HomeMy WebLinkAboutNCC191889_NOI Application_20190916Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/13/2019 2:47:33 PM (NCG01 NOI Submission)
Approve by Farkas, Jim J 9/13/2019 3:47:14 PM (Review - Construction NOI 15901)
• The task was assigned to Farkas, Jim J by round robin distribution 9/13/2019 2:47 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 17, 2019 5:00
PM 9/13/2019 2:47 PM
Submit by McCoy, Suzanne 9/16/2019 2:00:12 PM (Payment Verification for NCC191889)
* Robuck Design.
• McCoy, Suzanne assigned the task to McCoy, Suzanne 9/16/2019 1:59 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 25, 2019 5:00 PM
9/13/2019 3:47 PM
STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Avalaire Lots 89 & 90
2. County* Wake
3. Highway or Street 1401 Bailey Hill Drive
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Raleigh
5. State * NC
!r-G)a�T7i)ilf1Iif_T1IIa10141
6. Zip Code* 27609
7. Latitude * Enter the latitude in decirral degrees
35.9089
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-78.6279
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*
09/16/2019
Estimated Construction Project Start Date
10. Date to End*
09/15/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
3.20
disturbed*
(including off -site borrow and waste areas)
13. Total site area 3.54
(acres)*
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-WAKE-2019-Avalaire Lots 89 & 90
Tracking ID 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. Please
enter only immediate receiving waterbodies - not waters downstream of those unless the project extends there. You
may enter up to 3 waterbodies if needed.
15a. Receiving Honeycutt Creek
Waterbody* %ne of waterbody into which stornwater runoff will discharge
15b. Waterbody 27-20-(1)
Index No. * NCWaterbody Index N.arrber
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 Robuck Design Build
Name *
2. First Name* Gerri
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Herakovich
ff Corporation, enter Registered Agent Last Barre
3b. Title Manager
4. Permitee E-mail gerri@robuckdesignbuild.com
Address*
5. Permittee 919-422-2858
Telephone No.*
6. Permittee Mailing Street Address
Address* 6131 Falls of Neuse Road
Address Line 2
Suite 201
City
Raleigh
Rastal / Zip Code
27609
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
fJ Yes
Street Address
6131 Falls of Neuse Road
Address Line 2
Suite 201
City
Raleigh
Rastal / Zip Code
27609
State / Province / Region
NC
Country
USA
State / Province / Region
NC
Country
USA
C. Site Contact Information
Part C.
Proiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Gerri
Contact - First
Name *
3. Primary Site Herakovich
Contact - Last
Name *
4. Title Manager
5. Site Contact E- gerri@robuckdesignbuild.com
mail Address*
6. Site Contact 919-422-5828
Telephone No.*
7. Organization
Robuck Design Build
Name
8. Site Contact
Street Address
Mailing Address*
6131 Falls of Neuse Road
Address Line 2
City
Raleigh
Pbstal / Zip Code
27609
9. Consultant Name (optional)
Andrea Agee
First and Last name
10. Consultant E- aagee@thenauco.com
mail This person will be copied on all correspondence.
11.Consultant 703-785-9115
Telephone No.
State / Province / Pegion
NC
Country
United States
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 08/20/2019
Approved *
2. E&SC Plan Project SEC-021377-2019
Number/ID* 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 S_Conditional_Approval-
Approval 185.75KB
S&EConstructionPlan ReviewChecklist.pdf
letter/documentation
Mist be R7F forrrat
6. NOI Certification NCG01-eNOI-Certification-Form-Signed.pdf 269.64KB
Form Mist be RDFforrrat
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 electronically signs this Certification above must be the same person who signs the NOI
Certification Form. If that person is signing on behalf of the Permittee, that individual must be an authorized responsible
person within the same organization as the Permittee. *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* Gerri Herakovich
Title Manager
Organization Robuck Design Build
Date * 09/13/2019
F. Tracking and COC Info
NOI Tracking No. 15901
NC Reference No. NCG01-2019-1889
Uses 'count number variable (incremrented by SP)
Certificate of NCC191889
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 1889
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.)