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HomeMy WebLinkAboutNCC204857_NOI Application_20201029Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 10/27/2020 9:47:45 AM (NCG01 NOI Submission) Approve by Clark, Paul 10/27/2020 3:42:21 PM (Review- Construction NOI 34276) • The task was assigned to Clark, Paul by round robin distribution 10/27/2020 9:47 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 29, 2020 5:00 PM. The priority is: High 10/27/2020 9:47 AM Submit by Selkane, Aziza 10/29/2020 11:21:22 AM (Payment Verification for NCC204857) * Christopher J Sprenger • Selkane, Aziza assigned the task to Selkane, Aziza 10/29/2020 11:20 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 8, 2020 5:00 PM. The priority is: High 10/27/2020 3:42 PM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting f• No an NOI that was r Yes rejected before? 1a. Project Name * Sanstone Office & Storage Expansion 1 b. Specific Lot This field nay be used to list specifc lot nunbers. Numbers 2. County* Henderson 3. Highway or Street Old Haywood Road Address* Street narre only is acceptable if no address number assigned yet 4. City or Township* Mills River 5. State * NC 6. Zip Code * 28759 7. Latitude* Enter the latitude in decirral degrees 35.4251 8. Longitude* Enter the longitude in decir al degrees (NALIST be negative) -82.5765 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* 10/19/2020 Estinated Construction Project Start Date 10. Date to End* 12/31/2020 Estimated Construction Project End fate 11. SIC (Primary)* Commercial (1542) Standard Industrial Classification for Leveloprrent 12. Acres to be 4.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 6.00 (acres) * 14. Post- 1.48 construction (Estirrated) impervious area (acres) * NCC Project NCC-HENDE-2020-Sanstone Office & Storage Expansion Tracking ID Assigned autonaticaly 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 McDowell Creek Waterbody* %rm of waterbody into which storrrwater runoff will discharge 15b. Waterbody 6-58 Index No.* NCWaterbody Index Nunber Stormwater V No discharges will flow r Yes to additional wate rs * 16a. Is this project F Yes subject to the NC r No, not subject to NC SPCA Sediment Pollution Control Act?* B. Permittee Information Part B. ^ Fbrnittee 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 Legally Responsible Entity Name * Sanstone Home Office Properties, LLC It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. Note: The organization name must match the business entity name registered with the NC Secretary of State. You can verify the registration here. 2. First Name * Christopher If Corporation, enter Registered Agent First Wre 3. Last Name* Sprenger It Corporation, enter F;bgistered Agent Last %rre 3b. Title Manager 4. Permitee E-mail info@sanstonehealth.com Address* 5. Permittee 888-413-6811 Telephone No.* 6. Permittee Mailing Street Address Address* 229 Airport Rd Address Line 2 Suite 7-104 City State / Frovince / Fbgion Arden NC Fbstal / Zip Code Country 28704 us Check box if the V Yes street address the same as mailing address 7. Permittee Street Street Address Address* 229 Airport Rd Address Line 2 Suite 7-104 City State / Ftovince / Region Arden NC Fbstal / Zip Code Country 28704 us 8. Type of Non -Government Ownership* C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site George Contact - First Name * 2. Primary Site Pendleton Contact - Last Name * 3. Title 4. Site Contact E- gwpandco@bellsouth.net mail Address* 5. Site Contact 828-697-5625 Telephone No. 6. Organization George Pendleton & Co, Inc Name 7. Site Contact Street Address Mailing Address* P.O. BOX457 Address Line 2 city Naples Fbstal / Zip Code 28760 8. Consultant Name (Optional) Mark Brooks First and Last nacre 9. Consultant E-mail mbrooks@brooksea.com This person will be copied on all correspondence. 10. Consultant 828-432-4700 Telephone No. State / Rovince / Region NC Country us D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 06/26/2020 Approved * 2. E&SC Plan Project HENDE-2020-013 Number/ID * Assigned by agency or local program 3. E&SC Plan r State DEQ Office Approved by* r Local Program 4. State DEQ Office * Asheville (ARO) 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 NCDEQ Approval 6-26-2020.docx.pdf 134.24KB Approval letter or Mast 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 Signed Form.pdf 79.29KB Form Wst be RDFfornat This is an Express f No Review Project* r Yes E. Certification North Carolina General Statute 143-215.6E (i) 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 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 [trdCrF�t Type Name * Christopher J Sprenger Title Manager Organization Legally Responsible Entity Sanstone Home Office Properties, LLC Date * 10/27/2020 F. Tracking and COC Info NOI Tracking No. 34276 NC Reference No. NCG01-2020-4857 Uses 'count_nunber' variable (increrrented by SP) Certificate of NCC204857 Coverage (COC) Uses 'count nurrber' variable (increrrented by SP) No.* Count Number 4857 Sequential nunber for subnittal that is incremented by Stored Frocedure COC Year 2020 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC204857-2020 Invoice Due Date 11/26/2020 Initial Fee $ 100.00 Invoice Status OPEN