NCC205981_NOI Application_20210106

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/29/2020 7:54:54 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 12/29/2020 2:16:44 PM (Review- Construction NOI 39836)
• The task was assigned to Garcia, Lauren V by round robin distribution 12/29/2020 7:55 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 31, 2020 5:00
PM 12/29/2020 7:55 AM
Submit by Selkane, Aziza 1/6/2021 9:09:24 AM (Payment Verification for NCC205981)
* J and S Land Development LLC
• Selkane, Aziza assigned the task to Selkane, Aziza 1/6/2021 9:08 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 9, 2021 5:00 PM
12/29/2020 2:17 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting IT No
an NOI that was r Yes
rejected before?
1a. Project Name * Bella Point
1 b. Specific Lot This field nay be used to list specifc lot nunbers.
Numbers
1 c. Parcel ID List all RED associated w ith this project.
Number(s) (PIN) 2020000103
2. County* Brunswick
3. Highway or Street Sunset Harbor Road
Address* Street name only is acceptable if no address nunber assigned yet
4. City or Township* Lockwood Folly
5. State * NC
6. Zip Code* 28422
7. Latitude* Enter the latitude in decinal degrees
33.9794
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-78.1935
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*
12/31/2020
Estirrated Construction Project Start Rate
10. Date to End *
12/30/2021
Estinated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be
64.00
disturbed*
(including off -site borrow and waste areas)

13. Total site area 75.01
(acres) *
14. Post- 24.56
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-BRUNS-2020-Bella Point
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 Mill Creek
Waterbody* Narreof waterbody into which storrrwater runoff will discharge
15b. Waterbody 15-25-1-18-(1)
Index No. * NCWaterbody Index Narrber
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project r Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B. ^
Fbrnittee Inforrration - Legally Fbsponsible Entity and Individual
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 Legally Pesponsible Entity
Name * J & S Land Development, LLC
IF pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * Steve
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Shuttleworth
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Managing Member
4. Permitee E-mail [e-mail]
Address*
5. Permittee 719-499-1373
Telephone No.*
6. Permittee Mailing Street Address
Address* 8630 River Road
Address Line 2
City
Wilmington
Fbstal / Zip Code
28412-3334
Check box if the V Yes
street address the
same as mailing
address
State / Frovince / Fbgion
NC
Country
us
7. Permittee Street
Street Address
Address*
8630 River Road
Address Line 2
city
State / Frovince / Faegion
Wilmington
NC
Fbstal / Zip Code
Country
28412-3334
us
8. Type of
Ojvnership is only individual if an individual is naned in B.1. above.
Ownership*
Non -Government

C. Site Contact Information
Part C.
Project Site Contact Inforrration
...........................................................................................................................................................................................................................................................................
1. Primary Site
Steve
Contact - First
Name *
2. Primary Site
Shuttleworth
Contact - Last
Name *
3. Title
Managing Member
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
719-499-1373
Telephone No.*
6. Organization
J & S Land Development, LLC
Name
7. Site Contact
Street Address
Mailing Address*
8630 River Road
Address Line 2
City
State / Province / Region
Wilmington
NC
Postal / Zip Code
Country
28412-3334
us
8. Consultant Name
(Optional)
Phil Norris
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
9102875900
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person a-rrail (older NOIs may not populate)
12. Billing
(For Annual Fee correspondence)
Telephone
719-499-1373
Default is legally responsible person telephone (older NOls rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 12/22/2020
Approved *
2. E&SC Plan Project BRUNS-2019-084
Number/ID * Assigned by agency or local program
3. E&SC Plan r State DEQ Office
Approved by* r Local Program
4. State DEQ Office * Wilmington (WiRO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can
include the beginning point and end point coordinates in the "Notes" box below).
5. E&SC Plan Approval BRUNS-2019-084 Revised 12-22-2020
Approval letter or 291.36KB
(J&S Land Dev.).pdf
Grading Permit
Mast be FL7Ffon-rat
6. Site Location Map Mist be RDFforrret (lint 201VB)
20090 usgs color.pdf 457.35KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Provide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
This project was previously permitted under Wilmington West
Properties, LLC.
The notice of termination for NCC190523 was submitted on 12-21-
2020
8. NOI Certification Notice of Intent (J&S Land Development) print for
Form 926.69KB
signature.pdf
Mast be R7Ffon-rat
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowingly makes anyfalse 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; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Artcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
Commission implementing this Artcle shall be guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
17 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.
* 17 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:* IT The Legally Responsible Person named on this Notice of Intent
f Authorized Responsible Person* (signing on behalf of Legally Responsible
Person named in Part B)
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
�il�c�e.Cff
Type Name * Steve Shuttleworth
Title Managing Member
Organization Legally Responsible Entity
J & S Land Development, LLC
Date * 12/29/2020

F. Tracking and COC Info
NOI Tracking No. 39836
NC Reference No. NCG01-2020-5981
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of NCC205981
Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5981
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC205981-2020
Invoice Due Date 1/28/2021
Initial Fee $ 100.00
Invoice Status OPEN