NCC213695_NOI Application_20210621

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/17/2021 5:00:46 PM (NCGO1 NOI Submission)
App— by Broussard, Brooklyn C 6/18/2021 8:24:30 AM (Review - Construction NOI 56750)
* The task was assigned to Broussard, Brooklyn C by round robin distribution 6/17/2021 5:01 PM
The task was assigned to DEMLR NCGO1 NOI Review Team. The due date is: June 21, 2021 5:00 PM
6/17/2021 5:01 PM
Submit by Selkane, Aziza 6/21/2021 8:57:24 AM (Payment Verification for NCC2113695)
p Athan Parker
* Selkane, Azjza assigned the task to Selkane, Azjza 6/21/2021 8:56 AM
The task was assigned to DEMLR NCGOII Payment Team. The due date is: July 30, 2021 5:00 PM
6/18/2021 8:25 AM

NORTH CAROLINA
ErpirironmertW quailly
A. Project Information
Part A.
Project Location and Waterbody Inforn-ation
Are you submitting IT No
an N01 that was r Yes
rejected before?
1 a. Project Name * Archer's Park Subdivision
1b. Specific Lot This field rray be used to list specif c lot nunbers.
Numbers
1c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 272200-64-1289
2. County * Johnston
3. Highway or Street NCHWY231
Address* Street narre only is acceptable if no address nunber assigned yet
4.CityorTownship* O'Neals
5. State * NC
6. Zip Code* 27557
7. Latitude* Enter the latitude in decirral degrees
35.7339
8. Longitude Enter the longitude in clecirral degrees (MJST be negative)
-78.2379
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*
06/28/2021
Estirrated Construction Project Start Date
10. Date to End
09/30/2021
Fstirnated Construction Project End Date
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassif ication for Developrrent
12. Acres to be
52.67
disturbed*
(including off -site borrow and waste areas)

13. Total site area 51.51
(acres)*
14. Post- 8.74
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-JOHNS-2021 -Archer's Park Subdivision
Tracking ID Assigned autorratically
Below you must enter waterbody information for surface waters affected by this project. Pleaseconsult
IDWR'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 Moccasin Creek (Bunn Lake)
Waterbody* �bn-e of w aterbody into w hich storrrw ater runoff w ill discharge
15b. Waterbody 27-86-2
Index No.* NCWaterbody Index Rinber
Sto rmwate r V No
discharges will flow F— 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.
FbrniUee Inforrration - Legally Fbsponsible Entity and Individual
..................................... ­­ ................................................................ ­­­­­­­ ....................................................................................................... ...................
Important: The person Who signs the N01 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 NCGO1 0000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
1. Organization Legally Pesponsible Entity
Name P and P Land Development, Inc
If 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 Athan
If Corporation, enter Pbegistered Agent First Wre
3. Last Name* Parker
If Corporation, enter F;bgistered Agent Last %rre
3b. Title Vice President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-795-9594
Telephone No.*
6. Permittee Mailing StreetAddress
Address* PO Box 4580
Address Line 2
City State / Frovince / Fbgion
Emerald Isle NC
Flostal / Zip Code Country
28594 United States
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
8754 Reed Dr
Address Line 2
Suite 14
city
State / Frovince / F;bgion
Emerald Isle
NC
Fbstal / Zip Code
Country
28594
United States
8. Type of
ON nership is only individual if an individual is nan-ed in B. 1. above.
Ownership*
Non -Government

C. Site Contact Information
Part C.
Roject Ste Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Athan
Contact - First
Name *
2. Primary Site
Parker
Contact - Last
Name *
3. Title
Vice President
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-795-9594
Telephone No.
6. Organization
P and P Land Development, Inc
Name
7. Site Contact
Street Address
Mailing Address
PO Box 4580
Address Line 2
city
Emerald Isle
Fbstal / Zip Code
28594
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 e-rn3il
12. Billing
(For Annual Fee correspondence)
Telephone
919-795-9594
Default is legally responsible person telephone
State / Frovince / R—egion
NC
Country
United States

D. E&SC Plan
Part D.
aosion & Sediment Control (E&SC) Ran Approval Information
........................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 05/27/2021
Approved *
2. E&SC Plan Project JC# 21-016-P
Number/ID* Assigned by agency or local program
3. E&SC Plan r State DEQ Office
Approved by* r Local Program
4. Local Program* Johnston 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 shoWng 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 21-016 Archers Park Subdivision ESC Appr 591.67KB
Approval letter or 5.27.2l.pdf
Grading Permit Mist be RDF f orm3t
6. Site Location Map Must be RDF forn-Bt (linit 20 `VB)
Page 1 from 244.07KB
2021.05.2 1.ArchersPa rk. Revised Plan Set. pdf
Hease 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.
Cover sheet of the plan set has been uploaded as the Site Location
Map as site location is on this sheet.
8. NOI Certification 20210617164821549.pdf 54.15KB
Form K/Ust be PDF format
This is an Express r No
Review Project * r Yes

E. Certification
North Carolina General Statute 143-215.613 (1) provides that:
Any person who knoWngly 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 knoWngly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the
Commission implementing this Atcle shall be guilty of a Class 2 misdemeanor which may include a fine not to e)ceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
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.
PF 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.
I will abide by all conditions of the NCGO10000 General Permit and the
approved Erosion and Sediment Control Plan.
PF If the Erosion and Sediment Control Plan approved by the delegated program is
not compliant with Part 11 (Stormwater Pollution Prevention Plan) of the
NCGO1 0000 General Permit. I will nonetheless ensure that all conditions of Part
11 of the permit are met on the project at all times.
I hereby request coverage under the NCGO10000 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 NCGO10000 General Permit. For more
information on signatory requirements, see Part IV, Section B, Item (6) of that permit.
Signature
0�e 11911, e4l
Type Name* Athan M. Parker
Title Vice President
Organization Legally Fbsponsible Entity
P and P Land Development, Inc
Date * 06/17/2021

F. Tracking and COC Info
NOI Tracking No. 56750
NC Reference No.
NCGOl-2021-3695
Uses 'count nurrber' variable (increrrented by SP)
Certificate of
NCC213695
Coverage (COC)
Uses 'count—nun-ber' variable (incren-ented by SP)
No. *
Count Number 3695
Sequential nurrber for subrrittal that is incren-ented by Stored Frocedure
COC Year 2021
Yearof clatereviewed (used to assign YY digits after "NOMnODCno.)
Initial Invoice No. NCC213695-2021
Invoice Due Date 7/18/2021
Initial Fee $ 100.00
Invoice Status OPEN