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HomeMy WebLinkAboutNCC200686_NOI Application_20200220Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 2/19/2020 4:13:29 PM (NCG01 NOI Submission) Approve by McCoy, Suzanne 2/20/2020 7:11:39 AM (Review- Construction NOI 22154) • The task was assigned to McCoy, Suzanne by round robin distribution 2/19/2020 4:14 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: February 21, 2020 5:00 PM 2/19/2020 4:14 PM Submit by McCoy, Suzanne 2/20/2020 12:02:16 PM (Payment Verification for NCC200686) * Ryan Smith • McCoy, Suzanne assigned the task to McCoy, Suzanne 2/20/2020 12:01 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 2, 2020 5:00 PM 2/20/2020 7:11 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information 1. Project Name * Krystle & Willie Baldwin Lot Grading (#404951) 2. County* Mecklenburg 3. Highway or Street 2618 Fox Hollow Rd Address * Street narre only is acceptable if no address number assigned yet 4. City or Township* Charlotte 5. State * NC 6. Zip Code * 28227 7. Latitude * Enter the latitude in decimal degrees 35.1620 8. Longitude* Enter the longitude in decimal degrees (M. ST be negative) -80.6440 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* 02/21/2020 Estimated Construction Project Start Date 10. Date to End* 10/30/2020 Estimated Construction Project End Cute 11. SIC (Primary) * Residential, Single Family Houses (SFE) (1521) Standard Industrial aassification for Developrrent 12. Acres to be 0.46 disturbed* (including off -site borrow and waste areas) 13. Total site area 0.68 (acres) * 14. Post- 0.12 construction (Estimated) impervious area (acres)* NCC Project NCC-MECKL-2020-Krystle & Willie Baldwin Lot Grading (#404951) Tracking ID Assignedautonatically 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 Goose Creek Wate rbody* Nacre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 13-17-18 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 Fa sponsible 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 Kryslte Baldwin Name * 2. First Name* Krystle If Corporation, enter Pegistered Agent First Barre 3. Last Name* Baldwin If Corporation, enter Faegistered Agent Last %rre 3b. Title Homeowner 4. Permitee E-mail balduvin.krystle@gmail.com Address * 5. Permittee 704-746-3084 Telephone No.* 6. Permittee Mailing Street Address Address* 341 Alcove Rd Address Line 2 341 Alcove Road city State / Frovince / Faegion Mooresville NC Fbstal / Zip Code Country 28117 United States Check box if the rJ Yes street address the same as mailing address 7. Permittee Street Street Address Address* 341 Alcove Rd Address Line 2 341 Alcove Road City State / Frovince / Fbgion Mooresville NC Fbstal / Zip Code Country 28117 United States 8. Type of Non -Government Ownership* C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Stan Contact - First Name * 2. Primary Site Hale Contact - Last Name * 3. Title Building Superintendent 4. Site Contact E- shale@schumacherhomes.com mail Address* 5. Site Contact 980-582-3894 Telephone No. 6. Organization Schumacher Homes of NC Inc Name 7. Site Contact Street Address Mailing Address* 341 Alcove Road Address Line 2 city Mooresville Fbstal / Zip Code 28117 8. Consultant Name (Optional) Becky Siemieniec First and Last narre 9. Consultant E-mail bsiemieniec@schumacherhomes.com This person will be copied on all correspondence. 10. Consultant 704-746-3084 Telephone No. State / Rovince / Region North Carolina Country United States D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 02/14/2020 Approved * 2. E&SC Plan Project 404951 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. For linear projects, please also upload a site map showing the overall extent of the project. 5. E&SC Plan EC Doc -Approved Itr #404951.pdf 67.38KB Approval Wst be FDFfornat letter/documentation Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support the application. 6. NOI Certification NOI.pdf 89.12KB Form Mast be RDFformat 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 Article; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Artcle; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the Commission implementing this Artcle 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 I�LY-S /�A-Lt1;! Type Name* Krystle Baldwin Title Homeowner Organization Krystle Baldwin Date * 02/19/2020 F. Tracking and COC Info NOI Tracking No. 22154 NC Reference No. NCG01-2020-0686 Uses 'count number' variable (incremrented by SP) Certificate of NCC200686 Coverage (COC) Uses 'count number' variable (incremented by SP) No.* Count Number 686 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.)