Loading...
HomeMy WebLinkAboutNCC214717_NOI Application_20210820Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 8/17/2021 1:15:19 PM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 8/18/2021 7:23:44 AM (Review- Construction NOI 62327) • The task was assigned to Broussard, Brooklyn C by round robin distribution 8/17/2021 1:16 PM • The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 19, 2021 5:00 PM. The priority is: High 8/17/2021 1:16 PM Submit by Miller, Ariyelle L 8/20/2021 3:43:41 PM (Payment Verification for NCC214717) * Two Dots LLC • Miller, Ariyelle L assigned the task to Miller, Ariyelle L 8/20/2021 3:42 PM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 29, 2021 5:00 PM. The priority is: High 8/18/2021 7:24 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 * Two Dots Storage 1 b. Specific Lot This field may be used to list specifc lot numbers. Numbers 4-R 1 c. Parcel ID List all Rim associated w ith this project. Number(s) (PIN) 857000705573 2. County* Moore 3. Highway or Street 205 PARKWAY DR. Address* Street name only is acceptable if no address number assigned yet 4.CityorTownship* ABERDEEN 5. State * NC 6. Zip Code* 28315 7. Latitude* Enter the latitude in decimal degrees 35.1249 8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative) -79.4090 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* 09/30/2021 Estirrated Construction Project Start Late 10. Date to End * 03/30/2022 Estinated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial aassification for Development 12. Acres to be 4.14 disturbed* (including off -site borrow and waste areas) 13. Total site area 4.14 (acres) * 14. Post- 61,251.00 construction (Estimated) impervious area (acres) * Project Tracking ID NCC-MOORE-2021-Two Dots Storage 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 ABERDEEN CREEK Waterbody* Narreof waterbody into which stormwater runoff will discharge 15b. Waterbody 14-2-11-(6) Index No. * NCWaterbody Index Number Stormwater V No discharges will flow r Yes to additional wate rs * 16a. Is this project subject to the NC Sediment Pollution Control Act?* 16b. Is this project subject to the US Clean Water Act? r Yes r No, not subject to NC SPCA r Yes r No, not subject to US CWA 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 * TWO DOTS 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 * LEASA If Corporation, enter Faegistered Agent First %rre 3. Last Name* HASELDEN It Corporation, enter Pbegistered Agent Last %rre 3b. Title Manager 4. Permitee E-mail Leasahaselden@gmail.com Address* 5. Permittee 770-315-3053 Telephone No.* 6. Permittee Mailing Street Address Address* P.O. BOX3123 Address Line 2 City State / Frovince / Fbgion Pinehurst NC Fbstal / Zip Code Country 28374 MOORE Check box if the F Yes street address the same as mailing address 7. Permittee Street Street Address Address* 325 LINDEN RD. Address Line 2 City State / Frovince / Faegion PINEHURST NC Fbstal / Zip Code Country 28374 MOORE 8. Type of ONnership is only individual if an individual is naned in B.1. above. Ownership* Individual C. Site Contact Information Part C. Roject Site Contact Inforrration ........................................................................................................................................................................................................................................... 1. Primary Site JOHN Contact - First Name * 2. Primary Site HARVEL Contact - Last Name * 3. Title CONTRACTOR 4. Site Contact E- JHHARVEL@GMAIL.COM mail Address* 5. Site Contact 910-315-2222 Telephone No. 6. Organization US 1 REALTY Name 7. Site Contact Street Address Mailing Address* 1930 N Poplar St # 1 Address Line 2 City State / Rovince / Region SOUTHERN PINES NC Fbstal / Zip Code Country 28387 MOORE 8. Consultant Name (Optional) SEVEN LAKES ENGINEERING SERVICES INC, LLC. First and Last narre 9. Consultant E-mail 7LAKESENGRG@GMAIL.COM This person will be copied on all correspondence. 10. Consultant 910-638-0965 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) Leasahaselden@gmail.com Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 770-315-3053 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 08/02/2021 Approved * 2. E&SC Plan Project MOORE-2022-005 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 * Fayetteville (FRO) 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 moo re-2022-005exa p. pdf 773.45KB Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Mist be RDFforrret (lint 20 NB) TS 1.pdf 4.12MB 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 NCG01 Certification Form Two Dots, LLC.pdf 475.84KB Form Wst be RDF formal This is an Express f 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:* r The Legally Responsible Person named on this Notice of Intent r 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 * LEASA HASELDEN Title MANAGER Organization Legally Plesponsible Entity TWO DOTS LLC. Date * 08/17/2021 F. Tracking and COC Info NOI Tracking No. 62327 NC Reference No. NCG25-2021-4717 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC214717 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 4717 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. NCC214717-2021 Invoice Due Date 9/17/2021 Initial Fee $ 100.00 Invoice Status OPEN