbody* Narreof waterbody into which storrrwater runoff will discharge
15b. Waterbody 30-21e2
Index No. * NCWaterbody Index Nurrber
Stormwater V 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. ^
Fternittee 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 * Nags Head Construction, Inc
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 * Alfred
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Norman
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Vice President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 757-652-5012
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box 16472
Address Line 2
Chesapeake
Fbstal / Zip Code
23328
Check box if the V Yes
street address the
same as mailing
address
State / Frovince / Fbgion
VA
Country
United States
7. Permittee Street
Street Address
Address*
PO Box 16472
Address Line 2
city
State / Frovince / Faegion
Chesapeake
VA
Fbstal / Zip Code
Country
23328
United States
8. Type of
Ojvnership is only individual if an individual is naned in B.1. above.
Ownership*
Non -Government

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Alfred
Contact - First
Name *
2. Primary Site
Norman
Contact - Last
Name *
3. Title
Vice President
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
7576525012
Telephone No.
6. Organization
Nags Head Construction, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
PO Box 16472
Address Line 2
city
Chesapeake
Fbstal / Zip Code
23328
8. Consultant Name
(Optional)
Cathleen Saunders
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
252-202-7112
Telephone No.
State / Rovince / Region
VA
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/22/2020
Approved *
2. E&SC Plan Project DARE-2021-007
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 * Washington (WaRO)
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 Dare-2021-007 Coastal Villas Subdivision -
Approval letter or 724.89KB
10222020.pdf
Grading Permit
Mist be FL7Fforrrat
6. Site Location Map Mist be RDFforrret (lint 201VB)
4-18085-TOPO.pdf 649.61 KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Provide 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 Signed NOI.pdf 72.23KB
Form Mist be RDFforrret
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66 (1) 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 Legally Responsible Person named on this Notice of Intent
f Authorized Responsible Person* (signing on behalf of Legally Responsible
Person named in Part B)
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 * Alfred Norman
Title Vice President
Organization Legally Plesponsible Entity
Nags Head Construction & Development, Inc
Date * 12/09/2020

F. Tracking and COC Info
NOI Tracking No. 38703
NC Reference No.
NCG01-2020-5702
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205702
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5702
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. NCC205702-2020
Invoice Due Date 1/8/2021
Initial Fee $ 100.00
Invoice Status OPEN