NCC214621_NOI Application_20210817

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/12/2021 8:44:02 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 8/12/2021 8:50:39 AM (Review- Construction NOI 62002)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 8/12/2021 8:44 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 16, 2021 5:00
PM 8/12/2021 8:44 AM
Submit by Selkane, Aziza 8/17/2021 1:43:51 PM (Payment Verification for NCC214621)
* Broadwell Land Company
• Selkane, Aziza assigned the task to Selkane, Aziza 8/17/2021 1:43 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 23, 2021 5:00
PM 8/12/2021 8:51 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was r Yes
rejected before?
Previous Rejected 61976
NOI No.
Prior Reviewer Brooklyn Broussard
Name
1a. Project Name * Elliot Farms Phase 1 A, B & C
1 b. Specific Lot This field may be used to list specifc lot nunbers.
Numbers Lots 14 - 65 & Lots 67 - 113
1 c. Parcel ID List all RW associated w ith this project.
Number(s) (PIN) 0542-29-7533
2. County* Cumberland
3. Highway or Street Elliot Farm Road SR 1606
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Fayetteville
5. State * NC
6. Zip Code* 28311
7. Latitude* Enter the latitude in decimal degrees
35.2052
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.8567
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* 08/16/2021
Estimated Construction Project Start Date
10. Date to End * 08/16/2022
Estimated Construction Project End Date

11. SIC (Primary)* Residential, Other than SFE (1522)
Standard Industrial aassification for Development
12. Acres to be 67.60
disturbed* (including off -site borrow and waste areas)
13. Total site area 102.00
(acres) *
14. Post- 16.00
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-CUMBE-2021-Elliot Farms Phase 1 A, B & C
Assigned automatically (not used)
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 Carvers Creek
Waterbody* %rreof waterbody into which stormwater runoff will discharge
15b. Waterbody 18-24-2
Index No. * NCWaterbody Index Number
Stormwater V 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. ^
Fternittee 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 * Broadwell Land Company
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 * Dohn
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Broadwell, Jr.
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-484-5193
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box53587
Address Line 2
City
Fayetteville
Fbstal / Zip Code
28305
Check box if the F Yes
street address the
same as mailing
address
State / Frovince / Plegion
NC
Country
USA
7. Permittee Street
Street Address
Address*
903 Hay Street
Address Line 2
city
State / Frovince / Faegion
Fayetteville
NC
Fbstal / Zip Code
Country
28305-5313
US
8. Type of
Ojvnership 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
Dohn
Contact - First
Name *
2. Primary Site
Broadwell, Jr.
Contact - Last
Name *
3. Title
President
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-484-5193
Telephone No.*
6. Organization
Broadwell Land Company
Name
7. Site Contact
Street Address
Mailing Address*
P.O. Box53587
Address Line 2
City
State / Rovince / Region
Fayetteville
NC
Fbstal / Zip Code
Country
28305
USA
8. Consultant Name
(Optional)
Kevin Lindsay, Crawford Design Company
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
910-221-0033
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
910-484-5193
Default is legally responsible person telephone

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 08/05/2021
Approved *
2. E&SC Plan Project CUMBE-2022-002
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 * Fayetteville (FRO)
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 cumbe-2014-117rev.pdf
Approval letter or Mist beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 201VB)
101.47KB
EC Rev Plan 7-16-21 - Copy.pdf 2.79MB
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.
8. NOI Certification NOI Elliot Ph 1 ABC Signed.pdf 781.91KB
Form Must be RDFforrret
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 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
hk pn�. P1.
Type Name* Dohn Broadwell, Jr.
Title President
Organization Legally Pesponsible Entity
Broadwell Land Company
Date * 08/12/2021

F. Tracking and COC Info
NOI Tracking No. 62002
NC Reference No. NCG01-2021-4621
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of NCC214621
Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 4621
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. NCC214621-2021
Invoice Due Date 9/11/2021
Initial Fee $ 100.00
Invoice Status OPEN