NCC192701_NOI Application_20191108

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 11/7/2019 12:42:32 PM (NCG01 NOI Submission)
Approve by Clark, Paul 11/7/2019 12:50:02 PM (Review- Construction NOI 18247)
• The task was assigned to Clark, Paul by round robin distribution 11/7/2019 12:42 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 11, 2019 5:00
PM 11/7/2019 12:42 PM
Submit by Garcia, Lauren V 11/8/2019 8:51:06 AM (Payment Verification for NCC192701)
* Stancil Vineyards LLC
• Garcia, Lauren V assigned the task to Garcia, Lauren V 11/8/2019 8:50 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 19, 2019 5:00
PM 11/7/2019 12:50 PM

1 r-i) iTiT 7i) M fiIi f_T1II a 10141
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Panther Lake Rd Subdivision
2. County* Wake
3. Highway or Street Panther Lake Rd
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township * Middle Creek
5. State * NC
6. Zip Code* 27592
7. Latitude * Enter the latitude in decirral degrees
35.5871
8. Longitude * Enter the longitude in decirral degrees (MJSTbe negative)
-78.7109
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*
11/18/2019
Estimated Construction Project Start Date
10. Date to End*
06/15/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
8.85
disturbed*
(including off -site borrow and waste areas)
13. Total site area 36.36
(acres)*
14. Post- 10.85
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-WAKE-2019-Panther Lake Rd Subdivision
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 Black Creek
Waterbody* Narre of waterbody into which stornwater runoff will discharge
15b. Waterbody 27-45-(1)
Index No. * NCWaterbody Index N.arrber
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 Stancil Vineyards LLC
Name *
2. First Name* Bradley
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Stancil
ff Corporation, enter Registered Agent Last Barre
3b. Title Vice President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-639-2073
Telephone No.*
6. Permittee Mailing Street Address
Address* 466 Stancil Road
Address Line 2
City
State / Province / Region
Angier
NC
Postal / Zip Code
Country
27501-8342
us
Check box if the r% Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 466 Stancil Road
Address Line 2
City
State / Province / Region
Angier
NC
Pastal / Zip Code
Country
27501-8342
us

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Bo
Contact - First
Name *
3. Primary Site Bridgers
Contact - Last
Name *
4. Title Project Manager
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
919-639-2073
Telephone No.*
7. Organization
Bradley Built Inc.
Name
8. Site Contact
Street Address
Mailing Address*
466 Stancil Road
Address Line 2
oty
Angier
Rbstal / Zip Code
27501-8342
9. Consultant Name (optional)
Jon Frazier
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant 9196101051
Telephone No.
State / Province / Region
NC
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 10/28/2019
Approved *
2. E&SC Plan Project SEC-016588-2019
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* Wake 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 Panther Lake Road
Approval Subdivision_WatershedManagementApproval_V.2_...322.25KB
letter/documentation
28-19.pdf
Mist be RCF format
6. NOI Certification Panther Lake Rd_NCG01-eNO1-Certification-Form-
Form 629.52KB
20190507-DEMLR-SW. pdf
Mist be RJFfornat
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* Bradley Stancil
Title Vice Presient
Organization Stancil Vineyards LLC
Date * 11 /07/2019

F. Tracking and COC Info
NOI Tracking No. 18247
NC Reference No. NCG01-2019-2701
Uses 'count_nunber variable (increrrented by SP)
Certificate of NCC192701
Coverage (COC) Uses'count_nunber'variable (incremented by SF)
No. *
Count Number 2701
Sequential nunber for subrrittal that is increrrented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)