NCC210308_NOI Application_20210120

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/18/2021 8:48:18 AM (NCG01 NOI Submission)
Approve by Clark, Paul 1/18/2021 12:42:40 PM (Review- Construction NOI 41241)
• The task was assigned to Clark, Paul by round robin distribution 1/18/2021 8:48 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 20, 2021 5:00
PM 1/18/2021 8:48 AM
Submit by Selkane, Aziza 1/20/2021 8:10:15 AM (Payment Verification for NCC210308)
* Chad D Brinley
• Selkane, Aziza assigned the task to Selkane, Aziza 1/20/2021 8:09 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 1, 2021 5:00 PM
1/18/2021 12:42 PM

.• SThF� ';
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 41039
NOI No.
Prior Reviewer Paul Clark
Name
1a. Project Name * Ray Property Subdivision
1 b. Specific Lot
This field may be used to list specffc lot numbers.
Numbers
1 c. Parcel ID
List all R% associated w ith this project.
Number(s) (PIN)
1801143618
1801145672
1801147809
1801148369
1801155487
1801230889
1801240992
1801244704
2. County*
Wake
3. Highway or Street 13408 New Light Road
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Wake Forest
5. State * NC
6. Zip Code* 27587
7. Latitude* Enter the latitude in decimal degrees
35.9881
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.6575
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*
01/15/2021
Estinated Construction Project Start Date
10. Date to End*
01/15/2023
Estinated Construction Project End late
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Leveloprrent
12. Acres to be
9.10
disturbed*
(including off -site borrow and waste areas)
13. Total site area 59.36
(acres) *
14. Post- 8.96
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-WAKE-2021-Ray Property Subdivision'
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 NEUSE RIVER (Falls Lake below normal pool
Waterbody*
elevation)
Name of waterbody into which stormwater runoff will discharge
15b. Waterbody
27-(5.5)b4d
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. ^
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 * Blanton's Creek Developers, 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 * Chad
IF Corporation, enter Faegistered Agent First Wre
3. Last Name* Brinley
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Manager/Member
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-845-6415
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box97487
Address Line 2
City
Raleigh
Fbstal / Zip Code
27624
Check box if the F Yes
street address the
same as mailing
address
State / Frovince / Region
NC
Country
USA
7. Permittee Street
Street Address
Address*
8368 Six Forks Road, Suite 204
Address Line 2
city
State / Frovince / Faegion
Raleigh
NC
Postal / Zip Code
Country
27624
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
Chad
Contact - First
Name *
2. Primary Site
Brinley
Contact - Last
Name *
3. Title
Member/Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
9197711997
Telephone No.*
6. Organization
Blanton's Creek Developers, LLC
Name
7. Site Contact
Street Address
Mailing Address*
8368 Six Forks Road, Suite 204
Address Line 2
City
State / Rovince / Region
Raleigh
NC
Fbstal / Zip Code
Country
27624
us
8. Consultant Name
(Optional)
Rhonda L. Brewington, PE
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
910-527-9209
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-n-ail (older NOts rray not populate)
12. Billing
(For Annual Fee correspondence)
Telephone
919-845-6415
Default is legally responsible person telephone (older NOIs rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 01/28/2019
Approved *
2. E&SC Plan Project SEC-3845-2018
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Wake County
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 Watershed Ma nagementApprovaI_.pdf 454.5KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrrat (lint 20 NB)
Site Location Map.pdf 410.35KB
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 NOI Certification Form_Signed.pdf 374.19KB
Form Wst be RDFforrrat
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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Amide or rules of the
Commission implementing this Atcle 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* Chad Brinley
ale Member/Manager
Organization Legally Ibsponsible Entity
Blanton's Creek Developers, LLC
01 /18/2021

F. Tracking and COC Info
NOI Tracking No. 41241
NC Reference No.
NCG01-2021-0308
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC210308
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 308
Sequential nunber for subnittal 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. NCC210308-2021
Invoice Due Date 2/17/2021
Initial Fee $ 100.00
Invoice Status OPEN