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HomeMy WebLinkAboutNCC215207_NOI Application_20210916Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 9/14/2021 4:46:36 PM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 9/15/2021 8:19:38 AM (Review- Construction NOI 64843) • The task was assigned to Broussard, Brooklyn C by round robin distribution 9/14/2021 4:47 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 16, 2021 5:00 PM. The priority is: High 9/14/2021 4:47 PM Submit by Miller, Ariyelle L 9/16/2021 11:20:52 AM (Payment Verification for NCC215207) * Amy Myers • Miller, Ariyelle L assigned the task to Miller, Ariyelle L 9/16/2021 11:20 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 27, 2021 5:00 PM. The priority is: High 9/15/2021 8:20 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 * At the Center (Vida 2) (Revision to CABAR-2017-074) 1 b. Specific Lot This field rray be used to list specifc lot numbers. Numbers 1 c. Parcel ID List all R% associated w ith this project. Number(s) (PIN) 56136924190000 2. County* Cabarrus 3. Highway or Street 200 S. Main St Address* Street name only is acceptable if no address number assigned yet 4. City or Township* Kannapolis 5. State * NC 6. Zip Code* 28081 7. Latitude* Enter the latitude in decimal degrees 35.4962 8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative) -80.6254 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* 09/20/2021 Estimated Construction Project Start Rate 10. Date to End* 12/31/2021 Estinated Construction Project End Cate 11. SIC (Primary)* Residential, Other than SFE (1522) Standard Industrial aassification for Development 12. Acres to be 3.58 disturbed* (including off -site borrow and waste areas) 13. Total site area 3.80 (acres) * 14. Post- 3.28 construction (Estimated) impervious area (acres) * Project Tracking ID NCC-CABAR-2021-At the Center (Vida 2) (Revision to CABAR- 2017-074) 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 Threemile Branch Waterbody* Name of waterbody into which stormwater runoff will discharge 15b. Waterbody 13-17-9-4-5 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. Fternittee 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 must 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. Permittee * Legally Pesponsible Entity Vida 2, LLC It pernittee is an individual, enter first and last narre in this field. Otherwise, enter organization/business narre. Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the registration here. 2. First Name * Peter IF Corporation, enter Faegistered Agent First Wre 3. Last Name* Flotz It Corporation, enter Pbegistered Agent Last %rre 3b. Title Managing Member 4. Permitee E-mail pflotz@lmgroup.us Address* 5. Permittee 3213022930 Telephone No.* 6. Permittee Mailing Street Address Address* 115 West Avenue Address Line 2 Cty Kannapolis Fbstal / Zip Code 28081-4332 Check box if the street address the same as mailing address 7. Permittee Street Address* F Yes Street Address 2420 East Sunrise Boulevard Address Line 2 city Fort Lauderdale Fbstal / Zip Code 33304 State / Frovince / Fbgion NC Country us State / Frovince / Faegion FL Country 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 Peter Contact - First Name * 2. Primary Site Flotz Contact - Last Name * 3. Title Managing Member 4. Site Contact E- pflotz@lmgroup.us mail Address* 5. Site Contact 3213022930 Telephone No. 6. Organization Vida 2, LLC Name 7. Site Contact Street Address Mailing Address* 115 West Avenue Address Line 2 City Kannapolis Fbstal / Zip Code 28081-4332 8. Consultant Name (Optional) Aaron Wagoner First and Last nacre 9. Consultant E-mail awagoner@landdesign.com This person will be copied on all correspondence. 10. Consultant 7043330325 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) pflotz@lmgroup.us Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 3213022930 Default is legally responsible person telephone State / Rovince / Region NC Country us D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 08/18/2021 Approved * 2. E&SC Plan Project CABAR-2017-074 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 * Mooresville (MRO) 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 At the Center (Vida 2) (CBAR-2017-074) approval w Approval letter or 317.4KB mods.pdf Grading Permit Mast be RDFforrrat 6. Signed FRO Financial Pesponsibility/Ojvnership Form Financial Responsiblity Form Executed.pdf 2.89MB Mast be RDFfornat 7. Site Location Map Mast be R7Fforrrat (lirrit 20IVB) SITE LOCATION MAP.pdf 963.27KB Rease do not upload entire set of E&SC plans. 8. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support the application. Include additional w aterbodies if necessary. 9. NOI Certification 20210914_NCGOI Notice of Intent (NOI) Certification Form 862.13KB Form.pdf Mast be FDFfornat 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:* IT 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 * Peter Flotz Title Managing Member Organization Legally Plesponsible Entity Vida 2, LLC Date * 09/14/2021 F. Tracking and COC Info NOI Tracking No. 64843 NC Reference No. NCG01-2021-5207 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC215207 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 5207 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. NCC215207-2021 Invoice Due Date 10/15/2021 Initial Fee $ 100.00 Invoice Status OPEN