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HomeMy WebLinkAboutNCC213300_NOI Application_20210602Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 5/28/2021 11:36:39 AM (NCG01 NOI Submission) Approve by Clark, Paul B 6/1/2021 10:45:30 AM (Review- Construction NOI 54321) • The task was assigned to Clark, Paul B by round robin distribution 5/28/2021 11:37 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 1, 2021 5:00 PM 5/28/2021 11:37 AM Submit by Selkane, Aziza 6/2/2021 4:40:17 PM (Payment Verification for NCC213300) * Jennifer Trull • Selkane, Aziza assigned the task to Selkane, Aziza 6/2/2021 4:39 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 13, 2021 5:00 PM 6/1/2021 10:46 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting IT No an NOI that was r Yes rejected before? 1a. Project Name * Buck Acres Lots 13-17 1 b. Specific Lot This field any be used to list specifc lot numbers. Numbers 13 through 17 1 c. Parcel ID List all RW associated w ith this project. Number(s) (PIN) 05020015, 05020016, 05020017, 05020018, 05020019 2. County* Union 3. Highway or Street Old Highway Road Address* Street name only is acceptable if no address number assigned yet 4. Cityor Township* Waxhtaw 5. State * NC 6. Zip Code* 28173 7. Latitude* Enter the latitude in decimal degrees 34.8681 8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative) -80.6643 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* 05/28/2021 Estimated Construction Project Start Rate 10. Date to End* 07/31/2021 Estinated Construction Project End Cate 11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521) Standard Industrial Oassification for Development 12. Acres to be 4.81 disturbed* (including off -site borrow and waste areas) 13. Total site area 15.58 (acres) * 14. Post- 1.00 construction (Estinated) impervious area (acres) * NCC Project NCC-UNION-2021-Buck Acres Lots 13-17 Tracking ID Assignedautonatically 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 Waxhaw Creek Waterbody* %rreof waterbody into which stornwater runoff will discharge 15b. Waterbody 11-139 Index No. * NCWaterbody Index Nunber Stormwater F No discharges will flow 17 Yes to additional wate rs * 15c. Additional Cane Creek Receiving Waterbody narre Waterbody 15d. Waterbody 11-140-(1) Index No. NCWaterbody Index Nanber 15e. Additional Waterbody name Receiving Waterbody 15f. Waterbody NCWaterbody Index Nbrrber Index No. 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 Legally Pesponsible Entity Name * Pinnacle Homes USA It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. Note: The organization name must match the business entity name registered with the NC Secretary of State. You can verify the registration here. 2. First Name * Ben IF Corporation, enter Faegistered Agent First Wre 3. Last Name* Russell It Corporation, enter Pbegistered Agent Last %rre 3b. Title Member 4. Permitee E-mail ben@pinnaclehomesusa.net Address* 5. Permittee 7042913150 Telephone No.* 6. Permittee Mailing Street Address Address* 4839 Indian Trail Fairview Road Address Line 2 City Indian Trail Fbstal / Zip Code 28079 Check box if the street address the same as mailing address 7. Permittee Street Address* V Yes Street Address 4839 Indian Trail Fairview Road Address Line 2 City Indian Trail Fbstal / Zip Code 28079 State / Frovince / Pegion NC Country US State / Frovince / Faegion NC Country US 8. Type of Ojvnership is only individual if an individual is naned in B.1. above. Ownership* Non -Government C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Ben Contact - First Name * 2. Primary Site Russell Contact - Last Name * 3. Title Member 4. Site Contact E- ben@pinnaclehomesusa.net mail Address* 5. Site Contact 7042913150 Telephone No. 6. Organization Pinnacle Homes USA Name 7. Site Contact Street Address Mailing Address* 4839 Indian Trail Fairview Road Address Line 2 city Indian Trail Fbstal / Zip Code 28079 8. Consultant Name (Optional) Bryan Linton First and Last narre 9. Consultant E-mail bryan@plotthoundengineering.com This person will be copied on all correspondence. 10. Consultant 7044396521 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) ben@pinnaclehomesusa.net Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 7042913150 Default is legally responsible person telephone State / Rovince / Region NC Country US D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 05/18/2021 Approved * 2. E&SC Plan Project Union-2020-072 Number/ID * Assigned by agency or local program 3. E&SC Plan r State DEQ Office Approved by* r Local Program 4. State DEQ Office * Mooresville (MRO) Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can include the beginning point and end point coordinates in the "Notes" box below). 5. E&SC Plan NCDEQ Approval - Buck Acres Lots 13-17.pdf 986.71 KB Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Mist be RDFforrret (lint 20 NB) Buck Acres Location Map.pdf 255.92KB Rease do not upload entire set of E&SC plans. 7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies if necessary. 8. NOI Certification NOI Certification Form.pdf 796.66KB Form Wst be RDFforrral 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 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:* IT The Legally Responsible Person named on this Notice of Intent f Authorized Responsible Person* (signing on behalf of Legally Responsible Person named in Part B) 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 �rfr,�rrJJFf/ Type Name* Ben Russell Title Manager Organization Legally Plesponsible Entity Pinnacle Homes USA LLC Date * 05/28/2021 F. Tracking and COC Info NOI Tracking No. 54321 NC Reference No. NCG01-2021-3300 Uses 'count_nunber' variable (increrrented by SP) Certificate of NCC213300 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 3300 Sequential nunber for subnittal that is incremented by Stored Frocedure COC Year 2021 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC213300-2021 Invoice Due Date 7/1/2021 Initial Fee $ 100.00 Invoice Status OPEN