NCC190025_NOI Application_20190408

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/8/2019 5:02:30 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 4/9/2019 2:58:59 PM (Review- Construction NOI 9974)
• The task was assigned to Morman, Alaina by round robin distribution 4/8/2019 5:02 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: April 10, 2019 5:00 PM
4/8/2019 5:02 PM
Submit by Morman, Alaina 4/9/2019 3:00:58 PM (Payment Verification - NCG01-2019-0025)
• The task was assigned to Morman, Alaina. The due date is: April 10, 2019 5:00 PM 4/9/2019 2:59 PM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Walden Single Family Phases 4
2. County* Mecklenburg
3. Highway or Street 14750 Fred Brown Road
Address * Street narra only is acceptable if no address nurrber assigned yet
4. City or Township* Huntersville
5. State * NC
!17-8)aIsT:2,11111711M1-11if_TiIa1010
6. Zip Code* 28078
7. Latitude * Enter the latitude in decirral degrees
35.4177
8. Longitude * Enter the longitude in decirral degrees (MUST be negative)
-80.8209
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) *
04/15/2019
Estirrated Construction Project Start Date
04/15/2020
Estirrated Construction Project End Date
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Developrrant
20.00
(including off -site borrow and waste areas)
30.30
5.79

NCC Project NCC-MECKL-2019-Walden Single Family Phases 4
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 North Prong Clarke Creek
Wate rbody* l\bre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 13-17-4-1
Index No. * NCWaterbody Index Ninber
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.
P rrrittee Information - Legally Fbsponsible Entity and Individual
.........................................................................................................................................................................
1. Organization TF Walden, LP
Name *
2. First Name* John
V Corporation, enter Fbgistered Agent First %rre
3. Last Name *
Brian
V Corporation, enter Registered Agent Last f brre
4. Permitee E-mail
[e-mail]
Address*
5. Permittee
9413880707
Telephone No.*
6. Permittee Mailing Street Address
Address* 6310 Capital Drive
Address Line 2
Suite 130
City
State / Province / Region
Lakewood Ranch
Florida
Fbstal / Zip Code
Country
34202
United States
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 6310 Capital Drive
Address Line 2
Suite 130
City
State / Province / Region
Lakewood Ranch
Florida
Postal / Zip Code
Country
34202
United States
h

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site John
Contact - First
Name *
3. Primary Site Brian
Contact - Last
Name *
4. Title
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 9413880707
Telephone No.*
7. Organization
Name
8. Site Contact Street Address
Mailing Address* 6310 Capital Drive
Address Line 2
Suite 130
City
Lakewood Ranch
Fbstal / Zip Code
34202
State / Rovince / Region
Florida
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 04/04/2019
Approved *
2. E&SC Plan Project 384587
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* Mecklenburg 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 PC05 approval doc #384587.pdf 69.73KB
Approval StormWaterPermit#384587.pdf 23.21KB
letter/documentation
Mist be RJF forrrat
6. NOI Certification NCG01-eNOI-Certification-Form-20190329-DEMLR-
Form 693.81 KB
SW_Signed.pdf
Mist be FDF format
This is an Express r No
Review Project* r 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'
"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
[1&r
Type Name* John Brian
Date * 04/08/2019

F. Tracking and COC Info
NOI Tracking No. 9974
NC Reference No. NCG01-2019-0025
Uses 'count_nunber variable (increrrented by SP)
Certificate of NCC190025
Coverage (COC) Uses 'count nunber variable (increrrented bySP)
No. *
Count Number 25
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.)