NCC190009_NOI Application_20190403

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/3/2019 3:36:28 PM (NCG01 NOI Submission)
Approve by Georgoulias, Bethany 4/4/2019 8:06:46 AM (Review- Construction NOI 9844)
• The task was assigned to Georgoulias, Bethany by round robin distribution 4/3/2019 3:36 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: April 5, 2019 5:00 PM
4/3/2019 3:36 PM
Submit by Georgoulias, Bethany 4/4/2019 8:07:15 AM (Payment Verification - NCG01-2019-0009)
• The task was assigned to Georgoulias, Bethany. The due date is: April 5, 2019 5:00 PM
4/4/2019 8:06 AM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Panther Landing
2. County* Currituck
3. Highway or Street Panther Landing Road
Address * Street narra only is acceptable if no address nurrber assigned yet
4. City or Township* Moyock
5. State * NC
1r-G)a�T:2,11111711MraIif_TiIa10141
6. Zip Code* 27958
7. Latitude * Enter the latitude in decirral degrees
36.5294
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-76.1538
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. Date to End*
11. SIC (Primary)*
12. Acres to be
disturbed *
13. Total site area
(acres)*
14. Post -
construction
impervious area
(acres) *
05/01 /2019
Estirrated Construction Project Start Date
05/01 /2022
Estirrated Construction Project End Date
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Developrrant
56.00
(including off -site borrow and waste areas)
66.33
8.84

NCC Project NCC-CURRI-2019-Panther Landing
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. You may
enter up to 3 waterbodies.
15a. Receiving Northwest River
Wate rbody* Wre of waterbody into which stornvwater runoff will discharge
15b. Waterbody 30-1-2-2
Index No. * NCWaterbody Index Nmber
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
.........................................................................................................................................................................
1. Organization Currituck Homes, Inc
Name *
2. First Name*
Jerry
ff Corporation, enter Registered Agent First l\brre
3. Last Name *
Old
V Corporation, enter Registered Agent Last f\brre
4. Permitee E-mail
[e-mail]
Address*
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 101 Oak Street
Address Line 2
City
State / Province / Region
Moyock
NC
Pbstal / Zip Code
Country
27958-9357
us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 101 Oak Street
Address Line 2
City
State / Province / Region
Moyock
NC
Postal / Zip Code
Country
27958-9357
us
h

C. Site Contact Information
Part C.
Project Site Contact Information
.............................................................................................
1. Type of
Non -Government
Ownership*
2. Primary Site
Jerry
Contact - First
Name *
3. Primary Site
Old
Contact - Last
Name *
4. Title
Agent, President
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
[phone]
Telephone No.*
7. Organization
Currituck Homes, Inc.
Name
8. Site Contact
Street Address
Mailing Address*
101 Oak Street
Address Line 2
City
State / Province / Region
Moyock
NC
Pbstal / Zip Code
Country
27958-9357
US
h

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 04/02/2019
Approved *
2. E&SC Plan Project Curri-2019-017
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 * Washington (WaRO)
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 Curri-2019-017 Panther landing - 04022019.pdf 1.15MB
Approval Mist be RCFformat
letter/documentation
6. NOI Certification Panther Landing notice of intent.pdf 366.75KB
Form Mist be R7Fformat
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*
*This form must be signed by a responsible corporate officer that 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 * Jerry L. Old
Date * 04/03/2019

F. Tracking and COC Info
NOI Tracking No. 9844
NC Reference No. NCG01-2019-0009
Uses 'count_nunber variable (increrrented by SP)
Certificate of NCC190009
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number
Sequential nunber for subrrittal that is increrrented by Stored Procedure
COC Year 2019
Year of date reviewed, used to assign YY digits after "NOC' in OOC no.)