NCC241315_NOI Signed Certification_20240506

NCGO1 Notice of Intent (NOI) Certification Form
Directions:
Print this form, complete,scan and upload to the electronic NOI.
Then, mail the original form to the NC DEMLR Stormwater Program (with $120 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
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.22]
Per NC General Statute 143-215.68 (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 a fine not to
exceed ten thousand dollars($10,000).
Under penalty of law, I certify that(check all boxes to indicate your agreement):
❑✓ 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.
ElI will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control
Plan.
0✓ If the approved Erosion and Sediment Control Plan 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.
E 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.
Project Name (must match Ala): Langtree Manor, LLC
Specific Lot Numbers(must match Alb):
Permittee(must match 81): Langtree Manor, LLC
Legally Responsible Person (must match 82& 83): Steven Bermes
Title of Legally Responsible Person (must match B3b): Manager
Print Name &Title of Signed if Authorized
Individual Differs from Legally Responsible Person: U e.X\ cb2,r r
Phone Number: 260-414-4448
bDVI)1120/ .(90 -a Li
S gnature of Legally Responsible 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.

Iredell County Planning & Development
11)
Erosion Control Section
1 R E D E L L 349 North Center Street
° U {' • P.O. Box788
- " Statesville, NC 28687
Date: April 22nd 2024
LETTER OF APPROVAL
Langtree Manor, LLC
Steve Bermes
662 Langtree Rd.
Mooresville,NC 28117
RE: Project Name: Langtree Manor, LLC
Acres Approved: 7.896
Project ID: IREDE-2024-086
Project Location: PIN 4635918590.000
Submitted By:Jordan Grant& Associates, PLLC
Date Received: March 27th 2024
Plan Type: New
Dear Mr. Bermes:
This office has reviewed the subject erosion and sedimentation control plan. We find the
plan to be acceptable and hereby issue this letter of Approval. The Certificate of
Approval must be posted at the job site. This plan approval shall expire three (3) years
following the date of approval as is required by Title 15A NCAC 4B.0129 and Appendix
H of the Iredell County Land Development Code.
Title 15A NCAC 4B 0118(a) and Appendix H of the Iredell County Land Development
Code requires that a copy of the approved erosion control plan be on file at the job site.
Any amendments and/or revisions to the approved plan must be reviewed and approved
prior to implementation in order for the site to remain in compliance. Failure to submit
plans for approval may result in administrative actions and/or penalties as indicated in the
Iredell County Land Development Code. Also, this letter gives notice as required by G.S.
l 13A-61.1(a)and Appendix H of the Iredell County Land Development Code, of our
right of periodic inspection to insure compliance with the approved plan.
Iredell County's Sedimentation Pollution Control Program is performance-oriented,
requiring protection of existing natural resources and adjoining properties. If, following
the commencement of this project, it is determined that the erosion and sedimentation
control plan is inadequate to meet the requirements of the Iredell County Land
Development Code and the Sedimentation Pollution Control Act of 1973,(North

Letter of Approval
Langtree Manor, LLC
April 22nd 2024
Page 2 of 3
Carolina General Statute 113A-51 through 66),this office may require revisions to the
plan and implementation of the revisions to insure compliance with the Act and Code.
Acceptance and approval of this plan is conditioned upon your compliance with Federal
and State water quality laws, regulations, and rules. In addition, local city or county
ordinances or rules may also apply to this land-disturbing activity. This approval does
not supersede any other permit or approval. It is the responsibility of the applicant to
obtain all other required permits or approvals.
As of April 1, 2019,all new construction activities are required to complete and submit
an electronic Notice of Intent(eNOI) form requesting a Certificate of Coverage (COC)
under the NCGO10000 Construction General Permit.After the form is reviewed and
found to be complete,you will receive a link with payment instructions for the applicable
annual permit fee. After the fee is processed, you will receive the COC via email. As the
Financially Responsible Party shown on the FRO form submitted for this project,you
MUST obtain the COC prior to commencement of any land disturbing activity. The eNOI
form and fee details may be accessed at deq.nc.gov/NCGO1. Please direct questions about
the eNOI form to the Stormwater Program staff in the Raleigh central office. If the
owner/operator of this project changes in the future,the new responsible party must
obtain a new COC.
Please note that this approval is based in part on the accuracy of the information provided
in the Financial Responsibility Form, which you provided. You are requested to file an
amended form if there is any change in the information included on the form. In
addition, it is required that this office to be notified of the proposed starting date for this
project. Failure to notify this office of the starting date may result in a Notice of
Violation and civil penalty. As required in the approved plan construction sequencing,
please schedule a preconstruction conference with our staff prior to land disturbing
activity.
Your cooperation is appreciated.
Sincerely,
c?"-70494.— 4.41:-:-.._6,,___
Jonathan Williams,CESSWI
Erosion Control Coordinator
Enclosures: Fact Sheet on the New NCGOI Permit
Permit