NCC190352_NOI Application_20190522

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/22/2019 1:11:54 PM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 5/22/2019 1:22:49 PM (Review- Construction NOI 11286)
• The task was assigned to McCoy, Suzanne by round robin distribution 5/22/2019 1:12 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 24, 2019 5:00 PM
5/22/2019 1:12 PM
Submit by McCoy, Suzanne 5/22/2019 1:23:29 PM (Payment Verification - NCG01-2019-0352)
• The task was assigned to McCoy, Suzanne. The due date is: May 23, 2019 5:00 PM
5/22/2019 1:22 PM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * The Palisades at Wake Forest
2. County* Wake
3. Highway or Street 0 Forbes Road
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Wake Forest
5. State * NC
117-8) TiT M'G) M 111 f_T1II a 10141
6. Zip Code* 27587
7. Latitude * Enter the latitude in decirral degrees
35.9500
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-78.5200
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*
05/22/2019
Estimated Construction Project Start Date
10. Date to End*
05/22/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Other
than SFE (1522)
Standard Industrial Gassification for Development
12. Acres to be
15.20
disturbed*
(including off -site borrow and waste areas)
13. Total site area
19.42
(acres)*
14. Post-
7.37
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-WAKE-2019-The Palisades at Wake Forest
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 Richaland Creek
Wate rbody* Nbrre of waterbody into which storawater runoff will discharge
15b. Waterbody 27-21-(1.5)
Index No.* NC Waterbody Index Narrber
Stormwater rJ No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project r Yes
subject to the NC f 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 Triangle Real Estate
Name *
2. First Name* William
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Ratchford
ff Corporation, enter Registered Agent Last Barre
3b. Title VP
4. Permitee E-mail [e-mail]
Address*
5. Permittee 7046983930
Telephone No.*
6. Permittee Mailing Street Address
Address* [e-mail]
Address Line 2
City State / Province / Region
Gastonia NC
Postal / Zip Code Country
28053 United States
Check box if the r% Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* [e-mail]
Address Line 2
City State / Province / Region
Gastonia NC
Rastal / Zip Code Country
28053 United States

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site William
Contact - First
Name *
3. Primary Site Ratchford
Contact - Last
Name *
4. Title VP
5. Site Contact E-
[e-mail]
mail Address*
6. Site Contact
7046983930
Telephone No.*
7. Organization
Triangle Real Estate
Name
8. Site Contact
Street Address
Mailing Address*
165 S York St
Address Line 2
city
Gastonia
Fbstal / Zip Code
28053
State / Province / Region
NC
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 05/10/2019
Approved *
2. E&SC Plan Project SP-18-12
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* Town of Wake Forest
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
Wake Forest -Land Distrubing Permit.pdf
278.38KB
Approval
07A-Erosion Control Plan A -Phase 1.pdf
1.17MB
letter/documentation
0713-Erosion Control Plan A -Phase 2.pdf
1.3MB
09-Erosion Control Plan A -Phase 3.pdf
1.52MB
10-Erosion Control Plan B-Phase 3.pdf
1.64MB
0813-Erosion Control Plan B-Phase 2.pdf
1.42MB
08A-Erosion Control Plan B-Phase 1.pdf
1.31 MB
Mast be RCF format
6. NOI Certification
Wake Forest-NOI Certification Form.pdf-1.pdf
371.46KB
Form
lutist be ROFformat
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 signs this Certification above and signs the NOI Certification Form should be the same
person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information)
of this form. *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
%��llrz�rr�trat.�
Type Name* William Ratchford
Title VP
Organization Triangle Real Estate
Date * 05/22/2019

F. Tracking and COC Info
NOI Tracking No. 11286
NC Reference No. NCG01-2019-0352
Uses 'count number variable (incremrented by SP)
Certificate of NCC190352
Coverage (COC) Uses 'count nunber variable (increrrentedbySP)
No. *
Count Number 352
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)