NCC201129_NOT Closeout Documents_20240504

SEECLICKFIX ID PRIORITY
14016396 Normal
REQUEST TYPE ADDRESS
Construction Site Runoff 401 Center Pointe Ct Archdale NC 27263, United States
Control
ASSIGNEE SLA EXPIRES REPORTED
Stormwater Program February 01, 2023 08:59
Manager- Seneres
SECONDARY QUESTIONS LOCATION
Site location? r—1
401 center point ct
r9,l
First Church of n
Penman Rd
God Day School V ;or ®r
Ter
9a
Ballard Sheet Metal inc
Go gle Map data©2024
SUMMARY&DESCRIPTION MEDIA
Construction Site Runoff Control
Tenth of inch rainfall recorded Pond looks great
Reported by:An anonymous SeeClickFix user 02/01/2023-
08:59AM
'_;t_ /
•
TIMESTAMP INTERNAL COMMENT COMMENTER
February Archdale, NC assigned this issue to Stormwater Program Manager-Seneres Archdale,
01,2023 NC
08:59
February Thank You for Using Online Portal consistent with current DEMLR Monitoring Stormwater
13,2023 Form Rev.07012020 under your responsibility and consistent with On Site Program
15:39 Observations. Manager-
Seneres

May 02, Yes Thank You for Using Online Portal consistent with current Division of Energy, Stormwater
2024 07:20 Mineral,and Land Resources Monitoring Form Rev.07012020 under your Program
responsibility, Division of Energy, Mineral,and Resources Form Rev 01272021 and Manager-
consistent with On Site Observations in reference to a received plan on March 16, Seneres
2020 and approved under COA-2020-030 dated March 16,2020 and Certificate of
Coverage NCG01-2020-1129 NCC 201129 dated March 20,2020 located in WS-IV
17-9-(1) HUC 030300030106 with a noted longitude and latitude. On Site
Observations observed by a Verified Official as defined by See Click Fix Protocol.
In addition,the site being in the jurisdiction of Randolph County and defined by
the noted location generated by geofencing with latitude and longitude located
in the headwaters of the defined river basin with a 911 project designation with
the person financially responsible verified on the authorized Certificate of
Approval.The site currently is not under notice of violation and no notations to
subparagraphs of a standard North Carolina Sedimentation Report are
warranted at this time.Any documentation,observations,and photographic are
included with additional comments if needed
As evidenced by the photographic documentation,no significant violations have
been observed using paragraphs 5a through 51 not used unless noted and
paragraphs 6a through 6v through site observations of a verified official.

Certificate of Coverage
•
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL,AND LAND RESOURCES
GENERAL PERMIT NO. NCG010000
NC Reference No.NCG01-2020-1129
Certificate of Coverage No. NCC201129
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1,other lawful standards and regulations
promulgated and adopted by the North Carolina Environmental Management Commission,and the Federal Water
Pollution Control Act,as amended,
Brian Lucas
is hereby authorized to discharge stormwater associated with CONSTRUCTION ACTIVITIES to surface waters of North
Carolina from a site located at:
Center Pointe Townhomes
Weant Rd
•
Archdale
Randolph County
in accordance with the effluent limitations,monitoring requirements,and other conditions set forth in N.C.General Permit
No.NCG010000.
This Certificate of Coverage is affiliated with E&SC Plan Project No.COA-2020-30
This Certificate of Coverage shall become effective 3/20/2020.
This Certificate of Coverage shall remain in effect until rescinded or expired.
This Certificate of Coverage will expire on the anniversary of its effective date unless it is renewed by payment of the
annual administration and compliance fee.
for Brian Wrenn
Acting Director,Division of Energy, Mineral,and Land Resources
By the Authority of the Environmental Management Commission

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FINANCIAL RESPONSIB LIVE/OWNNERSHIP FORM — ) j i
SEDIMENTATION POLLUTION CONTROL ACT (�
No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and,if the question is not applicable or the e-mail and/or fax information
unavailable,place N/A in the blank.)
Part A. -
1. Project Name Center Pointe Townhornes
2. Location of land-disturbing activity: County Randoplh City or Township Archdale .
Highway/Street Weant Rd Latitude 3•' - �J45T / Longitude 7 J ' '
3. Approximate date land-disturbing activity will commence: ASAP
4. Purpose of development(residential,commercial, industrial,institutional,etc.): Residential
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas):2•�� 3,./ '12- .
o _l
6. Amount of fee enclosed: $ . The application fee of$65.00 per acre (rounded
up to the next acre)is assessed without a ceiling amount (Example:a 9-acre application fee is$585).
7. Has an erosion and sediment control plan been filed? Yes - _ No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity;
Name Brian Lucas E-mail Address [e-mail]
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This form must be signed by the Financially Responsible Person if an individual
or his attorney-in-fact, or if not an individual, by an officer,director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any change in the information provided herein.
Brian Lucas Owner
Type or print am L-� Title or Authority
12/18/19
Si nature Date
I, Sex 1 �c ')Q S , a Notary Public of the County of 1\0,nf\rj�o f\
State of North Carolina, hereby certify that fa.v- `--1 Usk s appeared
personally before me this day and being duly sworn acknowledged that the above form was executed
by him.
Witness my hand and notarial seal,this IC'S. day of --1)QCQY 0- r ,20 \e1
SAMD RA*AWES \\,,,
Notary Public f�a Mrs �t'R.✓
Randolph Co.,North Carolina
My Cp nmission Expires Nov.15,2024 nary
My commission expires 1\-30\c. 15 202' (