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HomeMy WebLinkAboutNCC205282_NOI Application_20201208Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 11/17/2020 9:02:20 AM (NCG01 NOI Submission) Approve by Garcia, Lauren V 11/17/2020 4:00:25 PM (Review- Construction NOI 36347) • The task was assigned to Garcia, Lauren V by round robin distribution 11/17/2020 9:02 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 19, 2020 5:00 PM. The priority is: High 11/17/2020 9:02 AM Submit by McCoy, Suzanne 12/8/2020 2:38:30 PM (Payment Verification for NCC205282) * Wynnefield Properties inc • McCoy, Suzanne assigned the task to McCoy, Suzanne 12/8/2020 2:37 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 29, 2020 5:00 PM. The priority is: High 11/17/2020 4:01 PM .• 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 * Aspen Point 1 b. Specific Lot This field nay be used to list specifc lot nunbers. Numbers 2. County* Forsyth 3. Highway or Street Stavvord Place Cir. Address* Street narre only is acceptable if no address number assigned yet 4. City or Township* Winston Salem 5. State * NC 6. Zip Code * 27127 7. Latitude* Enter the latitude in decinal degrees 36.0290 8. Longitude* Enter the longitude in decir al degrees (M.JST be negative) -80.2658 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* 11/20/2020 Estinated Construction Project Start Date 10. Date to End* 12/31/2021 Estirrated Construction Project End Date 11. SIC (Primary)* Residential, Other than SFE (1522) Standard Industrial aassification for Developrrent 12. Acres to be 6.72 disturbed* (including off -site borrow and waste areas) 13. Total site area 11.00 (acres) * 14. Post- 2.42 construction (Estirrated) impervious area (acres) * NCC Project NCC-FORSY-2020-Aspen Point Tracking ID Assigned autorratically 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 Sides Branch Waterbody* %rm of waterbody into which stornwater runoff will discharge 15b. Waterbody 12-94-13-6 Index No.* NCWaterbody Index Nunber Stormwater V 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. ^ 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 * Wynnefield Construction, 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 * Craig IF Corporation, enter Faegistered Agent First Wre 3. Last Name* Stone It Corporation, enter Pbegistered Agent Last %rre 3b. Title Member 4. Permitee E-mail matt.raab@wynnefieldproperties.com Address* 5. Permittee 336-880-3300 Telephone No.* 6. Permittee Mailing Street Address Address* PO Box395 Address Line 2 City State / Rovince / Fbgion Jamestown NC Fbstal / Zip Code Country 27282 United States Check box if the F Yes street address the same as mailing address 7. Permittee Street Street Address Address* 5614 Riverdale Dr. Address Line 2 City State / Frovince / Region Jamestown NC Fbstal / Zip Code Country 27282 United States 8. Type of Non -Government Ownership C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Matt Contact - First Name * 2. Primary Site Raab Contact - Last Name * 3. Title Construction Manager 4. Site Contact E- matt.raab@wynnefieldproperties.com mail Address* 5. Site Contact 3368803300 Telephone No. 6. Organization Wynnefield Properties Name 7. Site Contact Street Address Mailing Address* PO Box395 Address Line 2 Street Address 2 city Jamestown Fbstal / Zip Code 27282 8. Consultant Name (Optional) First and Last narre 9. Consultant E-mail This person will be copied on all correspondence. 10. Consultant Telephone No. State / Rovince / Region NC Country United States D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 10/30/2020 Approved * 2. E&SC Plan Project EN2000142 Number/ID * Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* Winston-Salem/Forsyth County Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a complete application. For linear projects, please also upload a site map showing the overall extent of the project or include the beginning point and end point coordinates in the "Notes" box below. 5. E&SC Plan Aspen Pointe - WS EC Approval.pdf 432.75KB Approval letter or Mast beRDFformal Grading Permit 6. Site Location Map Mist be RDFforrrat (lint 20 NB) Aspen - Site Map.pdf 995.95KB 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 documents support the application. Include additional waterbodies for linear projects if necessary. 8. NOI Certification Aspen Pointe - NCG01 Certification. pdf 551.7KB Form Wst be RDFforrrat 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 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 Atide 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 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 c. c C-5'mw Type Name* C. Craig Stone Title Member Organization Legally Iesponsible Entity Wynnefield Construction Date * 11 /17/2020 F. Tracking and COC Info NOI Tracking No. 36347 NC Reference No. NCG01-2020-5282 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC205282 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 5282 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2020 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC205282-2020 Invoice Due Date 12/17/2020 Initial Fee $ 100.00 Invoice Status OPEN