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HomeMy WebLinkAboutNCC200219_NOI Application_20200117Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 1/16/2020 3:16:19 PM (NCG01 NOI Submission) Approve by Morman, Alaina 1/17/2020 10:03:36 AM (Review- Construction NOI 20790) • The task was assigned to Morman, Alaina by round robin distribution 1/16/2020 3:17 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 20, 2020 5:00 PM 1/16/2020 3:17 PM Submit by McCoy, Suzanne 1/17/2020 2:21:46 PM (Payment Verification for NCC200219) * Michael Gribble • McCoy, Suzanne assigned the task to McCoy, Suzanne 1/17/2020 2:21 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 28, 2020 5:00 PM 1/17/2020 10:03 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information 1. Project Name * Smith King Property 2. County* Mecklenburg 3. Highway or Street 14624 Lancaster Hy Address * Street narre only is acceptable if no address number assigned yet 4. City or Township* Pineville 5. State * NC 6. Zip Code * 28134 7. Latitude * Enter the latitude in decimal degrees 35.0466 8. Longitude* Enter the longitude in decimal degrees (M. ST be negative) -80.8672 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* 01/27/2020 Estimated Construction Project Start Cate 10. Date to End* 01/31/2022 Estimated Construction Project End Cute 11. SIC (Primary) * Residential, Other than SFE (1522) Standard Industrial Classification for Ceveloprrent 12. Acres to be 13.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 11.60 (acres) * 14. Post- 6.00 construction (Estimated) impervious area (acres) * NCC Project NCC-MECKL-2020-Smith King Property 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. 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 McAlpine Creek (Waverly Lake) Wate rbody* %rre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 11-137-9 Index No.* NCWaterbody Index Number Stormwater rJ 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 NR Lancaster Property Owner LP Name * 2. First Name* Michael If Corporation, enter Pegistered Agent First Barre 3. Last Name* Gribble If Corporation, enter Faegistered Agent Last %rre 3b. Title Vice President 4. Permitee E-mail mgribble@nwravin.com Address * 5. Permittee 704-714-9681 Telephone No.* 6. Permittee Mailing Street Address Address* 558 East Stonewall Street Address Line 2 Suite 120 Qty Charlotte Fbstal / Zip Code 28202 Check box if the street address the same as mailing address 7. Permittee Street Address* V Yes Street Address 558 East Stonewall Street Address Line 2 Suite 120 Cty Charlotte Fbstal / Zip Code 28202 State / Ftovince / Region 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 Michael Contact - First Name * 3. Primary Site Gribble Contact - Last Name * 4. Title Developer 5. Site Contact E- mgribble@nwravin.com mail Address* 6. Site Contact 704-714-9681 Telephone No.* 7. Organization Northwood Ravin Name 8. Site Contact Street Address Mailing Address* 585 East Stonewall Street Address Line 2 City Charlotte Fbstal / Zip Code 28202 9. Consultant Name (Optional) Marc Van Dine First and Last narre 10. Consultant E- vandine@mcadamsco.com mail This person will be copied on all correspondence. 11.Consultant 980-221-0089 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 01/15/2020 Approved * 2. E&SC Plan Project 394500 Number/ID * Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* Mecklenburg 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 PCO5_approval_doc_#394500.pdf 65.06KB Approval Wst be RDFfornal letter/documentation 6. NOI Certification Smith King - NOI Certification Form 2020-01-16.pdf 75.71 KB Form Mist be R7Ffornat This is an Express F No Review Project* r Yes 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* Michael Gribble Title Vice President Organization NR Lancaster Property Owner LP Date * 01 /16/2020 F. Tracking and COC Info NOI Tracking No. 20790 NC Reference No. NCG01-2020-0219 Uses 'count number' variable (incremrented by SP) Certificate of NCC200219 Coverage (COC) Uses 'count number' variable (incremented by SP) No.* Count Number 219 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.)