NCC205892_NOI Application_20210212

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/21/2020 8:23:22 AM (NCG01 NOI Submission)
Approve by Meloy, Michael 12/21/2020 8:30:15 AM (Review- Construction NOI 39528)
• The task was assigned to Meloy, Michael by round robin distribution 12/21/2020 8:23 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 23, 2020 5:00
PM 12/21/2020 8:23 AM
Submit by Selkane, Aziza 2/12/2021 4:34:42 PM (Payment Verification for NCC205892)
* Email reminder sent on 113012021, no response, no payment received.
• Selkane, Aziza assigned the task to Selkane, Aziza 2/12/2021 4:33 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 1, 2021 5:00 PM
12/21/2020 8:30 AM

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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 38697
NOI No.
Prior Reviewer Alaina Morman
Name
1a. Project Name * Wedgefield, Phase 11113- Lots 67-69 & 72-74
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) 494660101003
2. County* Hoke
3. Highway or Street Cloverwood Lane
Address* Street name only is acceptable if no address nunber assigned yet
4. City or Township* McLauchlin Township
5. State * NC
6. Zip Code* 28376
7. Latitude* Enter the latitude in decinal degrees
35.0399
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-79.1201
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* 12/09/2020
Estirrated Construction Project Start Date
10. Date to End* 01/31/2023
Estinated Construction Project End Date

11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be 1.03
disturbed* (including off -site borrow and waste areas)
13. Total site area 1.24
(acres) *
14. Post- 0.47
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-HOKE-2020-Wedgefield, Phase IIIB - Lots 67-69 & 72-74
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 Puppy Creek
Waterbody* %rreof waterbody into which stormwater runoff will discharge
15b. Waterbody 18-31-19
Index No. * NCWaterbody Index Nunber
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 * Furr Construction and Development, 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 * Harold
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Furr
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Reg. Agent
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-391-3670
Telephone No.*
6. Permittee Mailing Street Address
Address* 327 Dick Street, Suite 102
Address Line 2
City
Fayetteville
Fbstal / Zip Code
28301
Check box if the V Yes
street address the
same as mailing
address
State / Frovince / Fbgion
NC
Country
USA
7. Permittee Street
Street Address
Address*
327 Dick Street, Suite 102
Address Line 2
City
State / Frovince / Faegion
Fayetteville
NC
Fbstal / Zip Code
Country
28301
USA
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
Adam
Contact - First
Name *
2. Primary Site
Furr
Contact - Last
Name *
3. Title
Agent
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-391-3670
Telephone No.
6. Organization
Furr Construction and Development, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
327 Dick Street, Suite 102
Address Line 2
city
Fayettevillle
Fbstal / Zip Code
28301
8. Consultant Name
(Optional)
Dennis A. Gilbert
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
910-484-5191
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
910-391-3670
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
USA

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/24/2020
Approved *
2. E&SC Plan Project HOKE-2021-022
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 * Fayetteville (FRO)
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 APPROVAL- HOKE-2021-022-F u rr. pdf 82.31KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mast be RDFfornat (lint 20 NB)
Wedgefield E -Lots 67-69 & 72-74-Approved Plan
969.9KB
p1.pdf
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 w aterbodies if necessary.
8. NOI Certification Wedgefield NOI Certificate.pdf 11VIB
Form Mast be FDFfornat
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:* 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
Type Name * Harold G. Furr
Title Reg. Agent
Organization Legally Responsible Entity
Furr Construction and Development, Inc.
Date * 12/21 /2020

F. Tracking and COC Info
NOI Tracking No. 39528
NC Reference No.
NCG01-2020-5892
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205892
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5892
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. NCC205892-2020
Invoice Due Date 1/20/2021
Initial Fee $ 100.00
Invoice Status OPEN