HomeMy WebLinkAboutNCC191360_NOI Application_20190815Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/13/2019 10:39:02 AM (NCG01 NOI Submission)
Approve by Georgoulias, Bethany 8/14/2019 5:38:45 PM (Review- Construction NOI 14778)
In Review note: Person who digitally signed and submitted this eNO1 is within same organization but not
the same person as the permittee listed; however, the NOI Certification form was signed by the permittee.
It is the applicant's responsibility to ensure authority was delegated as described in Part IV of the general
permit. Also verified with applicant that begin date entered, which was prior to E&SC Plan approval, is
accurate.
• The task was assigned to Georgoulias, Bethany by round robin distribution 8/13/2019 10:39 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 15, 2019 5:00
PM 8/13/2019 10:39 AM
Submit by McCoy, Suzanne 8/15/2019 10:38:36 AM (Payment Verification for NCC191360)
• McCoy, Suzanne assigned the task to McCoy, Suzanne 8/15/2019 10:38 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 28, 2019 5:00 PM
8/14/2019 5:38 PM
STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Stonewater Phase 4
2. County* Wake
3. Highway or Street 1420 Margrave Dr
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Wake Forest
5. State * NC
1r-i)iTII1T7G)MFalif_T1IIa10141
6. Zip Code* 25787
7. Latitude * Enter the latitude in decirral degrees
35.9292
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-78.5019
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*
02/28/2019
Estimated Construction Project Start Date
10. Date to End*
12/31 /2019
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
2.47
disturbed*
(including off -site borrow and waste areas)
13. Total site area 2.47
(acres)*
14. Post- 0.69
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-WAKE-2019-Stonewater Phase 4
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 Sanford Creek
Wate rbody* Nbrre of waterbody into which stormwater runoff will discharge
15b. Waterbody 27-23-5
Index No. * NCWaterbody Index Nimber
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
.....................................................................................................................................................................
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 Braswell Custom Homes Inc
Name *
2. First Name* Ron
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Braswell
Y Corporation, enter Registered Agent Last Barre
3b. Title President
4. Permitee E-mail matthew@braswellcustomhomesinc.com
Address*
5. Permittee 7702861013
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box40159
Address Line 2
City
Raleigh
Postal / Zip Code
27629
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
r Yes
Street Address
3908 Blackard Pond Road
Address Line 2
City
Raleigh
Fbstal / Zip Code
27604-9789
State / Province / Region
NC
Country
Wake
State / Province / Region
NC
Country
us
C. Site Contact Information
Part C.
Roiect Site Contact hforrration
1. Type of Non -Government
Ownership*
2. Primary Site Matthew
Contact - First
Name *
3. Primary Site Kerul
Contact - Last
Name *
4. Title
5. Site Contact E- matthew@braswellcustomhomesinc.com
mail Address*
6. Site Contact 7702861013
Telephone No.*
7. Organization
Braswell Custom Homes
Name
8. Site Contact
Street Address
Mailing Address*
P.O. Box40159
Address Line 2
city
Raleigh
Fbstal / Zip Code
27629
State / Rovince / Region
North Carolina
Country
United States
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran ADDroval Information
1. Date E&SC Plan 08/12/2019
Approved *
2. E&SC Plan Project Stonewater S/D Phase 4, Lots 63, 123, 132,
Number/ID* 134, 148, and 150
Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* Wake 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 SW Phase 4 SEC-022607-2019 Approval.pdf 276.65KB
Approval Mast be PCFfornat
letter/documentation
6. NOI Certification SW Phase 4 NOI Certification Form.pdf 230.07KB
Form Mast be RDFfornet
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.
* V 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.
* V 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
Type Name* Matthew Kerul
Title Project Assistant
Organization Braswell Custom Homes Inc
Date * 08/13/2019
F. Tracking and COC Info
NOI Tracking No. 14778
NC Reference No. NCG01-2019-1360
Uses 'count number variable (incremrented by SP)
Certificate of NCC191360
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 1360
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.)