HomeMy WebLinkAboutNCC215398_NOI Application_20211007Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/28/2021 5:53:59 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 9/28/2021 9:51:06 AM (Review- Construction NOI 66681)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 9/28/2021 5:54 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 30, 2021 5:00
PM 9/28/2021 5:54 AM
Submit by Evans, Shaundra M 10/7/2021 8:39:31 AM (Payment Verification for NCC215398)
* Alex Elledge
• Evans, Shaundra M assigned the task to Evans, Shaundra M 10/7/2021 8:38 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 9, 2021 5:00
PM 9/28/2021 9:51 AM
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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting
IT No
an NOI that was
r Yes
rejected before?
1a. Project Name *
Overlook Lot 20
1 b. Specific Lot
This field may be used to list specifc lot numbers.
Numbers
20
1 c. Parcel ID List all RED associated w ith this project.
Number(s) (PIN) 0891019055
2. County* Wake
3. Highway or Street 1508 Starry Night Ct
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Raleigh
5. State * NC
6. Zip Code* 27613
7. Latitude* Enter the latitude in decimal degrees
35.9779
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.6928
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*
09/30/2021
Estimated Construction Project Start Rate
10. Date to End *
06/30/2022
Estinated Construction Project End Cate
11. SIC (Primary)*
Residential, Single Family Houses (SFE) (1521)
Standard Industrial Oassification for Development
12. Acres to be
0.57
disturbed*
(including off -site borrow and waste areas)
13. Total site area 0.97
(acres) *
14. Post- 0.11
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-WAKE-2021-Overlook Lot 20
Assigned automatically (not used)
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 Unamed Tributary at Camp Adventure
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b. Waterbody 27-15.5-(2)
Index No. * NCWaterbody Index Number
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 must 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. Permittee * Legally Pesponsible Entity
Legacy Custom Homes
It pernittee is an individual, enter first and last narre in this field. Otherwise, enter organization/business narre.
Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the
registration here.
2. First Name * Alex
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Elledge
It Corporation, enter Pegistered Agent Last %rre
3b. Title project manager
4. Permitee E-mail alex@legacycustomhomes.com
Address*
5. Permittee 9196169441
Telephone No.*
6. Permittee Mailing Street Address
Address* 3304 Six Forks Rd
Address Line 2
suite 100
Cty
Raleigh
Fbstal / Zip Code
27609
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
3304 Six Forks Rd
Address Line 2
suite 100
city
Raleigh
Fbstal / Zip Code
27609
State / Ffovince / Fbgion
North Carolina
Country
United States
State / Ftovince / Faegion
North Carolina
Country
United States
8. Type of Ownership is only individual if an individual is naned in B.1. above.
Ownership* Non -Government
C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Alex
Contact - First
Name *
2. Primary Site
Elledge
Contact - Last
Name *
3. Title
project manager
4. Site Contact E-
alex@legacycustomhomes.com
mail Address*
5. Site Contact
9196169441
Telephone No.
6. Organization
Legacy Custom Homes
Name
7. Site Contact
Street Address
Mailing Address*
3304 Six Forks Rd
Address Line 2
Suite 100
city
Raleigh
Fbstal / Zip Code
27609
8. Consultant Name
(Optional)
Alex Elledge
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
alex@legacycustomhomes.com
Default is legally responsible person a-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
9196169441
Default is legally responsible person telephone
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 09/21/2021
Approved *
2. E&SC Plan Project sec-065725-2021
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Wake County
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can
include the beginning point and end point coordinates in the "Notes" box below).
5. E&SC Plan OV 20 SEC approval.pdf
Approval letter or Mast beRFforml
Grading Permit
286.77KB
6. Signed FRO Financial Responsibility/Ojvnership Form
OV 20 FRP.pdf 1.78MB
Mast be RFfornat
7. Site Location Map Mast be RDFforrrat (lirrit 20IVB)
Overlook-20-SitePlan (6-29-21).pdf 3.41 MB
Rease do not upload entire set of E&SC plans.
8. Notes (Optional) Provide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies if necessary.
9. NOI Certification OV 20 NCG01 eNOI Certification Form.pdf 864.85KB
Form Mast be FDFfon-rat
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 Legally Responsible Person named on this Notice of Intent
IT Authorized Responsible Person' (signing on behalf of Legally Responsible
Person named in Part B)
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
r1W°
Type Name* Alex Elledge
Title project manager
Organization Legally Pesponsible Entity
Legacy Custom Homes
Date * 09/28/2021
F. Tracking and COC Info
NOI Tracking No. 66681
NC Reference No.
NCG01-2021-5398
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC215398
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5398
Sequential nunber for subnittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC215398-2021
Invoice Due Date 10/28/2021
Initial Fee $ 100.00
Invoice Status OPEN