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HomeMy WebLinkAboutNCC200135_NOI Application_20200114Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 1/8/2020 2:11:54 PM (NCG01 NOI Submission) Approve by Farkas, Jim J 1/10/2020 3:28:56 PM (Review- Construction NOI 20347) • The task was assigned to Farkas, Jim J by round robin distribution 1/8/2020 2:12 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 10, 2020 5:00 PM 1/8/2020 2:12 PM Submit by McCoy, Suzanne 1/14/2020 7:18:27 AM (Payment Verification for NCC200135) * Poythress Const. co. • McCoy, Suzanne assigned the task to McCoy, Suzanne 1/14/2020 7:18 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 21, 2020 5:00 PM 1/10/2020 3:29 PM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information 1. Project Name * Seaforth Landing Lot 3A 2. County* Chatham 3. Highway or Street 2182 Seaforth Rd Address * Street narre only is acceptable if no address number assigned yet 4. City or Township* Pittsboro 5. State * NC 6. Zip Code * 27312 7. Latitude * Enter the latitude in decimal degrees 35.7160 8. Longitude* Enter the longitude in decir al degrees (M. ST be negative) -79.0680 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* 01/08/2020 Estimated Construction Project Start Cate 10. Date to End* 07/31/2020 Estimated Construction Project End Cute 11. SIC (Primary) * Residential, Single Family Houses (SFE) (1521) Standard Industrial aassification for Developrrent 12. Acres to be 0.80 disturbed* (including off -site borrow and waste areas) 13. Total site area 1.98 (acres) * 14. Post- 0.12 construction (Estimated) impervious area (acres)* NCC Project NCC-CHATH-2020-Seaforth Landing Lot 3A Tracking ID Assignedautorratically 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 B Everett Jordan Lake - New Hope River Wate rbody* Narre of waterbody into which stornwater runoff will discharge 15b. Waterbody 16-41-(3.5) Index No. * NC Waterbody Index Minter Stormwater V 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. ^ F2rnittee Inforrration - Legally Fbsponsible 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 Poythress Construction Company, Inc. Name * 2. First Name* Kevin IF Corporation, enter Pegistered Agent First Barre 3. Last Name* Poythress IF Corporation, enter Faegistered Agent Last %rre 3b. Title President 4. Permitee E-mail kevin@pccbuilder.com Address * 5. Permittee 9194221655 Telephone No.* 6. Permittee Mailing Street Address Address* 1011 Classic Road Address Line 2 city Apex Fbstal / Zip Code 27539-4402 Check box if the street address the same as mailing address 7. Permittee Street Address* V Yes Street Address 1011 Classic Road Address Line 2 City Apex Fbstal / Zip Code 27539-4402 State / Frovince / Faegion NC Country us State / Frovince / Fbgion NC Country us C. Site Contact Information Part C. Roject Site Contact Inforrration _............................................................................................................................................._ 1. Type of Non -Government Ownership * 2. Primary Site Kevin Contact - First Name * 3. Primary Site Poythress Contact - Last Name * 4. Title President 5. Site Contact E- kevin@pccbuilder.com mail Address* 6. Site Contact 9194221655 Telephone No.* 7. Organization Poythress Construction Company, Inc Name 8. Site Contact Street Address Mailing Address* 1011 Classic Road Address Line 2 City Apex Fbstal / Zip Code 27539-4402 9. Consultant Name (Optional) First and Last narre 10. Consultant E- This person will be copied on all correspondence. mail 11. Consultant Telephone No. State / Rovince / Fbgion NC Country US D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 01/08/2020 Approved * 2. E&SC Plan Project 2019-09877 Number/ID * Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* Chatham 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 Letter of Approval.pdf Approval Wst be RDFfornat letter/documentation 6. NOI Certification NOICertificationForm-3ASL-1.8.2020.pdf Form Mist be R7Ffornat This is an Express F No Review Project* r Yes 84.28KB 361.28KB E. Certification North Carolina General Statute 143-215.66 (1) provides that: Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other document filed or required to be maintained under this Article or a rule implementing this Atide; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Amide or rules of the Commission implementing this Atcle shall be guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). Under penalty of law, I certify that: 17 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. * 17 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. * 17 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 f 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* Kevin Poythress Title President Organization Poythress Construction Company, Inc. Date * 01 /08/2020 F. Tracking and COC Info NOI Tracking No. 20347 NC Reference No. NCG01-2020-0135 Uses 'count number' variable (incremrented by SP) Certificate of NCC200135 Coverage (COC) Uses 'count number' variable (incremented by SP) No.* Count Number 135 Sequential number for submittal that is incremented by Stored Frocedure COC Year 2020 Year of date reviewed (used to assign YY digits after "NOC' in COCno.)