HomeMy WebLinkAboutNCC190316_NOI Application_20190517Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/17/2019 6:31:36 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 5/20/2019 8:01:25 AM (Review- Construction NOI 11147)
The task was assigned to Morman, Alaina by round robin distribution 5/17/2019 6:31 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 21, 2019 5:00 PM.
The priority is: High 5/17/2019 6:31 PM
Submit by Morman, Alaina 5/20/2019 8:01:59 AM (Payment Verification - NCG01-2019-0316)
The task was assigned to Morman, Alaina. The due date is: May 21, 2019 5:00 PM. The priority is:
High 5/20/2019 8:01 AM
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NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Froggy Meadows Subdivision
2. County* Currituck
3. Highway or Street Puddin Ridge Road
Address * Street name only is acceptable if no address number assigned yet
4. City or Township* Moyock
5. State * NC
6. Zip Code* 27958
7. Latitude * Enter the latitude in decimal degrees
36.5124
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-76.1837
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 *
07/01 /2019
Estimated Construction Project Start Date
10. Date to End*
11 /04/2019
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
25.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 47.95
(acres)*
14. Post- 8.50
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-CURRI-2019-Froggy Meadows Subdivision
Tracking ID Assigned automatically
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. You may
enter up to 3 waterbodies.
15a. Receiving Moyock Run
Wate rbody* l\bre of waterbody into which stormwater runoff will discharge
15b. Waterbody 30-1-2-2-1
Index No. * NCWaterbody Index Ninber
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.
P rrrittee 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 Landmark Custom Homes and Design, Inc.
Name *
2. First Name* Brad
ff Corporation, enter Registered Agent First kbrre
3. Last Name * Smith
ff Corporation, enter Registered Agent Last Barre
3b. Title Owner
4. Permitee E-mail bsmith@buildwithlandmark.com
Address*
5. Permittee 757-286-9990
Telephone No.*
6. Permittee Mailing Street Address
Address* 112 Bunch Road
Address Line 2
City State / Province / Region
Ayd Jett NC
Postal / Zip Code Country
27916 United States
Check box if the r% Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 112 Bunch Road
Address Line 2
City
State / Province / Region
Aydlett
NC
Pastal / Zip Code
Country
27916
United States
C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Brad
Contact - First
Name *
3. Primary Site Smith
Contact - Last
Name *
4. Title Owner
5. Site Contact E-
bsmith@buildwithlandmark.com
mail Address*
6. Site Contact
757-286-9990
Telephone No.*
7. Organization
Landmark Custom Homes and Design, Inc.
Name
8. Site Contact
Street Address
Mailing Address*
112 Bunch Road
Address Line 2
city
Aydlett
Fbstal / Zip Code
27916
State / Province / Region
NC
Country
us
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
............................................................................................................................................................
1. Date E&SC Plan 05/14/2019
Approved *
2. E&SC Plan Project Curri-2019-021
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 * Washington (WaRO)
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 Curri-2019-021 Froggy Meadows Subdivision
Approval 1.1 MB
(EXPRESS) - 05142019.pdf
letter/documentation
Mist be FCF format
6. NOI Certification P18077 - NCG01-eNOI-signed.pdf 137.13KB
Form Mist be RJFforrrat
This is an Express r No
Review Project* r Yes
h
E. Certification
North Carolina General Statute 143-215.613 (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.
* 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.
* I7 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 Responsible Person named on this Notice of Intent
r Authorized Responsible Person*
Important: The person who signs this Certification above and signs the NOI Certification Form should be the same
person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information)
of this form. *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 * Brad Smith
Title Owner
Organization Landmark Custom Homes and Design, Inc.
Date * 05/17/2019
F. Tracking and COC Info
NOI Tracking No. 11147
NC Reference No. NCG01-2019-0316
Uses 'count _nunber'variable (increrrented by SP)
Certificate of NCC190316
Coverage (COC) Uses'count_nunber'variable (incremented by SF)
No. *
Count Number 316
Sequential nunber for subrrittal that is increrrented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)