NCC215505_NOI Application_20211006

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/1/2021 8:49:28 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 10/4/2021 8:19:06 AM (Review- Construction NOI 67641)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 10/1/2021 8:50 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 5, 2021 5:00
PM 10/1/2021 8:50 AM
Submit by Evans, Shaundra M 10/6/2021 8:11:46 AM (Payment Verification for NCC215505)
* Ryan Jackson
• Evans, Shaundra M assigned the task to Evans, Shaundra M 10/6/2021 8:10 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 15, 2021 5:00
PM 10/4/2021 8:19 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 66752
NOI No.
Prior Reviewer Brooklyn Broussard
Name
1a. Project Name* Bridle Run
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers
1 c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 0782474590, 0782477601, 0782572676
2. County* Wake
3. Highway or Street 4505 Tryon Rd, 4525 Tryon Rd, 2301 Dover Farm rd
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Raleigh
5. State * NC
6. Zip Code* 27606
7. Latitude* Enter the latitude in decimal degrees
35.7484
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.7127
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* 09/30/2021
Estimated Construction Project Start late
10. Date to End * 05/27/2022
Estimated Construction Project End late

11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Developrrent
12. Acres to be 16.80
disturbed* (including off -site borrow and waste areas)
13. Total site area 16.77
(acres) *
14. Post- 5.03
construction (Estirrated)
impervious area
(acres) *
Project Tracking ID NCC-WAKE-2021-Bridle Run
Assigned autorratically (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 Unamed Tributary to Swift Creek (Yates Mill
Waterbody* Pond)
Bane of waterbody into which stornwater runoff will discharge
15b. Waterbody 27-43-5(1.5)
Index No.* NCWaterbody Index Nirrber
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.
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 must 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. Permittee * Legally Pesponsible Entity
CND -Bridle Run, LLC
It pernittee is an individual, enter first and last narre in this field. Otherwise, enter organization/business narre.
Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the
registration here.
2. First Name * Ryan
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Jackson
It Corporation, enter F;bgistered Agent Last %rre
3b. Title Land Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-659-1502
Telephone No.*
6. Permittee Mailing Street Address
Address* 1901 North Harrison Ave
Address Line 2
Suite 200
City
State / Ffovince / Fbgion
Cary
NC
Fbstal / Zip Code
Country
27513-2410
UA
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 1901 North Harrison Ave
Address Line 2
Suite 200
City
State / Frovince / Region
Cary
NC
Fbstal / Zip Code
Country
27513-2410
ILIA
8. Type of ONnership 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
Ryan
Contact - First
Name *
2. Primary Site
Jackson
Contact - Last
Name *
3. Title
Land Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-659-1502
Telephone No.
6. Organization
CND -Bridle Run, LLC
Name
7. Site Contact
Street Address
Mailing Address*
1901 North Harrison Avenue
Address Line 2
Suite 200
city
Cary
Postal / Zip Code
27513-2410
8. Consultant Name
(Optional)
Arnaldo Echevarria
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
9194693340
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
RJackson@d\Athomes.com
Default is legally responsible person e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
919-659-1502
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 09/23/2021
Approved *
2. E&SC Plan Project LDG-007976-2021
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 Raleigh
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
Approval letter or
Grading Permit
6. Signed FRO
LDG-007976-2021-Bridle Run.pdf
Mast be RDFforrrat
112.92KB
Financial Pesponsibility/Ownership Form
BridleRun_SPR_FinancialResponsibilityOwnership... 767.82KB
Mast be RDFforrral
7. Site Location Map Mast be FDFfornat (lirrit 20IVB)
SPR-0227-2019 APPROVED REV-1 BRIDLE-
14.19MB
RUN Cover_Erosion.pdf
Rease do not upload entire set of E&SC plans.
8. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
9. NOI Certification Bridle Run NOI V.pdf 516.26KB
Form Mast 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
r-
Type Name* Ryan Jackson
Title Land Manager
Organization Legally Ibsponsible Entity
CND -Bridle Run. LLC
Date * 10/01 /2021

F. Tracking and COC Info
NOI Tracking No. 67641
NC Reference No.
NCG01-2021-5505
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC215505
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5505
Sequential nunber for subnittal 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. NCC215505-2021
Invoice Due Date 11/3/2021
Initial Fee $ 100.00
Invoice Status OPEN