NCC211825_NOI Application_20210329

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/23/2021 9:48:48 AM (NCG01 NOI Submission)
Approve by EADS\pbclark 3/24/2021 3:44:40 PM (Review- Construction NO148371)
• The task was assigned to Clark, Paul by round robin distribution 3/23/2021 9:49 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 25, 2021 5:00
PM 3/23/2021 9:49 AM
Submit by Selkane, Aziza 3/29/2021 8:20:13 AM (Payment Verification for NCC211825)
* John Richardson
• Selkane, Aziza assigned the task to Selkane, Aziza 3/29/2021 8:19 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 5, 2021 5:00 PM
3/24/2021 3:45 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 * Clear Creek SD (Early Single Family Grading & Erosion Control)
1 b. Specific Lot This field rray be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all RED associated w ith this project.
Number(s) (PIN) 9660819519
2. County* Henderson
3. Highway or Street 825 Clear Creek Rd
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Hendersonville
5. State * NC
6. Zip Code* 28792
7. Latitude* Enter the latitude in decimal degrees
35.3476
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-82.4567
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*
03/19/2021
Estimated Construction Project Start Rate
10. Date to End*
05/31/2022
Estinated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Oassification for Development
12. Acres to be
46.34
disturbed*
(including off -site borrow and waste areas)

13. Total site area 48.28
(acres) *
14. Post- 18.90
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-HENDE-2021-Clear Creek SD (Early Single Family Grading &
Tracking ID Erosion Control)
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 Clear Creek
Wate rbody* I\brre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 6-55-11-(5)
Index No. * NCWaterbody Index Nunber
Stormwater P 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.
Rarmttee Inforrration - Legally Fbsponsible Entity and Individual
...........................................................................................................................................................
Important: The person vvho 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 ovvns 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 Faesponsible Entity
Name * Forestar (USA) Real Estate Group Inc.
If pernittee is an individual (i.e., organization does not apply), enter first and last nave 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 * John
If Corporation, enter Faegistered Agent First None
3. Last Name* Richardson
If Corporation, enter Fbgistered Agent Last I\bne
3b. Title Director of Real Estate Investments & Development
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-604-1571
Telephone No.*
6. Permittee Mailing Street Address
Address* 481 Munn Road E. Suite 150
Address Line 2
City
Fort Mill
Postal / Zip Code
29715
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
481 Munn Road E. Suite 150
Address Line 2
city
Fort Mill
Fbstal / Zip Code
29715
State / Province / Fbgion
Sc
Country
United States
State / Province / Plegion
SC
Country
United States
8. Type of Ownership is only individual if an individual is named in B.1. above.
Ownership* Non -Government

C. Site Contact Information
Part C.
Project Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Ali
Contact - First
Name *
2. Primary Site
Seabaugh
Contact - Last
Name *
3. Title
Development Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
864-399-8705
Telephone No.
6.Organization
Forestar
Name
7. Site Contact
Street Address
Mailing Address*
481 Munn Road East
Address Line 2
city
Fort Mill
Postal / Zip Code
29715-8408
8. Consultant Name
(Optional)
Jared DeRidder
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
8286877177
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
704-604-1571
Default is legally responsible person telephone
State / Province / Region
SC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 03/27/2020
Approved *
2. E&SC Plan Project 2020-023
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Henderson 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 20200023-CCSD COPA 3-27-2020.pdf 144.29KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrrat (lint 20 NB)
Single Family Site Plan.pdf 301.24KB
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 Clear Creek SD NOI (Signed).pdf 72.67KB
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 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* John Richardson
Title Director of Real Estate Investments & Development
Organization Legally Ibsponsible Entity
Forestar (USA) Real Estate Group Inc.
Date * 03/23/2021

F. Tracking and COC Info
NOI Tracking No. 48371
NC Reference No.
NCG01-2021-1825
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC211825
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 1825
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. NCC211825-2021
Invoice Due Date 4/23/2021
Initial Fee $ 100.00
Invoice Status OPEN