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HomeMy WebLinkAboutNCC214632_NOI Application_20210816Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 8/12/2021 12:03:19 PM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 8/16/2021 7:21:49 AM (Review- Construction NOI 62030) • The task was assigned to Broussard, Brooklyn C by round robin distribution 8/12/2021 12:04 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 16, 2021 5:00 PM 8/12/2021 12:04 PM Submit by Selkane, Aziza 8/16/2021 10:17:36 AM (Payment Verification for NCC214632) * John M Bell • Selkane, Aziza assigned the task to Selkane, Aziza 8/16/2021 10:17 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 27, 2021 5:00 PM 8/16/2021 7:22 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 * Westover Village - Residence Inn (2020-1842) 1 b. Specific Lot This field rray be used to list specifc lot nunbers. Numbers Lot 1B (P.B. 205, PG. 124) 1 c. Parcel ID List all RNs associated w ith this project. Number(s) (PIN) Parcel: 226984 PIN: 7855842495 2. County* Guilford 3. Highway or Street 2114 Enterprise Rd Address* Street name only is acceptable if no address number assigned yet 4.CityorTownship* Greensboro 5. State * NC 6. Zip Code* 27408 7. Latitude* Enter the latitude in decimal degrees 36.0952 8. Longitude * Enter the longitude in decirral degrees (MJST be negative) -79.8181 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* 10/01/2021 Estimated Construction Project Start Date 10. Date to End * 10/02/2023 Estinated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial aassification for Developrrent 12. Acres to be 1.88 d istu rbe d * (including off -site borrow and waste areas) 13. Total site area 1.55 (acres) * 14. Post- 1.33 construction (Estimated) impervious area (acres) * Project Tracking ID NCC-GUILF-2021-Westover Village - Residence Inn (2020-1842) Assigned automatically (not used) 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 North Buffalo Creek Waterbody* Narreof waterbody into which stormwater runoff will discharge 15b. Waterbody 16-11-14-1 Index No. * NCWaterbody Index Number 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. ^ Fl rnittee 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 * Battleground Hotel Partners, LLC 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 * John Michael If Corporation, enter Faegistered Agent First %rre 3. Last Name* Bell It Corporation, enter Pbegistered Agent Last %rre 3b. Title Manager 4. Permitee E-mail BellAtlanta@comcast.net Address* 5. Permittee (404) 683-0332 Telephone No.* 6. Permittee Mailing Street Address Address* 30081 Britt Address Line 2 City Chapel Hill Fbstal / Zip Code 27517-8495 Check box if the V Yes street address the same as mailing address State / Frovince / Fbgion NC Country us 7. Permittee Street Street Address Address* 30081 Britt Address Line 2 city State / Frovince / Faegion Chapel Hill NC Fbstal / Zip Code Country 27517-8495 us 8. Type of Ownership 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 John Michael Contact - First Name * 2. Primary Site Bell Contact - Last Name * 3. Title Manager 4. Site Contact E- BellAtlanta@comcast.net mail Address* 5. Site Contact (404) 683-0332 Telephone No.* 6. Organization Battleground Hotel Partners, LLC Name 7. Site Contact Street Address Mailing Address* 30081 Britt Address Line 2 city State / Rovince / Region Chapel Hill NC Fbstal / Zip Code Country 27517-8495 us 8. Consultant Name (Optional) CPT Engineering & Surveying, Inc. (Steven T. Webb, P.E.) First and Last nacre 9. Consultant E-mail stevew@cptengineering.com This person will be copied on all correspondence. 10. Consultant (336) 812-8800 ext. 310 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) BellAtlanta@comcast.net Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone (404) 683-0332 Default is legally responsible person telephone D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 08/12/2021 Approved * 2. E&SC Plan Project 2020-1842 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 Greensboro 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 Approval Letter (2020-1842).pdf 379.6KB Approval letter or Mast beRDFforml Grading Permit 6. Site Location Map Wst be RDFfornat (lint 20 NB) C-7 Erosion Control Plan —Revised 6-25-21.pdf 762.97KB Rease do not upload entire set of E&SC plans. 7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies if necessary. 8. NOI Certification NCG01-eNO1-Certification-Form-20210514-DEMLR- Form 984.12KB SW signed 8-11-21.pdf Mast be R7Ffon-rat 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 Atide; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Amide or rules of the Commission implementing this Atcle 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 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 Type Name* John Michael Bell Title Manager Organization Legally Ibsponsible Entity Battleground Hotel Partners, LLC Date * 08/12/2021 F. Tracking and COC Info NOI Tracking No. 62030 NC Reference No. NCG01-2021-4632 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC214632 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 4632 Sequential nurrber for subrrittal 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. NCC214632-2021 Invoice Due Date 9/15/2021 Initial Fee $ 100.00 Invoice Status OPEN