NCC211979_NOI Application_20210401

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/30/2021 2:19:17 PM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 3/31/2021 3:23:50 PM (Review- Construction NOI 49269)
. The task was assigned to Garcia, Lauren V by round robin distribution 3/30/2021 2:20 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: April 1, 2021 5:00 PM
3/30/2021 2:20 PM
Submit by Selkane, Aziza 4/1/2021 10:01:01 AM (Payment Verification for NCC211979)
* William Kiselick
• Selkane, Aziza assigned the task to Selkane, Aziza 4/1/2021 10:00 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 12, 2021 5:00 PM
3/31 /2021 3:24 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 * The Hills
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers 1-88
1 c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 02103108, 02103107, 02103138, 02103132, 02103104
2. County* Mecklenburg
3. Highway or Street Asbury Chapel Rd
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Huntersville
5. State * NC
6. Zip Code* 28078
7. Latitude* Enter the latitude in decimal degrees
35.3996
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-80.8034
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*
04/12/2021
Estimated Construction Project Start Rate
10. Date to End *
04/08/2022
Estinated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Oassification for Development
12. Acres to be
34.56
disturbed*
(including off -site borrow and waste areas)

13. Total site area 62.00
(acres) *
14. Post- 12.11
construction (Estinated)
impervious area
(acres) *
NCC Project NCC-MECKL-2021-The Hills
Tracking ID Assignedautonatically
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 Ferreltown Creek
Waterbody* Narreof waterbody into which stornwater runoff will discharge
15b. Waterbody 13-17-4-3
Index No. * NCWaterbody Index Nunber
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional South Prong Clarke Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 13-17-4-2
Index No. NC Waterbody Index Nmber
15e. Additional Waterbody name
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Narrber
Index No.
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. ^
Fl rnittee 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 * KB Home Charlotte, 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 * Bill
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Kiselick
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Division President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-400-4536
Telephone No.*
6. Permittee Mailing Street Address
Address* 4506 South Miami Boulevard
Address Line 2
Suite 100
City
Durham
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
Fbstal / Zip Code
27703-8000
V Yes
Street Address
4506 South Miami Boulevard
Address Line 2
Suite 100
city
Durham
Fbstal / Zip Code
27703-8000
State / Ffovince / 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
Bill
Contact - First
Name *
2. Primary Site
Kiselick
Contact - Last
Name *
3. Title
Division President
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
704-400-4536
Telephone No.
6. Organization
KB Home Charlotte, Inc.
Name
7. Site Contact
Street Address
Mailing Address*
4506 South Miami Boulevard
Address Line 2
Suite 100
city
Durham
Fbstal / Zip Code
27703-8000
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
704-400-4536
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 02/26/2021
Approved *
2. E&SC Plan Project 414933
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Town of Huntersville
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 The Hills EC Plan Approval Ltr 2-26-21.pdf 119.11 KB
Approval letter or Mist beRDFformat
Grading Permit
6. Site Location Map Mast be RFforrret (lint 20 NB)
The Hills 3-30-21.pdf 194.91KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
In addition to this 62 acres there are 5 lots on Autumncrest Rd that
we are viewing as part of "The Hills". On the approved plan it is
called "Autumncrest Subdivision". Those 5 lots were approved
under a separate set of plans and approved in August of 2019. 1 will
submit a second application for those lots.
8. NOI Certification The Hills NCG01 signed form.pdf 455.41KB
Form Mast 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 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* Bill Kiselick
Title Division President
Organization Legally Ibsponsible Entity
KB Home Charlotte, Inc.
Date * 03/30/2021

F. Tracking and COC Info
NOI Tracking No. 49269
NC Reference No.
NCG01-2021-1979
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC211979
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 1979
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. NCC211979-2021
Invoice Due Date 4/30/2021
Initial Fee $ 100.00
Invoice Status OPEN