NCC215600_NOI Application_20211008

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/7/2021 9:16:56 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 10/7/2021 9:21:43 AM (Review- Construction NOI 68130)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 10/7/2021 9:17 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 11, 2021 5:00
PM 10/7/2021 9:17 AM
Submit by Evans, Shaundra M 10/8/2021 9:10:29 AM (Payment Verification for NCC215600)
* Ryan Jackson
• Evans, Shaundra M assigned the task to Evans, Shaundra M 10/8/2021 9:09 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 18, 2021 5:00
PM 10/7/2021 9:21 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 *
Briar Chapel - Lot 1557 Drainage Improvements
1 b. Specific Lot
This field may be used to list specifc lot numbers.
Numbers
Lot 1557
1 c. Parcel ID List all RED associated w ith this project.
Number(s) (PIN) 91598
2. County* Chatham
3. Highway or Street 96 Abercorn Circle
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Chapel Hill
5. State * NC
6. Zip Code* 27516
7. Latitude* Enter the latitude in decimal degrees
35.8262
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-79.1261
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*
10/11/2021
Estirrated Construction Project Start Rate
10. Date to End*
11/30/2021
Estinated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be
0.03
disturbed*
(including off -site borrow and waste areas)

13. Total site area 0.03
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-CHATH-2021-Briar Chapel - Lot 1557 Drainage Improvements
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 Wilkinson Creek
Waterbody* %neof waterbody into which stormwater runoff will discharge
15b. Waterbody 16-35
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.
Fbrnittee 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
Weekley Homes, LLC
IF 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
IF 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 N. Harrison Avenue
Address Line 2
City
Cary
Fbstal / Zip Code
27513
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
1901 N. Harrison Avenue
Address Line 2
City
Cary
Fbstal / Zip Code
27513
State / Frovince / Pegion
NC
Country
United States
State / Frovince / Faegion
NC
Country
United States
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
Joe
Contact - First
Name *
2. Primary Site
Forehand
Contact - Last
Name *
3. Title
Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-761-3188
Telephone No.
6. Organization
David Weekley Homes
Name
7. Site Contact
Street Address
Mailing Address*
1901 North Harrison Avenue
Address Line 2
city
Cary
Fbstal / Zip Code
27513-2410
8. Consultant Name
(Optional)
Brian OKane
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
252-702-1910
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
RJackson@d\Nhomes.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 09/20/2021
Approved *
2. E&SC Plan Project WP-21-366
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Chatham 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 Letter of Approval.pdf
Approval letter or Mist beRDFformat
Grading Permit
128.38KB
6. Signed FRO Financial Responsibility/Ojvnership Form
Land Disturbance Application - Signed.pdf 1.51 MB
Mast be RDFfornat
7. Site Location Map Mast be RDFforrrat (lirrit 20 NB)
2021-10-06 - Lot 1557 - Vic Map.pdf 85.37KB
Rease do not upload entire set of E&SC plans.
8. Notes (Optional) Provide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies if necessary.
9. NOI Certification Lot 1557 NOI.pdf 769.65KB
Form Mast be RDFfon-rat
This is an Express F 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
Weekley Homes, LLC
Date * 10/07/2021

F. Tracking and COC Info
NOI Tracking No. 68130
NC Reference No.
NCG01-2021-5600
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC215600
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5600
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. NCC215600-2021
Invoice Due Date 11/6/2021
Initial Fee $ 100.00
Invoice Status OPEN