NCC190314_NOI Application_20190516

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/16/2019 1:03:28 PM (NCG01 NOI Submission)
Approve by Lucas, Annette 5/17/2019 3:33:09 PM (Review- Construction NOI 11081)
In Good luck with your project.
• The task was assigned to Lucas, Annette by round robin distribution 5/16/2019 1:03 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 20, 2019 5:00 PM
5/16/2019 1:03 PM
Submit by Lucas, Annette 5/17/2019 3:33:32 PM (Payment Verification - NCG01-2019-0314)
• The task was assigned to Lucas, Annette. The due date is: May 20, 2019 5:00 PM 5/17/2019 3:33 PM

1r-G)a�T7G)MraIi(-_ToIa10141
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Oaks at St Martin
2. County* Stanly
3. Highway or Street St Martin Road
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Town Of Oakboro
5. State * NC
6. Zip Code* 28129
7. Latitude * Enter the latitude in decirral degrees
35.2257
8. Longitude * Enter the longitude in decirral degrees (MJSTbe negative)
-80.3290
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*
05/17/2019
Estimated Construction Project Start Date
10. Date to End*
03/31 /2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
5.30
disturbed*
(including off -site borrow and waste areas)
13. Total site area 8.60
(acres)*
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-STANL-2019-Oaks at St Martin
Tracking ID Assigned automatically
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. You may
enter up to 3 waterbodies.
15a. Receiving Allison Branch waterbody
Waterbody* I\bme of waterbody into which stormvdater runoff will discharge
15b. Waterbody 13-17-31-5-5-1
Index No. * NCWaterbody Index camber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Gilberts Creek
Receiving Waterbody naYe
Waterbody
15d. Waterbody 13-17-29
Index No. NCWaterbody Index PJunber
15e. Additional Coldwater Branch
Receiving Waterbody name
Waterbody
15f. Waterbody 13-17-28
Index No. NC Waterbody Index N irrber
16a. Is this project f• Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B.
Perrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application
form should 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. Organization WJH LLC
Name *
2. First Name* Dave
ff Corporation, enter Registered Agent First Nacre
3. Last Name * Jennings
ff Corporation, enter Registered Agent Last Nbrre
3b. Title VPF
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-488-1100
Telephone No.*
6. Permittee Mailing Street Address
Address* 3300 Battleground Avenue
Address Line 2
Ste 101
City
Greensboro
Postal / Zip Code
27410
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
3300 Battleground Avenue
Address Line 2
Ste 101
City
Greensboro
Postal / Zip Code
27410
State / Province / Region
NC
Country
US
State / Province / Region
NC
Country
US

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Katie
Contact - First
Name *
3. Primary Site Dyess
Contact - Last
Name *
4. Title Permit Coordinator
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact
704-488-9996
Telephone No.*
7. Organization
WJH LLC
Name
8. Site Contact
Street Address
Mailing Address*
9325 Center Lake Drive
Address Line 2
Ste 160
city
Charlotte
Wstal / Zip Code
28216
State / Province / Pegion
NC
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 05/14/2019
Approved *
2. E&SC Plan Project STANL-2019-015
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* Iredell County
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application.
5. E&SC Plan 090SM-Oaks in St Martin Approval letter 5-15-
Approval 2.03MB
19.pdf
letter/documentation
Mist be RJF format
6. NOI Certification NCG01-eNOI-Certification-Form-20190507-DEMLR-
Form 329.42KB
SW- Signed 5-15-19.pdf
Mist be RCF format
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6B (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes 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 deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
rJ 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.
* V 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.
* I7 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* V 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.
* I7 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 Responsible Person named on this Notice of Intent
r Authorized Responsible Person*
Important: The person who signs this Certification above and signs the NOI Certification Form should be the same
person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information)
of this form. *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
al wl C WAQ,,i4 7d
Type Name* Dave Jennings for WJH LLC
Title VP of Finance
Organization WJH LLC dba Wade Jurney Homes
Date * 05/16/2019

F. Tracking and COC Info
NOI Tracking No. 11081
NC Reference No. NCG01-2019-0314
Uses 'count number variable (incremrented by SP)
Certificate of NCC190314
Coverage (COC) Uses'count_nunber'variable (incremented by SF)
No. *
Count Number 314
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NOC' in OOCno.)