NCC212379_NOI Application_20210428

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/20/2021 6:54:26 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 4/20/2021 10:26:45 AM (Review- Construction NOI 50560)
. The task was assigned to Garcia, Lauren V by round robin distribution 4/20/2021 6:55 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: April 22, 2021 5:00 PM
4/20/2021 6:55 AM
Submit by McCoy, Suzanne 4/28/2021 9:04:10 AM (Payment Verification for NCC212379)
* Boyd Corporation
• McCoy, Suzanne assigned the task to McCoy, Suzanne 4/28/2021 9:03 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: June 1, 2021 5:00 PM
4/20/2021 10:27 AM

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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 *
Golf Club of Camden Plantation
1 b. Specific Lot
This field may be used to list specifc lot numbers.
Numbers
Golf Course
1 c. Parcel ID List all Rios associated w ith this project.
Number(s) (PIN) 017081000362300000
2. County* Camden
3. Highway or Street McPherson Rd
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* South Mills
5. State * NC
6. Zip Code* 27976
7. Latitude* Enter the latitude in decimal degrees
36.5048
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-76.3435
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 *
04/12/2024
Estinated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial C]assification for Development
12. Acres to be
252.00
disturbed*
(including off -site borrow and waste areas)

13. Total site area 597.70
(acres) *
14. Post- 5.60
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-CAMDE-2021-Golf Club of Camden Plantation
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 Dismal Swamp Canal
Waterbody* %rreof waterbody into which stormwater runoff will discharge
15b. Waterbody 30-3-2
Index No. * NCWaterbody Index Number
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Joyce Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 30-3-2-2
Index No. NCWaterbody Index Number
15e. Additional Waterbody name
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Number
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. ^
Fbrnittee Inforrration - Legally Fa sponsible 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 * Camden Plantation Properties, 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 * Robert
If Corporation, enter Registered Agent First %rre
3. Last Name* Hobbs
It Corporation, enter F;bgistered Agent Last %rre
3b. Title Registered Agent
4. Permitee E-mail [e-mail]
Address*
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 544 Newtown Rd
Address Line 2
Suite 128
City
State / Ffovince / Fbgion
Virginia Beach
VA
Fbstal / Zip Code
Country
23462
us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
544 Newtown Rd
Address Line 2
Suite 128
City
State / Frovince / Region
Virginia Beach
VA
Fbstal / Zip Code
Country
23462
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
Ken
Contact - First
Name *
2. Primary Site
Merner
Contact - Last
Name *
3. Title
Director of Development
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
[phone]
Telephone No.
6. Organization
Boyd Homes
Name
7. Site Contact
Street Address
Mailing Address*
544 Newtown Road
Address Line 2
Suite 128
city
Virginia Beach
Fbstal / Zip Code
23462
8. Consultant Name
(Optional)
David Klebitz
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
[phone]
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
[phone]
Default is legally responsible person telephone
State / Rovince / Region
VA
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 09/14/2020
Approved *
2. E&SC Plan Project Camde-2018-004
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 * Washington (WaRO)
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
Camde-2018-004 Golf Club of Camden Plantation
Approval letter or
773.64KB
(REV).pdf
Grading Permit
Mast be FDFforrrat
6. Site Location Map
Wst be RDFforrret (lint 201VB)
Site Quad Map.pdf 592.96KB
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
Camden Plantation - NOI Certification Form (signed)
Form
398.27KB
4.14.21.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
Type Name * David S. Rudiger
Title President
Organization Legally Pesponsible Entity
Camden Plantation Properties, Inc.
Date * 04/20/2021

F. Tracking and COC Info
NOI Tracking No. 50560
NC Reference No.
NCG01-2021-2379
Uses 'count_nurber' variable (increrrented by SP)
Certificate of
NCC212379
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 2379
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. NCC212379-2021
Invoice Due Date 5/20/2021
Initial Fee $ 100.00
Invoice Status OPEN