NCC215767_NOI Application_20211105

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/14/2021 11:44:48 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 10/15/2021 8:22:27 AM (Review - Construction NOI 68749)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 10/14/2021 11:45 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 18, 2021 5:00
PM 10/14/2021 11:45 AM
Submit by Evans, Shaundra M 11/5/2021 8:08:18 AM (Payment Verification for NCC215767)
* Cindy Hardison
• Evans, Shaundra M assigned the task to Evans, Shaundra M 11/5/2021 8:07 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 26, 2021 5:00
PM 10/15/2021 8:22 AM

NORTH CAROLINA
Rrf Omrlm&tral Qualrly
A. Project Information
Part A.
�J
Project Location and Waterbody Information
...............................................................................................................................................................................................................................................................................................................................................................................................
Are you submitting No
an NOI that was Yes
rejected before?
la. Project Name* Mill Creek Cove
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers 4
5
6
9
12
14
19
20
21
23
30
31
32
35
37
38
39
40
42
43
44
45
46
47
48
49
50
51
52
55
56
58
59
62
63
64
66

VO
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
86
88
89
90
96
107
108
109
110
111
112
113
114
115
116
118
119
120
121
122
123
124
125
126
139
140
141
142
143
144
145
146
148
149
150
151
152
153
154
155
156
157
158
159
160

161
162
169
173
174
176
180
182
183
192
193
194
197
198
201
202
203
204
205
206
207
208
211
230
232
234
235
237
242
243
245
246
249
255
258
260
272
273
274
275
1 c. Parcel ID List all PINS associated with this project.
Number(s) (PIN) 201ND004
201 ND005
201 ND006
201 ND009
201 ND0012
201 ND0014
201 ND0019
201 ND0020
201 ND0021
201 ND0023
201 ND0030
201 ND0031
201 ND0032
201 ND0035
201 ND0037
201 ND0038
201 ND0039
201 NBOO 1
201 NB003

LV II146VV'+
201 N B005
201 NB006
201 N B007
201 N B008
201 N B009
201 N B010
201 NB011
201 NB012
201KB001
201KB004
201KB005
201KB007
201KB008
201 KB011
201KB012
201KC001
201KC003
201KC005
201KC006
201KC007
201KC008
201KC009
201KC010
201 KC011
201KC012
201KC013
201KC014
201KC015
201KC016
201KC017
201KC018
201KC019
201KCO20
201 KCO21
201KCO23
201KCO25
201KCO26
201KCO27
201KC033
201 NCO07
201 NCO08
201 NCO09
201 NC010
201 NC011
201 NC012
201 NC013
201 NCO14
201 NCO15
201 NC016
201 NC018
201 NCO19
201 NCO20
201 NCO21
201 NCO22
201 NCO23
201 NCO24
201 NCO25
201 NCO26
201 NC039
201 NC040
201 NC041

201 NC042
201 NC043
201 NC044
201 NC045
201 NC046
201 NC048
201 NC049
201 NCO50
201 NCO51
201 NCO52
201 NCO53
201 NCO54
201 NCO55
201 NCO56
201 NCO57
201 NCO58
201 NCO59
201 NC060
201 NC061
201 NC062
201 NC069
201 NC073
201 NC074
201 NC076
201 NC080
201 NC082
201 NC083
201 NC092
201KC038
201KC039
201KC042
201 NC093
201 NC096
201 NC097
201 NC098
201 NC099
201 NC100
201 NC101
201 NC102
201 NC103
201 NC106
201 NB013
201 NB015
201 NB017
201 NBO18
201 N B020
201 ND042
201 ND043
201 ND045
201 ND046
201 ND049
201 ND055
201 ND058
201 N D060
201 N BO35
201 NBO23
201 NB024
201 NBO25
2. County* Brunswick

