NCC223731_NOI Signed Certification_20221109

1 • - r . - � � s r
Directions:
Print this form, complete, scan and upload to the electronic NOI.
Then, mail the original form to the NC DEMLR Stormwater Program (with $100 check if paying by check) at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6th Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM OR PAYMENT UNTIL YOUR APPLICA fION HAS BEEN ACCEPTED AS COMPLETE.
TOHE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT OiG AQ 140 CPI 222.221
Per NC General Statute 143-215.6E (i), 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 ... shall be guilty of a Class 2 misdemeanor which may include o fine not to
exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that (check all boxes to indicate your agreement):
0 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 NCGO10000 General Permit and the approved Erosion and Sediment Control
Plan.
�✓ If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCGO10000 General Permit, I will nonetheless ensure that all conditions of Part II of the
permit are met on the project at all times.
Q✓ I hereby request coverage under the NCG010000 General Permit and understand that coverage under this
permit will constitute the permit requirements for the discharges) and is enforceable in the same manner as an
individual permit.
Project Name (must match Ala): The Range on Oleander
Specific Lot Numbers (must match Alb):
Permittee (must match B1): East West Partners Management Company, Inc.
Legally Responsible Person (must match B2 & B3): Roger Perry
Title of Legally Responsible Person (must match B3b): President
Name & Title of Signed if Authorized Individual
Differs from Legally Responsible Person:
Phone Numer: 9A9-904-7803
ly Re nsible Person or Authorized Individual Date
* IMPORTANT NOTE: This form must be signed by a responsible corporate officer that 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 permit.

APPLICATION FOR PERMIT FOR A File #
LAND DISTURBING ACTIVITY
Under the conditions set forth by LD Fee Review Fee _
The New Hanover County
Soil Erosion and Sedimentation Control Ordinance
Date Pd Date Pd
Engineering Department cc: [e-mail] N&T#21,090
Applicant or Applicant's Agent: Norris & Tunstall Consulting Engineers, P.C. I T. Jason Clark, P.E. or John S. Tunstall, P.E.
Mailing Address: 2602 Iron Gate Drive, Suite 102 Telephone Number: 910-343-9653 Fax Number: 910=343-9604
Wilmington, NC 28412 cark n
Email Address: 1 @ tengineers.com; jtunstall@ntengineers:com
Total Acres of Land Disturbance: _ Purpose of Development: The Range on Oleander
Description of Land Disturbance: The Range on Oleander i'
Address of Land Disturbance 5026 Oleander Dr., Wiim., NC Latitude:99-I h �� �;�� a Longitude:
Land owner(s) of record:
Name: The Oleander Company, Inc.
Address: P.O. Box 3145
STATEMENT OF FINANCIAL RESPONSIBILITY
Person or firm(s) financially responsible for the
land disturbing activity. If not a North Carolina
resident, you MUST have a N.C. agent. (List Below)
Nine: East west Partners Management Company, Inc.
Address: 1450 Environ Way
City/State: Wilmington, NC City/State Chapel Hill, NC
Zip Code: 28406 Zip Code: 27517
Telephone Number: 910-392-3300 Telephone Number: 919-904-7803
Email: [e-mail]910-392-5123 Emal:[e-mail] N/A
FaxNumber:
Location of deed(s) or instrument(s): County: New Hanover Book: Page:
The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath.
(This form must be signed by the financially responsible person if an individual and by an officer, director, partner, attorney -in -
fact, or other person of authority to execute instruments for the financially responsible person if not an individual.). I agree to
provide corrected information should there be any change in the information provided herein.
Date: -J - II Name Roger L. Perry Title President
Signature l/
a Notary Public of the County of r ]�/j7 d t.,- 1 -�,q State of
North Carolina, hereby certify that ', r`�- L , ¢�� g appeared personally before me this day and
being duly sworn acknowledged that the above form was efxecuted by him..
Witness > Lir hand anit. itat�! seal, this'47 day of. I�I1.l-tl , ZO 2i
Notary%hd1� • ,, J ,' fi My�comnussion expires -'- 151-2-i7L
L)A �E $ 4c;
a a, Notary Pul <L
C Durham O
`x County Z
Permission to Enter on Land "s� NIy Comm. Exp.
02.1.5-2026 �T`
I certify that I am authorized to grant''ap�, g in fact t,��errrission to the Erosion Control Inspector and his agents to enter on
the land in question in connection relateherAliFARIV application.
Signature and Date Jim Smith, Vice President of The Oleander Company, Inc.
PLEASE COMPLETE ALL PORTIONS OF APPLICATION

