NCC192157_NOI Application_20191003

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/1/2019 12:18:26 PM (NCG01 NOI Submission)
Approve by Lucas, Annette 10/2/2019 10:41:49 AM (Review- Construction NOI 16510)
• The task was assigned to Lucas, Annette by round robin distribution 10/1/2019 12:18 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 3, 2019 5:00
PM 10/1/2019 12:18 PM
Submit by EADS\smccoy2 10/3/2019 7:51:36 AM (Payment Verification for NCC192157)
* Shannon Judd.
• EADS\smccoy2 assigned the task to EADS\smccoy2 10/3/2019 7:51 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 13, 2019 5:00
PM 10/2/2019 10:41 AM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Garden Street Apartments ( Sitework Improvements)
2. County* Lee
3. Highway or Street Battle Street and Clark Circle
Address * Street name only is acceptable if no address nurrber assigned yet
4. City or Township * Jonesboro and East Sanford Township
5. State * NC
1re) frIT7i)Mfi1i(-_ToIa1010
6. Zip Code* 27331
7. Latitude * Enter the latitude in decirral degrees
35.4611
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-79.1758
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*
09/30/2019
Estimated Construction Project Start Date
10. Date to End*
09/30/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Other
than SFE (1522)
Standard Industrial Gassification for Development
12. Acres to be
3.58
disturbed*
(including off -site borrow and waste areas)
13. Total site area 12.20
(acres)*
14. Post- 2.00
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-LEE-2019-Garden Street Apartments ( Sitework
Tracking ID Improvements)
Assigned autorratically
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 Gastors Creek
Wate rbody* Narre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 18-20-5
Index No. * NC Waterbody Index Ninber
Stormwater PF No
discharges will flow r Yes
to additional
wate rs *
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 Sanford Housing Authority
Name *
2. First Name* Shannon
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Judd
ff Corporation, enter Registered Agent Last Barre
3b. Title CEO
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-897-2306
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box636
Address Line 2
P.O. Box 143
City
Sanford
Postal / Zip Code
27331
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
r Yes
Street Address
1000 Carthage Street
Address Line 2
City
Sanford
Postal / Zip Code
27330-4115
State / Province / Region
N.C.
Country
us
State / Province / Region
NC
Country
us

C. Site Contact Information
Part C.
Proiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Robbie
Contact - First
Name *
3. Primary Site Parker
Contact - Last
Name *
4. Title Project Manager
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 919-369-3527
Telephone No.*
7. Organization Mutual Builders, Inc.
Name
8. Site Contact Street Address
Mailing Address* P.O. Box270
Address Line 2
city
Smithfield
Pbstal / Zip Code
27577
9. Consultant Name (optional)
Johnny Glenn Tew
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant 910-897-3257 Ext. 3005
Telephone No.
State / Province / Region
N.C.
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (MSC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 09/30/2019
Approved *
2. E&SC Plan Project LEE-2020-010
Number/ID* Assigned by agency or local program
3. E&SC Plan f• State DEQ Office
Approved by r Local Program
4. State DEQ Office * Raleigh (RRO)
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 18-332 Garden Street Apartments - erosion
Approval 176.83KB
approval.pdf
letter/documentation
Mist be R7F forrret
6. NOI Certification Notice of Intent Certification Form Garden Street.pdf 497.49KB
Form Mist be RDFfornet
This is an Express f• No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.613 (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.
* rJ 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.
* rJ 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 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 * Shannon Judd
Title CEO
Organization Sanford Housing Authority
Date * 10/01 /2019

F. Tracking and COC Info
NOI Tracking No. 16510
NC Reference No. NCG01-2019-2157
Uses 'count number variable (incremrented by SP)
Certificate of NCC192157
Coverage (COC) Uses'count_nunber'variable (incremrented by SF)
No. *
Count Number 2157
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)