3. Highway or Street Pantego Blvd
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Bolivia
5. State* NC
6. Zip Code* 28422
7. Latitude* Enter the latitude in decimal degrees
33.9623
8. Longitude* Enter the longitude in decimal degrees (MUST be negative)
-78.2143
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*
09/01/2020
Estimated Construction Project Start Date
10. Date to End*
12/31/2022
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Classification for Development
12. Acres to be
34.00
disturbed *
(including off -site borrow and waste areas)
13. Total site area 34.00
(acres)*
14. Post -construction 34.00
impervious area (Estimated)
(acres) *
Project Tracking ID NCC-BRUNS-2020-Mill Creek Cove
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 Mill Creek
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody Index 15-25-1-18-(1)
No. * NC Waterbody Index Number
Stormwater No
discharges will flow Yes
to additional waters*
16a. Is this project • Yes
subject to the NC No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B.
Permittee Information - Legally Responsible 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
1. Permittee* Legally Responsible Entity
WJH LLC
If permittee is an individual, enter first and last name in this field. Otherwise, enter organization/business name.
Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the
registration here. Permittee must be the same entity that is responsible for the land -disturbing activity as listed on the NC
SPCA Financial Responsibility/Ownership (FRO) Form.
2. First Name* David
If Corporation, enter Registered Agent First Name
3. Last Name* Hodgman
If Corporation, enter Registered Agent Last Name
3b. Title Regional President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 3363626211
Telephone No.*
6. Permittee Mailing Street Address
Address* 3091 Governors Lake Drive Ste 300
Address Line 2
City State / Province / Region
Norcross Georgia
Postal / Zip Code Country
30071 United States
Check box if the Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
3091 Governors Lake Drive Ste 300
Address Line 2
City
State / Province / Region
Norcross
Georgia
Postal / Zip Code
Country
30071
United States
8. Type of
Ownership is only individual if an individual is named in B.1. above.
Ownership*
Non -Government

C. Site Contact Information
Part C.
Project Site Contact Information
1. Primary Site David
Contact - First
Name*
2. Primary Site Hodgman
Contact - Last Name*
3. Title Regional President
4. Site Contact E-mail [e-mail]
Address*
5. Site Contact 3363626211
Telephone No.*
6. Organization Name WJH LLC
7. Site Contact Street Address
Mailing Address* 3091 Governors Lake Drive Ste 300
Address Line 2
City
Norcross
Postal / Zip Code
30071
8. Consultant Name (optional)
First and Last name
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 e-mail
12. Billing Telephone
(For Annual Fee correspondence)
3363626211
Default is legally responsible person telephone
State / Province / Region
Georgia
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Plan Approval Information
1. Date E&SC Plan 10/09/2020
Approved *
2. E&SC Plan Project BRUNS-2021-017
Number/ID* Assigned by agency or local program
3. E&SC Plan State DEQ Office
Approved by* Local Program
4. State DEQ Office* Wilmington (WiRO)
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 MCC Erosion & Sediment Control permit.pdf 448.52KB
Approval letter or Must be PDF format
Grading Permit
6. Signed FRO Financial Responsibility/Ownership Form
Financial-Responsibility-Form-Feb2019 (1) - MILL
301.46KB
CREEK COVE (002).pdf
Must be PDF format
7. Site Location Map Must be PDF format (limit 20 MB)
Mill Creek Cove Erosion Control Plan.pdf 15.01 MB
Please do not upload entire set of E&SC plans.
8. Notes (Optional) Provide any additional information that might help the reviewer better understand how uploaded documents
support the application. Include additional waterbodies if necessary.
9. NOI Certification NCG01-eNOI-Certification-Form-20210514-DEMLR-
Form 920.83KB
SW -Mill Creek Cove.pdf
Must be PDF format
This is an Express • No
Review Project* Yes

E. Certification
North Carolina General Statute 143-215.613 (i) provides that:
Any person who knowingly makes any false 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 Article; 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 Article shall
be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
* 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.
* 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.
* I will abide by all conditions of the NCG010000 General Permit and the approved
Erosion and Sediment Control Plan.
* 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:* The Legally Responsible Person named on this Notice of Intent
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
olve, 73-wa'lli
Type Name* Dave Hodgman
Title Regional President
Organization Legally Responsible Entity
WJH LLC
Date * 10/14/2021

F. Tracking and COC Info
NOI Tracking No. 68749
NC Reference No.
NCG01-2021-5767
Uses'count_numb& variable (incremented by SP)
Certificate of
NCC215767
Coverage (COC) No.*
Uses'count_number' variable (incremented by SP)
Count Number
5767
Sequential number for submittal that is incremented by Stored Procedure
COC Year
2021
Year of date reviewed (used to assign YY digits after "NCC" in COC no.)
Initial Invoice No. NCC215767-2021
Invoice Due Date 11/14/2021
Initial Fee $ 100.00
Invoice Status OPEN