NCC192196_NOI Application_20191008

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/4/2019 11:02:19 AM (NCG01 NOI Submission)
Approve by EADS\Ivgarcia 10/7/2019 8:36:23 AM (Review- Construction NOI 16745)
• The task was assigned to EADS\Ivgarcia by round robin distribution 10/4/2019 11:02 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 8, 2019 5:00
PM 10/4/2019 11:02 AM
Submit by McCoy, Suzanne 10/8/2019 7:22:25 AM (Payment Verification for NCC192196)
* April Chianese
• McCoy, Suzanne assigned the task to McCoy, Suzanne 10/8/2019 7:21 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 18, 2019 5:00
PM 10/7/2019 8:36 AM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Honeycutt Farm Phase 11
2. County* Wake
3. Highway or Street 1000 Piney Grove Wilbon Road
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Town of Holly Springs
5. State * NC
1r-i)iTII1T7i1)MfiTi(-_ToIa10141
6. Zip Code* 27540
7. Latitude * Enter the latitude in decirral degrees
35.6242
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-78.8453
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*
10/04/2019
Estimated Construction Project Start Date
10. Date to End*
12/31 /2021
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
13.70
disturbed*
(including off -site borrow and waste areas)
13. Total site area 16.39
(acres)*
14. Post- 7.16
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-WAKE-2019-Honeycutt Farm Phase 11
Tracking ID 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 Buckhorn Creek
Waterbody* I\brre of waterbody into which stornwater runoff will discharge
15b. Waterbody 18-7-(1)
Index No. * NCWaterbody Index Nurrber
Stormwater fJ 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 AV Homes of Raleigh, LLC
Name *
2. First Name* Jeremy
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Medlin
ff Corporation, enter Registered Agent Last Barre
3b. Title VP of Land Acquisition & Development
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-291-3819
Telephone No.*
6. Permittee Mailing Street Address
Address* 15501 Weston Parkway
Address Line 2
Suite 100
City
Cary
Pastal / Zip Code
27513
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
15501 Weston Parkway
Address Line 2
Suite 100
City
Cary
Pastal / Zip Code
27513
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 Christian
Contact - First
Name *
3. Primary Site Sheppard
Contact - Last
Name *
4. Title
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact
910-638-1877
Telephone No.*
7. Organization
Taylor Morrison
Name
8. Site Contact
Street Address
Mailing Address*
15501 Weston Parkway
Address Line 2
Suite 100
aty
Cary
Pbstal/ Zip Code
27513
9. Consultant Name (optional)
Jeremy Finch
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant 919.361-5000
Telephone No.
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 07/03/2019
Approved *
2. E&SC Plan Project 14-2019
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* Town of Holly Springs
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 Honeycutt Farm Phase 11 Letter of Plan
Approval 975.6KB
Approval.pdf
letter/documentation
EDP Ph 11 7-3-19.pdf 228.87KB
Wst be POF format
6. NOI Certification Honeycutt PH11 NCG01.pdf 92.55KB
Form Wst be RDFformat
This is an Express r No
Review Project* f 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 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* Jeremy Dowd Medlin
Title VP, Land Acquisition and Development
Organization AV Homes of Raleigh, LLC
Date * 10/04/2019

F. Tracking and COC Info
NOI Tracking No. 16745
NC Reference No. NCG01-2019-2196
Uses 'count number variable (incremrented by SP)
Certificate of NCC192196
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 2196
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.)