HomeMy WebLinkAboutNCC190959_NOI Application_20190715 Action History (UTC-05:00) Eastern Time(US&Canada)
Submit by Anonymous User 7/15/2019 3:42:03 PM(NCG01 NOI Submission)
Approve by McCoy, Suzanne 7/16/2019 8:05:12 AM(Review-Construction NOI 13474)
• The task was assigned to McCoy, Suzanne by round robin distribution 7/15/2019 3:42 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:July 17,2019 5:00 PM
7/15/2019 3:42 PM
Submit by McCoy, Suzanne 7/16/2019 8:06:07 AM(Payment Verification-NCG01-2019-0959)
• The task was assigned to McCoy, Suzanne.The due date is:July 17,2019 5:00 PM
7/16/2019 8:05 AM
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NORTH CAROLINA
Ernvlronmental QUII
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name* Summerfield Ridge
2. County* Guilford
3. Highway or Street 7720-7748 Carson Path
Address* Street narra only is acceptable if no address nurrber assigned yet
4. City or Township* Summerfield
5. State* NC
6.Zip Code* 27358
7. Latitude* Enter the latitude in decirral degrees
36.2028
8. Longitude* Enter the longitude in decirral degrees(WISTbe negative)
-79.9555
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* 07/25/2019
Estimated Construction Project Start Date
10. Date to End* 08/31/2022
Estimated Construction Project End Date
11. SIC(Primary)* Residential, Single
Family Houses(SFE)
(1521)
Standard Industrial aassification for Developrrant
12.Acres to be 11.33
disturbed* (including off-site borrow and waste areas)
13.Total site area 28.14
(acres)*
14. Post- 6.50
construction (Estimated)
impervious area
(acres)*
NCC Project NCC-GUILF-2019-Summerfield Ridge
Tracking ID Assignedautoratically
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 Reedy Fork
Wate rbody* Nbrre of waterbody into which stornvwater runoff will discharge
15b.Waterbody 16-11-1
Index No.* NCWaterbody Index NJunber
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.
Perrrittee Information-Legally Responsible 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 Windsor Investments, LLC
Name*
2. First Name* David
ff Corporation,enter Registered Agent First l\b e
3. Last Name* Michaels
ff Corporation,enter Registered Agent Last Barre
3b.Title Company Agent
4. Permitee E-mail DMichaels@windsorinvestments.com
Address*
5. Permittee 336-207-8003
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box9147
Address Line 2
City State/Province/Region
GREENSBORO North Carolina
Postal/Zip Code Country
27429 USA
Check box if the r Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 5603 New Garden Village Drive
Address Line 2
City State/Province/Region
Greensboro NC
Pastal/Zip Code Country
27401 USA
C. Site Contact Information
Part C.
Project Site Contact Information
.............................................................................................
1.Type of Non-Government
Ownership*
2. Primary Site David
Contact-First
Name*
3. Primary Site Michaels
Contact-Last
Name*
4.Title Company Agent
5. Site Contact E- DMichaels@Wndsorinvestments.com
mail Address*
6. Site Contact 336-207-8003
Telephone No.*
7.Organization Windsor Investments, LLC
Name
8. Site Contact Street Address
Mailing Address* PO Box 9147
Address Line 2
City State/Province/Region
Greensboro NC
Fbstal/Zip Code Country
27429 USA
D. E&SC Plan
Part D.
Erosion&Sediment Control(E&SC)Ran Approval Information
....................................................................................................................................................................................................................................... .............................................................................................
1. Date E&SC Plan 07/05/2019
Approved*
2. E&SC Plan Project 19-05-SURP-04464
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* Guilford 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 SummerfieldRidgeLots_UPDATEDLetter_Approval
Approval Letter(002).pdf 92.87KB
letter/documentation
Mist be R7F forrrat
6. NOI Certification Summerfield Ridge NCG01 Certification.pdf 692.56KB
Form Mist be RDFfornat
This is an Express r No
Review Project* r Yes
E. Certification
North Carolina General Statute 143-215.6B(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 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.
* I7 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
017Z'��71 6 wa-J11
Type Name* David B. Michaels
Title Company Agent
Organization Windsor Investments, LLC
Date* 07/15/2019
F. Tracking and COC Info
NOI Tracking No. 13474
NC Reference No. NCG01-2019-0959
Uses'count number variable(incremented by SP)
Certificate of NCC190959
Coverage (COC) Uses'count_nunber'variable(increrrented bySP)
No.*
Count Number 959
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.)