NCC205958_NOI Application_20210202

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/22/2020 5:50:19 PM (NCG01 NOI Submission)
Approve by Gamble, Aana C 12/24/2020 3:40:43 PM (Review- Construction NOI 39709)
• The task was assigned to Gamble, Aana C by round robin distribution 12/22/2020 5:50 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 24, 2020 5:00
PM 12/22/2020 5:50 PM
Submit by Selkane, Aziza 2/2/2021 11:33:01 AM (Payment Verification for NCC205958)
* Lucas L Woodburn
• Selkane, Aziza assigned the task to Selkane, Aziza 2/2/2021 11:31 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 4, 2021 5:00 PM
12/24/2020 3:40 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 37992
NOI No.
Prior Reviewer Paul Clark
Name
1a. Project Name * Pennant Square
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)
56135804110000
56135862580000
56135863270000
56135864850000
56135855710000
56135845850000
56135844550000
56135854100000
2. County*
Cabarrus
3. Highway or Street 161 W. D. Street
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Kannapolis
5. State * NC
6. Zip Code* 28081
7. Latitude* Enter the latitude in decimal degrees
35.4930
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-80.6270
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*
12/31/2020
Estinated Construction Project Start Date
10. Date to End*
12/31/2024
Estinated Construction Project End late
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Developrrent
12. Acres to be
14.56
disturbed*
(including off -site borrow and waste areas)
13. Total site area 10.80
(acres) *
14. Post- 9.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-CABAR-2020- Pen na nt Square
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 Irish Buffalo Creek
Waterbody* Plane of waterbody into which stormwater runoff will discharge
15b. Waterbody 13-17-9-(2)
Index No. * NCWaterbody Index Narrber
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. ^
Fbrnittee 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 * Tri Pointe Homes, Inc.
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 * Luke
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Woodburn
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Director of Land Development
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-944-4434
Telephone No.*
6. Permittee Mailing Street Address
Address* 3436 Toringdon Way, Suite 210
Address Line 2
City
Charlotte
Fbstal / Zip Code
28277-2450
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
3436 Toringdon Way, Suite 210
Address Line 2
City
Charlotte
Fbstal / Zip Code
28277-2450
State / Frovince / Fbgion
NC
Country
us
State / Ftovince / 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
Luke
Contact - First
Name *
2. Primary Site
Woodburn
Contact - Last
Name *
3. Title
Director of Land Development
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
704-944-4434
Telephone No.
6. Organization
Tri Pointe Homes, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
3436 Toringdon Way, Suite 210
Address Line 2
City
Charlotte
Fbstal / Zip Code
28277-2450
8. Consultant Name
(Optional)
Andrew P. Grant, PE
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
980-5008961
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
Default is legally responsible person a-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
Default is legally responsible person telephone
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 09/09/2020
Approved *
2. E&SC Plan Project CABAR-2021-018
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 * Mooresville (MRO)
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 2020-0909 - NCDEQ Pennant Square EC
Approval letter or 137.05KB
Approval.pdf
Grading Permit
Mast be FDFfon-rat
6. Site Location Map Mist be RDFforrret (lint 201VB)
Pennant Square Site Aerial.pdf 292.63KB
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 docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form 698.68KB
SW -Pennant Square.pdf
Mast be FCFfon-rat
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:* IT 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
l�r� I�rr�df
Type Name* Luke Woodburn
Title Director of Land Development
Organization Legally Plesponsible Entity
Tri Pointe Homes, Inc.
Date * 12/22/2020

F. Tracking and COC Info
NOI Tracking No. 39709
NC Reference No.
NCG01-2020-5958
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205958
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5958
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. NCC205958-2020
Invoice Due Date 1/23/2021
Initial Fee $ 100.00
Invoice Status OPEN