HomeMy WebLinkAboutNCC191428_NOI Application_20190821Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/15/2019 1:32:54 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 8/16/2019 2:13:17 PM (Review- Construction NOI 14907)
• The task was assigned to Morman, Alaina by round robin distribution 8/15/2019 1:33 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 19, 2019 5:00
PM 8/15/2019 1:33 PM
Submit by McCoy, Suzanne 8/21/2019 10:00:56 AM (Payment Verification for NCC191428)
* Janine Lightner.
• McCoy, Suzanne assigned the task to McCoy, Suzanne 8/21/2019 10:00 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 30, 2019 5:00 PM
8/16/2019 2:13 PM
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NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Parkway Meadows Phase One - Lot 21
2. County* Moore
3. Highway or Street Vanderbuilt Court
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Sandhills
5. State * NC
6. Zip Code* 28315
7. Latitude * Enter the latitude in decirral degrees
35.1240
8. Longitude * Enter the longitude in decirral degrees (MJSTbe negative)
-79.4150
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*
08/14/2019
Estimated Construction Project Start Date
10. Date to End*
03/02/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
0.32
disturbed*
(including off -site borrow and waste areas)
13. Total site area 0.32
(acres)*
14. Post- 0.08
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-MOORE-2019-Parkway Meadows Phase One - Lot 21
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 Devil Gut Branch
Waterbody* Nome of waterbody into which stormwater runoff will discharge
15b. Waterbody 14-2-11-7
Index No. * NCWaterbody Index Nimber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Aberdeen Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 14-2-11-(6)
Index No. NCWaterbody Index Number
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbodyIndex Namber
Index No.
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.
Rerrrittee 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 Land Development, Inc.
Name *
2. First Name* Watson
ff Corporation, enter Registered Agent First l\brre
3. Last Name * Caviness
ff Corporation, enter Registered Agent Last Barre
3b. Title Manager/Owner
4. Permitee E-mail pj@cavinessland.com
Address*
5. Permittee 910-481-0503
Telephone No.*
6. Permittee Mailing Street Address
Address* 1041B Robeson Street
Address Line 2
City
Fayetteville
Rastal / Zip Code
28305
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
r Yes
Street Address
1041 B Robeson Street
Address Line 2
City
Fayetteville
Rastal / Zip Code
28305
State / Province / Region
NC
Country
us
State / Province / Region
NC
Country
us
C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Watson
Contact - First
Name *
3. Primary Site Caviness
Contact - Last
Name *
4. Title Owner/Manager
5. Site Contact E- mbowyer@lkanda.com
mail Address*
6. Site Contact 910-481-0503
Telephone No.*
7. Organization
Caviness Land Development, Inc.
Name
8. Site Contact
Street Address
Mailing Address*
1041b Robeson Street
Address Line 2
City
Fayetteville
Fbstal / Zip Code
28305
State / Province / Pegion
NC
Country
us
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 08/14/2019
Approved *
2. E&SC Plan Project Moore-2020-006
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 APPROVAL MOORE 2020 006 CAVLAND.pdf 71.47KB
Approval Mist be PCFfornat
letter/documentation
6. NOI Certification signed NOI.pdf 85.86KB
Form Mist be RDFfornat
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
W�.c% �` ,,. , ,W,
Type Name *
Watson Caviness
Title
Owner/Manager
Organization
Caviness Land Development, Inc.
Date *
08/15/2019
F. Tracking and COC Info
NOI Tracking No. 14907
NC Reference No. NCG01-2019-1428
Uses 'count number variable (incremrented by SP)
Certificate of NCC191428
Coverage (COC) Uses'count_nunber'variable (incremrented by SF)
No. *
Count Number 1428
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.)