HomeMy WebLinkAboutNCC190648_NOI Application_20190618Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/18/2019 11:49:33 AM (NCG01 NOI Submission)
Approve by Morman, Alaina 6/19/2019 8:56:51 AM (Review- Construction NOI 12465)
• The task was assigned to Morman, Alaina by round robin distribution 6/18/2019 11:49 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 20, 2019 5:00 PM
6/18/2019 11:49 AM
Submit by Morman, Alaina 6/19/2019 8:58:00 AM (Payment Verification - NCG01-2019-0648)
• The task was assigned to Morman, Alaina. The due date is: June 20, 2019 5:00 PM
6/19/2019 8:56 AM
STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Roslin Farms West -Section 4, Part 2 (Lots 33 & 39)
2. County* Cumberland
3. Highway or Street Gadson Drive
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township * Rockfish Township
5. State * NC
1 r-i) iTiT 70) M 1i1 f_T1II a 1010
6. Zip Code* 28348
7. Latitude * Enter the latitude in decirral degrees
34.9057
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-78.9390
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*
06/06/2019
Estimated Construction Project Start Date
10. Date to End*
06/30/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
0.91
disturbed*
(including off -site borrow and waste areas)
13. Total site area 1.10
(acres)*
14. Post- 0.12
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-CUMBE-2019-Roslin Farms West -Section 4, Part 2 (Lots 33 &
Tracking ID 39)
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. You may
enter up to 3 waterbodies.
15a. Receiving Cold Camp Creek
Wate rbody* Narre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 14-22-1-1
Index No. * NC Waterbody Index Ninber
Stormwater PF 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 Caviness and Cates Building and Development Co.
Name *
2. First Name* Christopher
ff Corporation, enter Registered Agent First l\brre
3. Last Name * Cates
ff Corporation, enter Registered Agent Last Barre
3b. Title Vice President
4. Permitee E-mail pam@cavinessandcates.com
Address*
5. Permittee (910) 778-7902
Telephone No.*
6. Permittee Mailing Street Address
Address* 639 Executive Place, Suite 400
Address Line 2
City State / Province / Region
Fayetteville NC
Pastal / Zip Code Country
28305 us
Check box if the r% Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 639 Executive Place, Suite 400
Address Line 2
City
State / Province / Region
Fayetteville
NC
Pastal / Zip Code
Country
28305
us
C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Pamela
Contact - First
Name *
3. Primary Site Geddie
Contact - Last
Name *
4. Title Start Coordinator
5. Site Contact E- pam@cavinessandcates.com
mail Address*
6. Site Contact (910) 778-7902
Telephone No.*
7. Organization
Caviness and Cates Building and
Name
Development Co.
8. Site Contact
Street Address
Mailing Address*
639 Executive Place, Suite 400
Address Line 2
aty
Fayetteville
Fbstal / Zip Code
28305
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 06/06/2019
Approved *
2. E&SC Plan Project CUMBE-2019-162
Number/ID* Assigned by agency or local program
3. E&SC Plan f• State DEQ Office
Approved by r Local Program
4. State DEQ Office * Fayetteville (FRO)
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 CUMBE-2019-162-Approval.pdf 88.47KB
Approval Mist be RCFformat
letter/documentation
6. NOI Certification RF33 & 39 NOI.pdf 1.66MB
Form Mist be RDF format
This is an Express f• No
Review Project* r Yes
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 * Christopher E. Cates
Title Vice President
Organization Caviness & Cates Building and Development
Date * 06/18/2019
F. Tracking and COC Info
NOI Tracking No. 12465
NC Reference No. NCG01-2019-0648
Uses 'count number variable (incremrented by SP)
Certificate of NCC190648
Coverage (COC) Uses'count_nunber'variable (incremrented by SF)
No. *
Count Number 648
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.)