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HomeMy WebLinkAboutNCC201179_NOI Application_20200420Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 3/20/2020 3:13:20 PM (NCG01 NOI Submission) Approve by Morman, Alaina 3/23/2020 12:06:22 PM (Review- Construction NOI 23343) . The task was assigned to Morman, Alaina by round robin distribution 3/20/2020 3:13 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 24, 2020 5:00 PM 3/20/2020 3:13 PM Submit by Garcia, Lauren V 4/20/2020 12:30:31 PM (Payment Verification for NCC201179) * J Park Builders, Inc • Garcia, Lauren V assigned the task to Garcia, Lauren V 4/20/2020 12:29 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 4, 2020 5:00 PM 3/23/2020 12:06 PM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting r No an NOI that was r Yes rejected before? Previous Rejected NOI No. Prior Reviewer Name 1a. Project Name* 125 Blackwater 1 b. Specific Lot This field rray be used to list specifc lot numbers. Numbers 2. County* Pitt 3. Highway or Street 125 Blackwater Address * Street narre only is acceptable if no address number assigned yet 4. City or Township* Winterville 5. State * NC 6. Zip Code * 28590 7. Latitude * Enter the latitude in decimal degrees 35.5460 8. Longitude* Enter the longitude in decimal degrees (M. ST be negative) -77.3820 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* 04/01/2020 Estimated Construction Project Start Date 10. Date to End* 09/30/2020 Estimated Construction Project End Date 11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521) Standard Industrial aassification for Developrrent 12. Acres to be 0.23 disturbed* (including off -site borrow and waste areas) 13. Total site area 0.23 (acres) * 14. Post- 0.23 construction (Estirrated) impervious area (acres) * NCC Project NCC-PITT-2020-125 Blackwater Tracking ID Assignedautorraticaly 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 Fork Swamp Wate rbody* %rre of waterbody into which stornwater runoff will discharge 15b. Waterbody 27-97-4 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. ^ Fbrnittee 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 Legally Pesponsible Entity Name * J Park Builders Inc It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. 2. First Name * Parker IF Corporation, enter Faegistered Agent First %rre 3. Last Name* Lamm It Corporation, enter F;bgistered Agent Last %ne 3b. Title Project Manager 4. Permitee E-mail plamm05@yahoo.com Address* 5. Permittee 2523154838 Telephone No.* 6. Permittee Mailing Street Address Address* 1509 Forest Hills Road Northwest Address Line 2 City State / Rovince / F;bgion Wilson NC Fbstal / Zip Code Country 27896-1552 us Check box if the V Yes street address the same as mailing address 7. Permittee Street Street Address Address* 1509 Forest Hills Road Northwest Address Line 2 City State / Frovince / Region Wilson NC Fbstal / Zip Code Country 27896-1552 us 8. Type of Individual Ownership* C. Site Contact Information Part C. FRoject Site Contact Information .............................................................................................................................................................................................................................................................................................................................................................................................. 1. Primary Site Parker Contact - First Name * 2. Primary Site Lamm Contact - Last Name * 3. Title 4. Site Contact E- plamm05@yahoo.com mail Address* 5. Site Contact 2523154838 Telephone No.* 6. Organization Name 7. Site Contact Street Address Mailing Address* 1509 Forest Hills Road Northwest Address Line 2 City Wilson Fbstal / Zip Code 27896-1552 8. Consultant Name (Optional) First and Last narre 9. Consultant E-mail This person will be copied on all correspondence. 10. Consultant Telephone No. State / Frovince / Pegion NC Country us D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information .......................................................................................................................................................................................................................................................................................................................__ 1. Date E&SC Plan 03/06/2020 Approved * 2. E&SC Plan Project ESCP-2020-0023 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 Greenville 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 or include the beginning point and end point coordinates in the "Notes" box below. 5. E&SC Plan 125 Blackwater Drive Approval.pdf 209.8KB Approval letter or Mist beRDFformat Grading Permit 6. Site Location Map Helpful for linear project review (Optional) Mast be FCFfornat. Rease do not upload entire set of E&SCplans. 7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies for linear projects if necessary. 8. NOI Certification NCG01 Certification Form.pdf 380.34KB Form Mist be RDFfornat This is an Express r 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 Atide 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* Parker Lamm Title Project Manager Organization Legally Iesponsible Entity J Park Builders Inc Date * 03/20/2020 F. Tracking and COC Info NOI Tracking No. 23343 NC Reference No. NCG01-2020-1179 Uses 'count number' variable (incremrented by SP) Certificate of NCC201179 Coverage (COC) Uses 'count number' variable (incremented by SP) No.* Count Number 1179 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.)