HomeMy WebLinkAboutNCC192083_NOI Application_20190927 Action History (UTC-05:00) Eastern Time(US&Canada)
Submit by Anonymous User 9/25/2019 1:44:39 PM(NCG01 NOI Submission)
Approve by Lucas,Annette 9/26/2019 3:47:56 PM(Review-Construction NOI 16284)
• The task was assigned to Lucas,Annette by round robin distribution 9/25/2019 1:45 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: September 27,2019 5:00
PM 9/25/2019 1:45 PM
Submit by McCoy,Suzanne 9/27/2019 7:31:14 AM(Payment Verification for NCC192083)
* Cameron Village Apts
• McCoy, Suzanne assigned the task to McCoy,Suzanne 9/27/2019 7:30 AM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is: November 7,2019 5:00
PM 9/26/2019 3:48 PM
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NORTH CAROLINA
Environmental QUII
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name* Cameron Village Apartments
2. County* Wake
3. Highway or Street 2018 Smallwood Drive
Address* Street narra only is acceptable if no address nurrber assigned yet
4. City or Township* Raleigh
5. State* INC
6.Zip Code* 27605
7. Latitude* Enter the latitude in decirral degrees
35.7925
8. Longitude* Enter the longitude in decirral degrees(WISTbe negative)
-78.6598
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* 09/25/2019
Estimated Construction Project Start Date
10. Date to End* 09/25/2022
Estimated Construction Project End Date
11. SIC(Primary)* Residential, Other
than SIFE(1522)
Standard Industrial Gassification for Developrrent
12.Acres to be 1.60
disturbed* (including off-site borrow and waste areas)
13.Total site area 2.50
(acres)*
14. Post- 1.34
construction (Estimated)
impervious area
(acres)*
NCC Project NCC-WAKE-2019-Cameron Village Apartments
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 Pigeon House Branch
Wate rbody* Nbrre of waterbody into which stormuater runoff will discharge
15b.Waterbody 27-33-18
Index No.* NC Waterbody Index Narrber
Stormwater No
discharges will flow r Yes
to additional
wate rs*
16a.Is this project r 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 Cameron Village Apartments, LLC
Name*
2. First Name* Phil
ff Corporation,enter Registered Agent First l\b e
3. Last Name* York
ff Corporation,enter Registered Agent Last Barre
3b.Title Manager
4. Permitee E-mail psyork@mindspring.com
Address*
5. Permittee 9198327623
Telephone No.*
6. Permittee Mailing Street Address
Address* 2016 Cameron Street
Address Line 2
Suite 214
City State/Province/Region
Raleigh NC
Rastal/Zip Code Country
27605 USA
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 2016 Cameron Street
Address Line 2
Suite 214
City State/Province/Region
Raleigh NC
Rastal/Zip Code Country
27605 USA
C. Site Contact Information
Part C.
Project Site Contact Information
....................................................................................................................
1.Type of Non-Government
Ownership*
2. Primary Site Phil
Contact-First
Name*
3.Primary Site York
Contact-Last
Name*
4.Title Manager
5.Site Contact E- psyork@mindspring.com
mail Address*
6.Site Contact 9198327623
Telephone No.*
7.Organization Cameron Village Apartments, LLC
Name
8.Site Contact Street Address
Mailing Address* 2016 Cameron Street
Address Line 2
Suite 214
City State/Province/Fbgion
Raleigh NC
F bstal/Zip Code Country
27605 USA
9.Consultant Name (optional)
Johnny Edwards
First and Last narre
10.Consultant E- johnny@jaeco.com
mail This person will be copied on all correspondence.
11. Consultant 9198284428
Telephone No.
D. E&SC Plan
Part D.
Erosion&Sediment Control(E&SC)Ran Approval Information
............................................................................................................................................................................. ..................................................................................................
1. Date E&SC Plan 07/30/2019
Approved*
2. E&SC Plan Project 582559-484635-LD-116642
Number/ID* Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by r Local Program
4. Local Program* City of Raleigh
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 Cameron Village-Signed Grading Permit.pdf 31.55KB
Approval Mist be RDFfornat
letter/documentation
6. NOI Certification Cameron Village-eNO1 Certification Form.pdf 785.68KB
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 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
L' rVxw t.
Type Name* Phil York
Title Manager
Organization Cameron Village Apartments, LLC
Date* 09/25/2019
F. Tracking and COC Info
NOI Tracking No. 16284
NC Reference No. NCG01-2019-2083
Uses'count number variable(incremented by SP)
Certificate of NCC192083
Coverage (COC) Uses'count_nunber'variable(increrrented bySP)
No.*
Count Number 2083
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.)