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HomeMy WebLinkAboutNCC193087_NOI Application_20191210Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 12/3/2019 5:54:25 PM (NCG01 NOI Submission) Approve by Clark, Paul 12/6/2019 10:46:48 AM (Review- Construction NOI 19086) • Morman, Alaina reassigned the task to Clark, Paul 12/6/2019 8:59 AM * Just resending because / accidentally sent them to Suzanne. • Morman, Alaina reassigned the task to McCoy, Suzanne 12/6/2019 8:57 AM * These were Jim's reviews that are being reassigned per Annette's directions. • Morman, Alaina reassigned the task to Clark, Paul 12/6/2019 8:56 AM * These were Jim's reviews that are being reassigned per Annette's directions. • The task was assigned to Farkas, Jim J by round robin distribution 12/3/2019 5:54 PM • The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 5, 2019 5:00 PM 12/3/2019 5:54 PM Submit by McCoy, Suzanne 12/10/2019 1:44:04 PM (Payment Verification for NCC193087) * Herman Colon Johnson • McCoy, Suzanne assigned the task to McCoy, Suzanne 12/10/2019 1:43 PM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 17, 2020 5:00 PM 12/6/2019 10:46 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information 1. Project Name * Long Meadows 2. County* Alamance 3. Highway or Street Hallie Long Lane Address * Street narre only is acceptable if no address number assigned yet 4. City or Township* Burlington 5. State * NC 6. Zip Code * 27217 7. Latitude * Enter the latitude in decimal degrees 36.1167 8. Longitude* Enter the longitude in decir al degrees (M. ST be negative) -79.4200 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* 06/04/2019 Estinated Construction Project Start Date 10. Date to End* 06/04/2021 Estimated Construction Project End Cute 11. SIC (Primary) * Residential, Single Family Houses (SFE) (1521) Standard Industrial aassification for Developrrent 12. Acres to be 2.20 disturbed* (including off -site borrow and waste areas) 13. Total site area 16.42 (acres) * 14. Post- 3.90 construction (Estimated) impervious area (acres)* NCC Project NCC-ALAMA-2019-Long Meadows 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. 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 Staley Creek Waterbody* %rre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 16-15-1 Index No. * NC Waterbody Index N n ber Stormwater V 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 Herman Colon Johnson Irrevocable Trust of December 2012 Name * 2. First Name* Patty IF Corporation, enter Fbgistered Agent First Barre 3. Last Name * Wilson If Corporation, enter Faegistered Agent Last %rre 3b. Title Trustee 4. Permitee E-mail pattyjvalson92@yahoo.com Address * 5. Permittee 336-226-1684 Telephone No.* 6. Permittee Mailing Street Address Address* 818 East Hanover Road Address Line 2 city Graham Fbstal / Zip Code 27253-1922 Check box if the street address the same as mailing address 7. Permittee Street Address* V Yes Street Address 818 East Hanover Road Address Line 2 City Graham Fbstal / Zip Code 27253-1922 State / F rovince / Faegion NC Country us State / Frovince / Fbgion NC Country us C. Site Contact Information Part C. ^ Roject Site Contact Inforrration ....................................................................................................................................................................................................................................................................................................................................................................................... 1. Type of Individual Ownership * 2. Primary Site Patty Contact - First Name * 3. Primary Site Wilson Contact - Last Name * 4. Title Trustee 5. Site Contact E- pattyjwilson92@yahoo.com mail Address* 6. Site Contact 336-226-1684 Telephone No.* 7. Organization Herman Colon Johnson Irrevocable Trust of Name December 2012 8. Site Contact Street Address Mailing Address* 818 East Hanover Road Address Line 2 City State / Rovince / Fbgion Graham NC Fbstal / Zip Code Country 27253-1922 us 9. Consultant Name (Optional) Chad Huffine First and Last narre 10. Consultant E- chuffine08@gmail.com mail This person will be copied on all correspondence. 11. Consultant 336-227-8724 Telephone No. D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 06/04/2019 Approved * 2. E&SC Plan Project Permit No. 625 Number/ID * Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* City of Burlington 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 2019-06-04 Long Meadows —EC Approval Memo and Approval 1 AMB Permit.pdf letter/documentation Mist be FDFforrrat 6. NOI Certification 2019-12-03 Long Meadows_ eNO1 Certification Form 663.73KB Form NCDEMLR_SIGNED.pdf Mist be RDFfornat 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 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. * 17 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 f Authorized Responsible Person* 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 ��' C.'i�iAwFcar %{.r/ fsv, trrv�c'e7v Type Name * Patty Johnson Wilson Title Trustee Organization Herman Colon Johnson Irrevocable Trust of December 2012 Date * 12/03/2019 F. Tracking and COC Info NOI Tracking No. 19086 NC Reference No. NCG01-2019-3087 Uses 'count number' variable (incremrented by SP) Certificate of NCC193087 Coverage (COC) Uses 'count number' variable (incremented by SP) No.* Count Number 3087 Sequential number for submittal that is incremented by Stored Frocedure COC Year 2019 Year of date reviewed (used to assign YY digits after "NOC' in COCno.)