NCC213857_NOI Application_20210701

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/28/2021 11:09:31 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 6/28/2021 11:12:53 AM (Review- Construction NOI 57359)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 6/28/2021 11:10 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 30, 2021 5:00 PM
6/28/2021 11:10 AM
Submit by Selkane, Aziza 7/1/2021 12:34:24 PM (Payment Verification for NCC213857)
* Davidson Homes, LLC
• Selkane, Aziza assigned the task to Selkane, Aziza 7/1/2021 12:33 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 9, 2021 5:00 PM
6/28/2021 11:13 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 * Sierra Heights Phase 5 Subdivision Lots
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers 166-204 and 220-243 and 287
1 c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 168800-50-6460
168800-50-5325
168800-50-4266
168800-50-4210
168800-50-3164
168800-50-3017
168800-50-2061
168700-59-1955
168700-59-2839
168700-59-3813
168700-59-3797
168700-59-4829
168700-59-4987
168800-50-5150
168800-50-7106
168700-59-7998
168700-59-7802
168700-59-6724
168700-59-5617
168700-59-5691
168700-59-6565
168700-59-7449
168700-59-7682
168700-59-8740
168700-59-9707
168700-59-9885
168700-59-9996
168800-50-9068
168800-50-9272
168800-60-1242
168800-60-2009
168700-69-2916
168700-69-2824
168700-69-1781

168700-69-0544
168700-59-9486
168700-59-8369
168700-59-9343
168800-50-5682
168800-50-4568
168800-50-3583
168800-50-3436
168800-50-2480
168800-50-2334
168800-50-1287
168800-50-1231
168800-50-0185
168800-50-0036
168700-49-9846
168700-59-0811
168700-59-0785
168700-59-1750
168700-59-2624
168700-59-2599
168700-59-3563
168700-59-4437
168700-59-5402
168700-59-5386
168700-59-6351
168700-59-7225
168700-59-7290
168700-59-8164
168800-50-7516
2. County* Johnston
3. Highway or Street Badger Pass Drive
Address * Street narre only is acceptable if no address nun ber assigned yet
4. City or Township* Wilson Mills
5. State * NC
6. Zip Code* 27527
7. Latitude* Enter the latitude in decinal degrees
35.6150
8. Longitude* Enter the longitude in decinal degrees (N ISTbe negative)
-78.3740
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*
07/01/2021
Estinated Construction Project Start Date
10. Date to End*
07/03/2023
Estinated Construction Project End Date
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be
26.66
disturbed*
(including off -site borrow and waste areas)

13. Total site area 29.64
(acres) *
14. Post- 4.31
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-JOHNS-2021-Sierra Heights Phase 5 Subdivision Lots
Tracking ID Assignedautorratically
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 Neuse River
Wate rbody* %rre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-(38.5)
Index No.* NCWaterbody Index Number
Stormwater rJ 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. ^
F2rnittee 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 * Davidson Homes
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 *
Brad
IF Corporation, enter Faegistered Agent First Wre
3. Last Name*
Nelson
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title
Davidson Homes Raleigh Division President
4. Permitee E-mail
[e-mail]
Address*
5. Permittee 9842178561
Telephone No.*
6. Permittee Mailing Street Address
Address* 117 Centrewest Court
Address Line 2
City
Cary
Fbstal / Zip Code
27513-2015
Check box if the V Yes
street address the
same as mailing
address
State / Frovince / Fbgion
NC
Country
us
7. Permittee Street
Street Address
Address*
117 Centrewest Court
Address Line 2
City
State / Frovince / Faegion
Cary
NC
Fbstal / Zip Code
Country
27513-2015
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 Josh
Contact - First
Name *
2. Primary Site Clowes
Contact - Last
Name *
3. Title
Director of Construction Davidson Homes
Raleigh Division
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-609-6340
Telephone No.*
6. Organization
Davidson Homes
Name
7. Site Contact
Street Address
Mailing Address*
117 Centrewest Court
Address Line 2
City
Cary
Fbstal / Zip Code
27513-2015
8. Consultant Name
(Optional)
Kristi Anspach
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-883-8211
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person a -Trail
12. Billing
(For Annual Fee correspondence)
Telephone
9842178561
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 06/16/2021
Approved *
2. E&SC Plan Project JC# 19-095-P
Number/ID * Assigned by agency or local program
3. E&SC Plan f 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 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 JOCO 19-095 Sierra Heights Phase 5 Subdivision
Approval letter or 401.05KB
Lots ESC Appr 6.16.21.pdf
Grading Permit
Mast be FDFfon-rat
6. Site Location Map Mist be RDFforrret (lint 201VB)
Sierra Heights Location Map.pdf 419.71KB
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 Sierra Heights NCG01-eNO1-Certification-Form-
Form 111.85KB
Signed.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 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* Brad Nelson
ale Davidson Homes LLC Raleigh Division President
Organization Legally Ibsponsible Entity
Davidson Homes
06/28/2021

F. Tracking and COC Info
NOI Tracking No. 57359
NC Reference No.
NCG01-2021-3857
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC213857
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3857
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. NCC213857-2021
Invoice Due Date 7/28/2021
Initial Fee $ 100.00
Invoice Status OPEN