NCC204950_NOI Application_20201216

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/28/2020 3:54:50 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 10/30/2020 2:16:27 PM (Review- Construction NOI 34449)
p Per Rhonda Hall, WiRO: "Yes. This approval is for clearing and grading only. They will have to revise
the plan before adding additional impervious. " So, A14 can be 0.00 at this point.
• Gamble, Aana C reassigned the task to Morman, Alaina 10/28/2020 4:04 PM
• The task was assigned to Gamble, Aana C by round robin distribution 10/28/2020 3:55 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 30, 2020 5:00
PM 10/28/2020 3:55 PM
Submit by Selkane, Aziza 12/16/2020 8:34:05 AM (Payment Verification for NCC204950)
* Greta Harrelson
• Selkane, Aziza assigned the task to Selkane, Aziza 12/16/2020 8:33 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 11, 2020 5:00
PM 10/30/2020 2:16 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 34306
NOI No.
Prior Reviewer Alaina Morman
Name
1a. Project Name * Highland Forest, Town Home Phase 5
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all PIS associated w ith this project.
Number(s) (PIN)
2. County* Brunswick
3. Highway or Street Stirling Drive
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Shallotte
5. State * NC
6. Zip Code* 28470
7. Latitude* Enter the latitude in decimal degrees
33.9890
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.3720
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* 10/22/2020
Estimated Construction Project Start Date
10. Date to End* 12/31/2021
Estinated Construction Project End Date

11. SIC (Primary)* Residential, Other than SFE (1522)
Standard Industrial aassification for Development
12. Acres to be 13.77
disturbed* (including off -site borrow and waste areas)
13. Total site area 13.77
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-BRUNS-2020-Hig h land Forest, Town Home Phase 5
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 Woodward Branch
Waterbody* %rreof waterbody into which stormwater runoff will discharge
15b. Waterbody 15-25-2-8
Index No. * NCWaterbody Index Number
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. ^
Fl rnittee 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 * Shallotte Property Holdings, 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 * Bobby W.
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Harrelson
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Managing Member
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-392-9325
Telephone No.*
6. Permittee Mailing Street Address
Address* 115 North 3rd Street
Address Line 2
Suite 300
aty
Wilmington
Fbstal / Zip Code
28401-4076
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
115 North 3rd Street
Address Line 2
Suite 300
city
Wilmington
Fbstal / Zip Code
28401-4076
State / Ffovince / Fbgion
NC
Country
us
State / F rovince / Faegion
NC
Country
us
8. Type of Ownership 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
Mike
Contact - First
Name *
2. Primary Site
Hobbs
Contact - Last
Name *
3. Title
Vice President
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-343-6445
Telephone No.
6. Organization
East Coast Contracting, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
3224-C North College Road
Address Line 2
PMB 209
city
Wilmington
Postal / Zip Code
28405
8. Consultant Name
(Optional)
Michael Lawrence
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
9103438002
Telephone No.
State / Province / Region
NC
Country
US

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/19/2020
Approved *
2. E&SC Plan Project BRUNS-2021-023
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 * Wilmington (WiRO)
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 10- 1 9-2020-LETTER OF APPROVAL.pdf 136.39KB
Approval letter or Mast beRDFforml
Grading Permit
6. Site Location Map Mast be RDFfornat (lint 20 NB)
Rease do not upload entire set of E&SC plans.
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 NCG01 NOI.pdf 738.45KB
Form Mast be FDFformat
This is an Express F 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* Bobby W. Harrelson
Title Managing Member
Organization Legally Responsible Entity
Shallotte Property Holdings, LLC
Date * 10/28/2020

F. Tracking and COC Info
NOI Tracking No. 34449
NC Reference No.
NCG01-2020-4950
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC204950
Coverage (COC)
Uses 'count number' variable (increrrented by SP)
No.*
Count Number 4950
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. NCC204950-2020
Invoice Due Date 11/29/2020
Initial Fee $ 100.00
Invoice Status OPEN