NCC214708_NOI Application_20210818

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/17/2021 9:32:39 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 8/17/2021 9:45:13 AM (Review- Construction NOI 62286)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 8/17/2021 9:33 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 19, 2021 5:00
PM 8/17/2021 9:33 AM
Submit by Selkane, Aziza 8/18/2021 10:36:43 AM (Payment Verification for NCC214708)
* Mark T Sergent
• Selkane, Aziza assigned the task to Selkane, Aziza 8/18/2021 10:36 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 28, 2021 5:00
PM 8/17/2021 9:45 AM

.• SThF� ';
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 * Cresswind Phase 7C
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers 162
1 c. Parcel ID List all RW associated w ith this project.
Number(s) (PIN) 1112211110, 11122108, 11122107, 11122106, and 11122104
2. County* Mecklenburg
3. Highway or Street Rocky River Church Road
Address* Street name only is acceptable if no address number assigned yet
4.CityorTownship* Charlotte
5. State * NC
6. Zip Code* 28215
7. Latitude* Enter the latitude in decimal degrees
35.2267
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-80.6382
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*
08/09/2021
Estimated Construction Project Start Rate
10. Date to End*
12/01/2021
Estinated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Oassification for Development
12. Acres to be
45.00
disturbed*
(including off -site borrow and waste areas)

13. Total site area 47.00
(acres) *
14. Post- 28.00
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-MECKL-2021-Cresswind Phase 7C
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 McKee Creek
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 13-17-8-4
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.
Rarmttee Inforrration - Legally Fbsponsible Entity and Individual
...........................................................................................................................................................
Important: The person vvho 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 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 NCG010000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
1. Organization Legally Faesponsible Entity
Name * KH Mint Hill LLP
If perrrittee is an individual (i.e., organization does not apply), enter first and last nave 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 * Paul
If Corporation, enter Faegistered Agent First None
3. Last Name* Johnson
If Corporation, enter Fbgistered Agent Last I\bne
3b. Title Community Director
4. Permitee E-mail [e-mail]
Address*
5. Permittee 980-228-9044
Telephone No.*
6. Permittee Mailing Street Address
Address* 701 South Olive Street
Address Line 2
Suite 104
City
West Palm Beach
Fbstal / Zip Code
33407
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address *
V Yes
Street Address
701 South Olive Street
Address Line 2
Suite 104
city
West Palm Beach
Fbstal / Zip Code
33407
State / Province / Pegion
FL
Country
United States
State / Province / Faegion
FL
Country
United States
8. Type of Ojvnership is only individual if an individual is named in B.1. above.
Ownership* Non -Government

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Paul
Contact - First
Name *
2. Primary Site
Johnson
Contact - Last
Name *
3. Title
Community Director
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
980-228-9044
Telephone No.
6. Organization
KH Mint Hill LLP
Name
7. Site Contact
Street Address
Mailing Address*
8913 Silver Springs Court
Address Line 2
City
Charlotte
Fbstal / Zip Code
28215
8. Consultant Name
(Optional)
Matthew Kiker
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
980-521-5999
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
980-228-9044
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
United States

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 LDGP-2021-00191
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* City of Charlotte
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 Grading Letter of Approval - Cresswind Phase
Approval letter or 7C.pdf 91.83KB
Grading Permit
Mist be FL7Fforrrat
6. Site Location Map Wst be RDFforrret (lint 201VB)
Pages from 27393.0003 - APPROVED Cresswind
Phase 7C - Land Development - Sealed 2021-07- 968.76KB
12.pdf
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Provide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification NCG01-eNO1 (Signed).pdf 66.9KB
Form Wst 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 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
l 'f jpk x
Type Name* Paul Johnson
Title Community Director
Organization Legally Ibsponsible Entity
KH Mint Hill LLP
Date * 08/17/2021

F. Tracking and COC Info
NOI Tracking No. 62286
NC Reference No.
NCG01-2021-4708
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC214708
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 4708
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. NCC214708-2021
Invoice Due Date 9/16/2021
Initial Fee $ 100.00
Invoice Status OPEN