NCC224176_NOI Application_20230111

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/20/2022 11:38:49 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 12/21/2022 6:42:09 AM (Review - NOI 119527 Barrow Farms Home COnstruction)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 12/20/2022 11:39 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 23, 2022 5:00
PM 12/20/2022 11:39 AM
by Workflow 12/21/2022 6:42:24 AM (Workflow Start Event)
Submit by Holloman, Tevye L 1/11/2023 9:10:00 AM (Payment Verification for NCC224176)
* Melisa Smetana
Holloman, Tevye L assigned the task to Holloman, Tevye L 1/11/2023 9:09 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 1, 2023 5:00 PM
12/21/2022 6:42 AM

a
NORTH CAROLINA,
Enri--tn! C2-1;ly
A. Project Information
Part A.
Project Location and Waterbody Information
................................................................................................................... .
Are you submitting No
an NOI that was Yes
rejected before?
la. Project Name* Barrow Farms Home Construction
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers 1-33
1 c. Parcel ID List all PINS associated with this project.
Number(s) (PIN) 6878-17-4125
6878-17-3067
6878-16-2999
6878-16-2737
6878-16-1854
6878-16-0970
6878-07-9104
6878-06-9997
6878-07-8132
6878-17-1109
6878-17-2209
6878-07-9603
6878-07-8534
6878-07-6482
6878-07-6305
6878-07-5228
6878-07-4241
6878-07-3164
6878-07-2088
6878-07-2011
6878-06-1944
6878-06-0839
6878-07-7469
6878-06-0716
6878-06-4463
6878-16-0522
6878-06-9537
6878-06-8643
6878-06-7646
6878-06-6752
6878-06-6801
6878-06-5839
6878-06-4636
2. County* Forsyth

3. Highway or Street 3810 Old Flatrock Road
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Kernersville
5. State*
INC
6. Zip Code*
27284
7. Latitude*
Enter the latitude in decimal degrees
36.1819
8. Longitude*
Enter the longitude in decimal degrees (MUST be negative)
-80.1158
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*
10/15/2022
Estimated Construction Project Start Date
10. Date to End*
04/15/2024
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Classification for Development
12. Acres to be
26.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 34.10
(acres) *
14. Post -construction 4.24
impervious area (Estimated)
(acres)*
Project Tracking ID NCC-FORSY-2022-Barrow Farms Home Construction
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 Left Fork Belews Creek
Waterbody * Name of waterbody into which stormwater runoff will discharge
15b. Waterbody Index 22-27-5
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
Pulte Home Company, 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* Chris
If Corporation, enter Registered Agent First Name
3. Last Name* Raughley
If Corporation, enter Registered Agent Last Name
3b. Title VP of Land Development
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-816-1161
Telephone No.*
6. Permittee Mailing Street Address
Address* 1225 Crescent Green
Address Line 2
City State / Province / Region
Cary NC
Postal / Zip Code Country
27518 us
Check box if the Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
1225 Crescent Green
Address Line 2
City
State / Province / Region
Cary
NC
Postal / Zip Code
Country
27518
us
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 Kenneth
Contact - First
Name*
2. Primary Site Binkley
Contact - Last Name*
3. Title Land Planning and Entitlement Manger
4. Site Contact E-mail [e-mail]
Address*
5. Site Contact 336-480-5195
Telephone No.*
6. Organization Name Pulte Home Company, LLC
7. Site Contact
Mailing Address*
8. Consultant Name
Street Address
1225 Crescent Green
Address Line 2
City
Cary
Postal / Zip Code
27518
(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)
919-816-1161
Default is legally responsible person telephone
State / Province / Region
NC
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Plan Approval Information
1. Date E&SC Plan 12/15/2022
Approved *
2. E&SC Plan Project A/P#: EN2200231
Number/ID* Assigned by agency or local program
3. E&SC Plan State DEQ Office
Approved by* Local Program
4. Local Program* Winston-Salem/Forsyth 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
APPROVAL Email- Barrow Farms.pdf 254.78KB
Approval letter or
Must be PDF format
Grading Permit
6. Signed FRO
Financial Responsibility/Ownership Form
HB 489 Compliant Single Family Dwelling
Construction Sketch Erosion Control Plan 10-15-21- 1.42MB
Barrow Farms -SIGNED -REV 1-APPROVED.pdf
Must be PDF format
7. Site Location Map Must be PDF format (limit 20 MB)
20-066-BARROW FARMS -APPROVED GRADING-
1.35MB
GRID PLAN.pdf
20-066-BARROW FARMS-OVRL Site.pdf 1.19MB
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.
Winston-Salem/ Forsyth County states no FRO needed since we are
doing residential development while underlying developer still has
open permit as we close lots piecemeal through development until
all lots have been built. The HB 489 permit is used in its place.
9. NOI Certification NCG01-eNOI-Barrow Farms_SIGNED.pdf 403.56KB
Form 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.
* 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.
* 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
Type Name* Chris Raughley
Title VP of Land Development
Organization Legally Responsible Entity
Pulte Home Company, LLC
Date * 12/20/2022

F. Tracking and COC Info
NOI Tracking No. 119527
NC Reference No. NCG01-2022-4176
Indicates NCG01 or NCG25. Uses NOI number until approved, then uses NUMBER incremented by SP (passed
from workflow if eNOI approved)
Certificate of NCC224176
Coverage (COC) No.* Uses NOI number until approved, then uses NUMBER incremented by SIP (formatted and passed from workflow if
eNOI approved)
Initial Invoice No. NCC224176-2022
Invoice Due Date 1/20/2023
Initial Fee $ 100.00
Invoice Status OPEN