NCC214792_NOI Application_20210825

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/20/2021 12:06:47 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 8/23/2021 7:41:45 AM (Review- Construction NOI 62634)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 8/20/2021 12:07 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 24, 2021 5:00
PM 8/20/2021 12:07 PM
Submit by Miller, Ariyelle L 8/25/2021 1:32:41 PM (Payment Verification for NCC214792)
* J Kester & Rose LLC
• Miller, Ariyelle L assigned the task to Miller, Ariyelle L 8/25/2021 1:28 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 4, 2021 5:00 PM
8/23/2021 7:42 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 62630
NOI No.
Prior Reviewer Brooklyn Broussard
Name
1a. Project Name * Blackwood Farm Park - Phase II
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
1 c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 9872-55-7302
2. County* Orange
3. Highway or Street 4215 NC-86
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Hillsborough
5. State * NC
6. Zip Code* 27514
7. Latitude* Enter the latitude in decimal degrees
36.0190
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-79.0810
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* 08/23/2021
Estirrated Construction Project Start Date
10. Date to End* 06/01/2022
Estinated Construction Project End Date

11. SIC (Primary)* Other (9999)
Standard Industrial aasslfication for Development
12. Acres to be 7.54
disturbed* (including off -site borrow and waste areas)
13. Total site area 151.22
(acres) *
14. Post- 1.90
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-ORANG-2021-Blackwood Farm Park - Phase II
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 New Hope Creek
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 16-41-1-(0.5)
Index No. * NCWaterbody Index Nurrber
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 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 * Jernigan Kester LLC
If pernittee 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 * Jim
If Corporation, enter Faegistered Agent First Nine
3. Last Name* Kester
If Corporation, enter Fogistered Agent Last I\bne
3b. Title President / Owner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-285-4607
Telephone No.*
6. Permittee Mailing Street Address
Address* 119 South Fuquay Avenue
Address Line 2
City
Fuquay-Varina
Postal / Zip Code
27526-2210
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
119 South Fuquay Avenue
Address Line 2
city
Fuquay-Varina
Postal / Zip Code
27526-2210
State / Province / Pegion
NC
Country
us
State / Province / Pegion
NC
Country
us
8. Type of Ojvnership is only individual if an individual is named in B.1. above.
Ownership* Government -County

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
_....................................................................................................................................................
1. Primary Site
Kenneth
Contact - First
Name *
2. Primary Site
Fain
Contact - Last
Name *
3. Title
Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-673-8868
Telephone No.
6. Organization
Jernigan Kester LLC
Name
7. Site Contact
Street Address
Mailing Address*
119 S. Fuquay Avenue
Address Line 2
city
Fuquay Varina
Postal / Zip Code
27526
8. Consultant Name
(Optional)
First and Last nave
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 a-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
919-285-4607
Default is legally responsible person telephone
State / Province / Region
North Carolina
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 04/21/2021
Approved *
2. E&SC Plan Project ORANG-2021-010
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 * Raleigh (RRO)
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
Erosion Control Approval_ORANG-2021-
Approval letter or
010_20210421 pdf
326.77KB
Grading Permit
_COA.
Erosion Control ORANG-2021-
183.7KB
010_20210421 _LOAwM. pdf
Mast be FDFfon-rat
6. Site Location Map
Mist be RDFforrrat (lint 20 [vB)
Blackwood Farm Park Erosion Control Plan.pdf
1.04MB
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
JK LLC NCGOI Notice of Intent (NOI) Certification
Form
130.38KB
Form.pdf
Mast be FDFformat
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:* 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 NCG010000 General Permit. For more
information on signatory requirements, see Part IV, Section B, Item (6) of that permit.
Signature
Type Name* Kenneth Fain
Title Project Manager
Organization Legally Responsible Entity
Jernigan Kester LLC
Date * 08/20/2021

F. Tracking and COC Info
NOI Tracking No. 62634
NC Reference No.
NCG01-2021-4792
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC214792
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 4792
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. NCC214792-2021
Invoice Due Date 9/22/2021
Initial Fee $ 100.00
Invoice Status OPEN