NCC191782_NOI Application_20190910

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/9/2019 11:25:17 AM (NCG01 NOI Submission)
Approve by Farkas, Jim J 9/9/2019 2:51:14 PM (Review- Construction NOI 15700)
• The task was assigned to Farkas, Jim J by round robin distribution 9/9/2019 11:25 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 11, 2019 5:00
PM. The priority is: High 9/9/2019 11:25 AM
Submit by McCoy, Suzanne 9/10/2019 11:42:29 AM (Payment Verification for NCC191782)
* Avolis Engineering PA
• McCoy, Suzanne assigned the task to McCoy, Suzanne 9/10/2019 11:41 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 9, 2019 5:00 PM.
The priority is: High 9/9/2019 2:51 PM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * River Bluffs, Section X
2. County* Craven
3. Highway or Street NCSR1159
Address * Street narre only is acceptable if no address nurrber assigned yet
4. City or Township * New Bern
5. State * NC
1r-G)a�T7i)MfiIif_T1IIa10141
6. Zip Code* 28562
7. Latitude * Enter the latitude in decirral degrees
34.9996
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-76.9859
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*
10/01/2019
Estimated Construction Project Start Date
10. Date to End*
10/01 /2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Other
than SFE (1522)
Standard Industrial Gassification for Development
12. Acres to be
10.20
disturbed*
(including off -site borrow and waste areas)
13. Total site area
18.73
(acres)*
14. Post-
2.15
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-CRAVE-2019-River Bluffs, Section X
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 Brices Creek
Wate rbody* Nbrre of waterbody into which storawater runoff will discharge
15b. Waterbody 27-101-40-(1)
Index No.* NC Waterbody Index N nber
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 River Bluffs Limited Partnership
Name *
2. First Name* Stewart
ff Corporation, enter Registered Agent First l\brre
3. Last Name * Smith
ff Corporation, enter Registered Agent Last Barre
3b. Title Partner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 252-514-5198
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box25168
Address Line 2
City
State / Province / Region
Winston Salem
NC
Postal / Zip Code
Country
27144
us
Check box if the r% Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* PO Box25168
Address Line 2
City
State / Province / Region
Winston Salem
NC
Rastal / Zip Code
Country
27144
us

C. Site Contact Information
Part C.
Proiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Stewart
Contact - First
Name *
3. Primary Site Smith
Contact - Last
Name *
4. Title Partner
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 252-514-5198
Telephone No.*
7. Organization River Bluffs Limited Partnership
Name
8. Site Contact Street Address
Mailing Address* PO Box25168
Address Line 2
city
Winston Salem
Pbstal / Zip Code
27144
9. Consultant Name (optional)
Kevin Avolis, PE
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11.Consultant 252-633-0068
Telephone No.
State / Province / Region
NC
Country
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 09/04/2019
Approved *
2. E&SC Plan Project Crave-2020-006
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 Erosion Control Permit —River Bluffs, Section Xpdf 398.5KB
Approval Mist be RDFfornat
letter/documentation
6. NOI Certification NOI Certification Form River Bluffs, Section Xpdf 65.7KB
Form Mist be RDFfornat
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*
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
�F•rrr�rt�q �;��rrr`�
Type Name * Stewart Smith
Title Partner
Organization River Bluffs Limited Partnership
Date * 09/09/2019

F. Tracking and COC Info
NOI Tracking No. 15700
NC Reference No. NCG01-2019-1782
Uses 'count number variable (incremrented by SP)
Certificate of NCC191782
Coverage (COC) Uses'count_nunber'variable (incremrented by SF)
No. *
Count Number 1782
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.)