NCC210236_NOI Application_20210119

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/12/2021 12:47:10 PM (NCG01 NOI Submission)
Approve by Gamble, Aana C 1/13/2021 12:56:53 PM (Review- Construction NOI 40932)
• The task was assigned to Gamble, Aana C by round robin distribution 1/12/2021 12:47 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 14, 2021 5:00
PM 1/12/2021 12:47 PM
Submit by Selkane, Aziza 1/19/2021 8:44:02 AM (Payment Verification for NCC210236)
* Jessica Meyer
• Selkane, Aziza assigned the task to Selkane, Aziza 1/19/2021 8:43 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 24, 2021 5:00
PM 1/13/2021 12:57 PM

.• SThF� ';
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 * Belmont Lake Preserve - DR Horton Lots
1 b. Specific Lot This field rray be used to list specifc lot nunbers.
Numbers
1 c. Parcel ID List all Rim associated w ith this project.
Number(s) (PIN) 41663
41713
41936
4101
42120
42170
42332
42361
17671
42473
42474
42503
42509
42575
42588
42642
42643
42644
42744
42925
42948
42960
42966
43017
43020
43033
43045
43152
43203
43213
43283
43345
43346
43347

415,500
43350
43385
43398
43400
43401
43417
43438
43514
43527
43529
43533
43538
43541
43577
43612
43608
43633
43634
43663
43787
43799
43811
43819
43820
43827
43837
43838
43897
43907
43939
43941
43945
43950
42956
43999
44028
44031
44042
44048
44050
49062
49133
49137
2. County* Nash
3. Highway or Street Kings Road
Address * Street narre only is acceptable if no address nun ber assigned yet
4. City or Township* Rocky Mount
5. State * NC
6. Zip Code* 27804
7. Latitude* Enter the latitude in decimal degrees
36.0198
8. Longitude* Enter the longitude in decirral degrees (NUSTbe negative)
-77.7921

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*
02/01/2021
Estimated Construction Project Start Rate
10. Date to End *
01 /03/2022
Estirrated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be
23.50
disturbed*
(including off -site borrow and waste areas)
13. Total site area 42.00
(acres) *
14. Post- 5.87
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-NASI-I-2021-Belmont Lake Preserve - DR Horton Lots
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 Beach Branch
Wate rbody* N larre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 28-75-(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. ^
F2rnittee 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 * DR Horton, 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 * Jessica
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Meyer
It Corporation, enter F;bgistered Agent Last %rre
3b. Title NPDES Technical Compliance Administrator
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-215-6561
Telephone No.*
6. Permittee Mailing Street Address
Address* 2201 Aerial Center Parkway
Address Line 2
Suite 110A
Cty
Morrisville
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
Fbstal / Zip Code
27560
V Yes
Street Address
2201 Aerial Center Parkway
Address Line 2
Suite 110A
city
Morrisville
Fbstal / Zip Code
27560
State / Ffovince / Fbgion
NC
Country
us
State / Frovince / Region
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
Jessica
Contact - First
Name *
2. Primary Site
Meyer
Contact - Last
Name *
3. Title
NPDES Technical Compliance Administrator
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-215-6561
Telephone No.*
6. Organization
DR Horton, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
2201 Aerial Center Parkway
Address Line 2
City
State / Rovince / Region
Morrisville
NC
Fbstal / Zip Code
Country
27560
us
8. Consultant Name
(Optional)
Kristi Anspach, Eco Turf, Inc.
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-883-8211
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-n-ail (older NOIs rray not populate)
12. Billing
(For Annual Fee correspondence)
Telephone
919-215-6561
Default is legally responsible person telephone (older NOLs rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 12/16/2020
Approved *
2. E&SC Plan Project 2
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* City of Rocky Mount
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can
include the beginning point and end point coordinates in the "Notes" box below).
5. E&SC Plan Belmont Lake Letter of Approval 12-16-20.pdf 487.32KB
Approval letter or Mist beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrrat (lint 20 NB)
Belmont Lake Map.pdf 401.09KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional waterbodies if necessary.
8. NOI Certification Belmont NOI Certification Form.pdf 557.85KB
Form Wst be RDF formal
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 If the Erosion and Sediment Control Plan approved by the delegated program is
not compliant with Part II (Stormwater Pollution Prevention Plan) of the
NCG010000 General Permit. I will nonetheless ensure that all conditions of Part
II of the permit are met on the project at all times.
* 17 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* Jessica Meyer
Title NPDES Technical Compliance Administrator
Organization Legally Ibsponsible Entity
DR Horton. Inc.
Date * 01 /12/2021

F. Tracking and COC Info
NOI Tracking No. 40932
NC Reference No.
NCG01-2021-0236
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC210236
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 236
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC210236-2021
Invoice Due Date 2/12/2021
Initial Fee $ 100.00
Invoice Status OPEN