NCC211874_NOI Application_20210326

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/24/2021 3:10:55 PM (NCG01 NOI Submission)
Approve by Meloy, Michael 3/25/2021 12:54:15 PM (Review- Construction NOI 48526)
• The task was assigned to Meloy, Michael by round robin distribution 3/24/2021 3:11 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 26, 2021 5:00
PM 3/24/2021 3:11 PM
Submit by Selkane, Aziza 3/26/2021 9:57:55 AM (Payment Verification for NCC211874)
* Meredith Switzer
• Selkane, Aziza assigned the task to Selkane, Aziza 3/26/2021 9:56 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 6, 2021 5:00 PM
3/25/2021 12:55 PM

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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 * COBLE FARMS- LOTS 2, 180, 181, 189,190
1 b. Specific Lot
This field nay be used to list specifc lot numbers.
Numbers
LOTS2, 180, 181, 189, 190
1 c. Parcel ID
List all Rus associated w ith this project.
Number(s) (PIN)
N/A
2. County*
Harnett
3. Highway or Street 2423 Rawls Church Road, Fuquay-Varina, NC
Address* Street name only is acceptable if no address number assigned yet
4. Cityor Township* ANGIER
5. State * NC
6. Zip Code* 27526
7. Latitude* Enter the latitude in decimal degrees
35.5300
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.7700
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*
05/10/2021
Estimated Construction Project Start Rate
10. Date to End *
05/10/2023
Estirrated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be
0.85
disturbed*
(including off -site borrow and waste areas)

13. Total site area 21.45
(acres) *
14. Post- 0.30
construction (Estirreted)
impervious area
(acres) *
NCC Project NCC-HARNE-2021-COBLE FARMS- LOTS 2, 180, 181, 189, 190
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 Neills Creek (Cape Fear River Basin)
Waterbody* Narreof waterbody into which storrrwater runoff will discharge
15b. Waterbody 18-16-(0.3)
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 Responsible Entity
Name * NVR, 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 * JOE
IF Corporation, enter Registered Agent First Wre
3. Last Name* SCHMIDTKE
It Corporation, enter F;bgistered Agent Last %rre
3b. Title VICE PRESIDENT
4. Permitee E-mail [e-mail]
Address*
5. Permittee 9199871930
Telephone No.*
6. Permittee Mailing Street Address
Address* 5734 Trinity Road
Address Line 2
SUITE 200
City State / Ffovince / Fbgion
Raleigh NC
Fbstal / Zip Code Country
27607-3800 US
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
5734 Trinity Road
Address Line 2
SUITE 200
City
State / Frovince / Region
Raleigh
NC
Fbstal / Zip Code
Country
27607-3800
US
8. Type of
ONnership 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
CHRIS
Contact - First
Name *
2. Primary Site
CUSHENETTE
Contact - Last
Name*
3. Title
PRODUCTION MANAGER
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
704-201-2338
Telephone No.
6. Organization
NVR, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
5734 Trinity Rd.
Address Line 2
Ste 200
city
Raleigh
Fbstal / Zip Code
27607
8. Consultant Name
(Optional)
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person a-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
9199871930
Default is legally responsible person telephone
State / Rovince / Region
North Carolina
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 03/19/2021
Approved *
2. E&SC Plan Project HARNE-2021-098
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 Letter.pdf
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 20 NB)
90.82KB
Submission- ESC Plan.pdf 5.32MB
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 LOTS 2, 180, 181, 189, 190 NOI.pdf 459.52KB
Form Must be RDF format
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:* r The Legally Responsible Person named on this Notice of Intent
r 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
jot lcom
Type Name * JOE SCHMIDTKE
Title VICE PRESIDENT
Organization Legally Plesponsible Entity
NVR, Inc.
Date * 03/24/2021

F. Tracking and COC Info
NOI Tracking No. 48526
NC Reference No.
NCG01-2021-1874
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC211874
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 1874
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. NCC211874-2021
Invoice Due Date 4/24/2021
Initial Fee $ 100.00
Invoice Status OPEN