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HomeMy WebLinkAboutNCC192195_NOI Application_20191010Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 10/3/2019 1:53:01 PM (NCG01 NOI Submission) Approve by EADS\Ivgarcia 10/7/2019 8:29:26 AM (Review- Construction NOI 16699) • The task was assigned to EADS\Ivgarcia by round robin distribution 10/3/2019 1:53 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 7, 2019 5:00 PM 10/3/2019 1:53 PM Submit by McCoy, Suzanne 10/10/2019 12:37:53 PM (Payment Verification for NCC192195) * Phoenix Assc. at Brightwood LLC • McCoy, Suzanne assigned the task to McCoy, Suzanne 10/10/2019 12:37 PM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 18, 2019 5:00 PM 10/7/2019 8:29 AM STME NORTH CAROLINA Ernvlronmentol qualily A. Project Information Part A. Project Location and Waterbody Inforrration 1. Project Name * Brightwood Farms Phase 4A Sect. 2D, 3D & 4D 2. County* Guilford 3. Highway or Street 732 ZZ Breeders Cup Drive Address * Street name only is acceptable if no address nurrber assigned yet 4. City or Township* Sedalia 5. State * NC 1r-8)a�T7i1)Mfi1i(-_ToIa10141 6. Zip Code* 27048 7. Latitude * Enter the latitude in decirral degrees 36.0717 8. Longitude * Enter the longitude in decirral degrees (MIST be negative) -79.5906 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* 10/28/2019 Estimated Construction Project Start Date 10. Date to End* 10/30/2020 Estimated Construction Project End Date 11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521) Standard Industrial aassification for Development 12. Acres to be 27.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 27.50 (acres)* 14. Post- 5.00 construction (Estimated) impervious area (acres) * NCC Project NCC-GUILF-2019-Brightwood Farms Phase 4A Sect. 2D, 3D & 4D Tracking ID Assigned autonatically 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 Rock Creek Waterbody* Narre of Waterbody into which stornwater runoff will discharge 15b. Waterbody 16-19-3.5-(1) Index No. * NCWaterbody Index Nunber Stormwater fJ No discharges will flow r Yes to additional wate rs * 16a. Is this project F Yes subject to the NC r 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 Phoenix Associates at Brightwood, LLC Name * 2. First Name* Barry ff Corporation, enter Registered Agent First l\b e 3. Last Name * Siegal ff Corporation, enter Registered Agent Last Barre 3b. Title Member 4. Permitee E-mail bscholding@aol.com Address* 5. Permittee 336-587-3633 Telephone No.* 6. Permittee Mailing Street Address Address* PO Box 16168 Address Line 2 City High Point Postal / Zip Code 27261 Check box if the street address the same as mailing address 7. Permittee Street Address* r Yes Street Address 4425 Monument Trrace Address Line 2 City Greensboro R bstal / Zip Code 27409 State / Province / Region NC Country Guilford State / Province / Region NC Country Guilford C. Site Contact Information Part C. Proiect Site Contact Information 1. Type of Non -Government Ownership* 2. Primary Site Barry Contact - First Name * 3. Primary Site Siegal Contact - Last Name * 4. Title Member 5. Site Contact E- bscholding@aol.com mail Address* 6. Site Contact 336-587-3633 Telephone No.* 7. Organization Phoenix Associates at Brig htwood Name 8. Site Contact Street Address Mailing Address* Po Box 16168 Address Line 2 city High Point Pbstal / Zip Code 27261 9. Consultant Name (optional) Evans Engineering, Inc First and Last narre 10. Consultant E- adl@evans-eng.com mail This person will be copied on all correspondence. 11.Consultant 336-279-7450 Telephone No. State / Province / P egion NC Country Guilford D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Ran Approval Information ....................................................................................................................................................................................................................................... 1. Date E&SC Plan 10/01/2019 Approved * 2. E&SC Plan Project 19-07-GCRP-06206 Number/ID* Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by r Local Program 4. Local Program* Guilford County 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 Brightwood Farms Phase Approval 152.79KB 4A Section_2D_3D_4D_Approval Letter.pdf letter/documentation Mist be RDF fornat 6. NOI Certification Brightvmod Farms NOI Certification Form.pdf 751.38KB Form Mist be RDFfornat This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.6B (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. * V 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. * V 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. * I7 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 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* Barry Siegal Title Manager Organization Phoenix Associates, LLC Date * 10/03/2019 F. Tracking and COC Info NOI Tracking No. 16699 NC Reference No. NCG01-2019-2195 Uses 'count number variable (incremrented by SP) Certificate of NCC192195 Coverage (COC) Uses 'count _nunber'variable (increrrented bySP) No. * Count Number 2195 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.)