This application must be sealed by the notary and accompanied by 4 sets of plans, the fee, calculations, dimensions, temporary and
permanent seeding specifications, a maintenance plan for erosion control measures and seeding, and narrative statements as called for by
the ordinance. The following list specifies the minimum requirements.
SEDIMENTS AND EROSION CONTROL PLAN COMPONENTS
1. Name, address of the designer, phone number, fax number and email address.
2. Vicinity map. Address assigned by County Planning or the City of Wilmington.
3, Copy of deeds for the property.
4. Latitude and Longitude of Project.
S. DXF File. (On Disk)
6. Existing & Proposed topography.
7. Area to be disturbed (shown as construction limits on the plan with a legend. Include off site work).
8. Proposed site improvements (structures, roads, parking areas, lots, easements, etc.)
9. Construction Sequence.
10. Temporary sediment control measures (locations, dimensions, details and calculations).
11. Graveled construction entrance (dimensions and cross section details).
12. Proposed storm water network (swales, culverts, inlet and outlet structures, etc. with grades, elevations, details,
drainage calculations with velocities) and energy dissipater dimensions.
13. Permanent erosion controls (locations, dimensions, details and calculations)
14. Permanent & temporary seeding specifications (seedbed preparation, soil amendments, seeding rates & schedule).
15. Sediment and erosion control material specifications.
16. General notes.
17. Wetlands, C.A.M.A. areas, 100-year floodplain, 575' HQW, and Conservation Overlay Districts must be shown on the
plan if applicable.
18. Maintenance plan for all erosion control measures & stabilization methods.
19. Tree protection approval from the City of Wilmington or New Hanover County PIanning for subdivisions or New
Hanover County Zoning for Commercial Projects.
NARRATIVE STATEI4IENT COMPONENTS
I . Name and address of owner and of the financially responsible person, phone number, fax number & email address.
2. Sealed notarized financial responsibility form with a North Carolina agent and individual's name/signature.
3. Purpose of land disturbing activity.
4. Storm water run off calculations and explanation of the method of determination.
5. Construction sequence and schedule (flow chart if available).
6. Re -vegetation specifications (preparation, seed type and rates; fertilizer, lime and mulch rates and schedule)
The New Hanover County Erosion and Sedimentation Control Ordinance requires that all persons disturbing more than one (1) acre of
land must obtain approval of a soil erosion control plan and be issued a permit prior to the commencement of said land disturbing activity.
Before an application package is considered complete, this application must be completed and submitted along with the fees, plans, the
calculations, dimensions and the narrative to this office. The plans and narrative will be submitted to New Hanover County Soil
Conservation Service and State Stormwater. Plans must be submitted by the applicant to the New Hanover County Planning Department
for Conservation Overlay Review and subdivision tree approval. Commercial tree approval requires submittal to New Hanover County
Zoning. Projects within the City of Wilmington require City tree approval. Commencement of a land disturbing activity under the
jurisdiction of this Act prior to the approval of an erosion and sedimentation control plan is a violation of the Act. The Act further slates
that the application package must be filed a minimum of thirty (30) days prior to the activity and the approving authority must approve the
submitted plan within thirty (30) days of receipt. Failure of the approving authority to approve or disapprove the submitted plan within
the thirty (30) day period will be deemed approval of the plan. Additional information may be requested after the 30 day period in order to
meet requirements of the ordinance.
No activity should proceed on site without the issuance of a land disturbing activity unless the approving authority fails to notify the
applicant (usually the engineer) within the 30 day submittal period. If an environmental document is required, the application will be
deemed incomplete until the document is available for review by the County. In this case, the applicant will be notified that the 30 day
time limit for a review of the plan shall not begin until a complete environmental document is available for review. Revisions or
amendments to existing plans must be submitted for review 15 days prior to any site changes. Until such time as the revision is approved
by the County, the land disturbing activity shall not proceed. Any revlousl ermitted site that rr uires additional work no matter
what size must submit an amended erosion control plan for approval prior to any Chan es on site. All land disturbing activity,
on a tract since 1988 is cumulative towards the one acre threshold and requires a Permit. NO work should begin on site without a
nreconstruction erosion control conference,