NCC213373_NOI Application_20210604

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/2/2021 10:08:28 AM (NCG01 NOI Submission)
Approve by Meloy, Michael K 6/3/2021 8:00:32 AM (Review- Construction NOI 54575)
• The task was assigned to Meloy, Michael K by round robin distribution 6/2/2021 10:09 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 4, 2021 5:00 PM
6/2/2021 10:09 AM
Submit by Selkane, Aziza 6/4/2021 8:35:58 AM (Payment Verification for NCC213373)
* Leigh W Thompson
• Selkane, Aziza assigned the task to Selkane, Aziza 6/4/2021 8:35 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 15, 2021 5:00 PM
6/3/2021 8:00 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was r Yes
rejected before?
Previous Rejected 54561
NOI No.
Prior Reviewer Lauren Garcia
Name
1a. Project Name * Cottages at Glen Eagles Phase 2 Lots 26-37
1 b. Specific Lot
This field may be used to list specifc lot numbers.
Numbers
26-37
1 c. Parcel ID
List all RW associated w ith this project.
Number(s) (PIN)
1517-04-8246.000
1517-04-8109.000
1517-04-7059.000
1517-03-6976.000
1517-03-5859.000
1517-03-4939.000
1517-04-3055.000
1517-04-5189.000
1517-04-4244.000
1517-04-4460.000
1517-04-5483.000
1517-04-6383.000
2. County*
Harnett
3. Highway or Street Crescent Drive
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Dunn
5. State * NC
6. Zip Code* 28334
7. Latitude* Enter the latitude in decimal degrees
35.3272

8. Longitude * Enter the longitude in decimal degrees (MJST be negative)
-78.6301
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*
06/01/2021
Estirrated Construction Roject Start Rate
10. Date to End *
06/01 /2023
Estimated Construction Roject End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Development
12. Acres to be
5.20
disturbed*
(including off -site borrow and waste areas)
13. Total site area 8.14
(acres) *
14. Post- 2.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-HARNE-2021-Cottages at Glen Eagles Phase 2 Lots 26-37
Tracking ID Assignedautoratically
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 River
Wate rbody* %rre of waterbody into which stormwater runoff will discharge
15b. Waterbody 18-68-12-1
Index No.* NCWaterbody Index Number
Stormwater rJ 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. ^
F2rnittee 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 * RP Wellons Land and Development, LLC
It 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 * Robert
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Wellons
It Corporation, enter F;bgistered Agent Last %rre
3b. Title President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-892-3123
Telephone No.*
6. Permittee Mailing Street Address
Address* 2004 West Cumberland Street
Address Line 2
P.O. Box 730
City
Dunn
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
Fbstal / Zip Code
28334-4448
V Yes
Street Address
2004 West Cumberland Street
Address Line 2
P.O. Box 730
city
Dunn
Fbstal / Zip Code
28334-4448
State / Ffovince / i egion
NC
Country
us
State / Frovince / Region
NC
Country
us
8. Type of Ownership is only individual if an individual is naned in B.1. above.
Ownership* Non -Government

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
.........................................................................................................................................................................................................
1. Primary Site
Robert
Contact - First
Name *
2. Primary Site
Wellons
Contact - Last
Name *
3. Title
President
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-892-3123
Telephone No.
6. Organization
RP Wellons Land and Development, LLC
Name
7. Site Contact
Street Address
Mailing Address*
2004 West Cumberland Street
Address Line 2
PO Box 730
city
Dunn
Fbstal / Zip Code
28334-4448
8. Consultant Name
(Optional)
Fleet Temple
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
919-894-7765
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
I\Mhompson@v,iellonsrealty.com
Default is legally responsible person e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
910-892-3123
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 05/26/2021
Approved *
2. E&SC Plan Project HARNE-2021-120
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 * Fayetteville (FRO)
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 harne-2021-120-lots erosion.pdf 87.56KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFforrret (lint 20 NB)
vici n ity. pdf 8.29KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification NCG01-eNO1-Certification-Form-20210514-DEMLR-
Form 512.29KB
SW SIGNED.pdf
Mast be FDFformat
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
Type Name * Robert P. Wellons
Title President
Organization Legally Pesponsible Entity
RP Wellons Land and Development, LLC
Date * 06/02/2021

F. Tracking and COC Info
NOI Tracking No. 54575
NC Reference No.
NCG01-2021-3373
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC213373
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3373
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC213373-2021
Invoice Due Date 7/3/2021
Initial Fee $ 100.00
Invoice Status OPEN