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HomeMy WebLinkAboutNCC193336_NOI Application_20191231 Action History (UTC-05:00)Eastern Time(US&Canada) Subrrit by Anonymous User 12/27/2019 10:28:03 AM(NCG01 NOI Submission) Approve by Clark, Paul 12/30/2019 11:54:14 AM(Review-Construction NOI 19947) • The task was assigned to Clark, Paul by round robin distribution 12/27/2019 10:28 AM • The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: December 31,2019 5:00 PM 12/27/2019 10:28 AM Submit by McCoy, Suzanne 12/31/2019 7:33:41 AM(Payment Verification for NCC193336) * John Lehotsky • McCoy,Suzanne assigned the task to McCoy, Suzanne 12/31/2019 7:33 AM • The task was assigned to DEMLR NCG01 Payment Team.The due date is: February 10, 2020 5:00 PM 12/30/2019 11:54 AM �ThF1 1Construction Stormwater: Notice of Intent (NOI) National Pollutant Discharge Elimination System 'D application for•• - .•-under NorthCarolina's General Permit 1 1111:STORIVWATER DISCHARGES associated with construction activities(or NORTH CAROLINA Enrlrnnmenfu�Qr�arlry A. Project Information Part A. Project Location and Waterbody Information 1. Project Name* Mossy Ridge MHP 2.County* Jackson 3. Highway or Street Mossy Ridge Road Address* Street nacre only is acceptable if no address number assigned yet 4. City or Township* Cullowhee 5.State* NC 6.Zip Code* 28723 7. Latitude* Enter the latitude in decimal degrees 35.1880 8. Longitude* Enter the longitude in decimal degrees(MJSTbe negative) -83.1770 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* 12/31/2019 Estinated Construction Project Start Date 10. Date to End* 12/31/2020 Estimated Construction Project End Cute 11.SIC(Primary)* Residential, Single Family Houses(SFE) (1521) Standard Industrial aassification for Development 12.Acres to be 2.60 disturbed* (including off-site borrow and waste areas) 13.Total site area 6.20 (acres)* 14. Post- 1.60 construction (Estimated) impervious area (acres)* NCC Project NCC-JACKS-2019-Mossy Ridge MHP 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 Thorpe Lake Wate rbody* N n-e of waterbody into which storrrwater runoff w ill discharge 15b.Waterbody 2-79-23-(1) Index No.* NCWaterbody Index N nber 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 West Rock Investments LLC Name* 2. First Name* John ff Corporation,enter Pegistered Agent First Barre 3. Last Name* Lehotsky ff Corporation,enter Faegistered Agent Last%rre 3b.Title member 4. Permitee E-mail office@lehotskyandsons.com Address* 5. Permittee 8287435864 Telephone No.* 6. Permittee Mailing Street Address Address* PO BOx3291 Address Line 2 city State/Frovince/Faegion Cashiers nc Fbstal/Zip Code Country 28717 USA Check box if the r Yes street address the same as mailing address 7. Permittee Street Street Address Address* 87 Chestnut Square Address Line 2 City State/Frovince/Fbgion Cashiers NC Fbstal/Zip Code Country 28717 US C. Site Contact Information Part C. ^ Roject Site Contact Inforrration ....................................................................................................................................................................................................................................................................................................................................................................................... 1.Type of Individual Ownership* 2. Primary Site John Contact-First Name* 3. Primary Site Lehotsky Contact-Last Name* 4.Title member 5.Site Contact E- office@lehotskyandsons.com mail Address* 6.Site Contact 8287435864 Telephone No.* 7.Organization West Rock Investments LLC Name 8.Site Contact Street Address Mailing Address* PO Box3291 Address Line 2 City State/Rovince/Region Cashiers nc Fbstal/Zip Code Country 28717 usa 9. Consultant Name (Optional) First and Last narre 10. Consultant E- This person will be copied on all correspondence. mail 11. Consultant Telephone No. D. E&SC Plan Part D. ^ Erosion&Sediment Control(E&SC)Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 12/19/2019 Approved* 2. E&SC Plan Project 19-118 Number/ID* Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* Jackson 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 Mossy Ridge MHP 19-118 12.19.19.pdf 118.74KB Approval Wst be RDFforrrat letter/documentation 6. NOI Certification Mossy Ridge MHP 19-118 EC Permit 12.19.19.pdf 97.11KB Form Mist be R7Fforrrat This is an Express F No Review Project* r Yes E. Certification North Carolina General Statute 143-215.66(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 knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case underthis 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 guiltyofa Class 2 misdemeanor which mayinclude 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 [0///ar,�"114r,J.-1 Type Name* John Lehotsky Title member Organization West Rock Investments LLC Date* 12/27/2019 F. Tracking and COC Info NOI Tracking No. 19947 NC Reference No. NCG01-2019-3336 Uses'count_nurrber'variable(increrrented by SP) Certificate of NCC193336 Coverage (COC) Uses'count number'variable(increrrented by SP) No.* Count Number 3336 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2019 Year of date reviewed(used to assign YY digits after"NOC'in COCno.)