HomeMy WebLinkAboutNCC190682_NOI Application_20190620Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/20/2019 8:14:28 PM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 6/21/2019 8:00:56 AM (Review- Construction NOI 12680)
• The task was assigned to McCoy, Suzanne by round robin distribution 6/20/2019 8:15 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 24, 2019 5:00 PM.
The priority is: High 6/20/2019 8:15 PM
Submit by McCoy, Suzanne 6/21/2019 8:02:36 AM (Payment Verification - NCG01-2019-0682)
• The task was assigned to McCoy, Suzanne. The due date is: June 24, 2019 5:00 PM. The priority is:
High 6/21/2019 8:01 AM
1r-i)iTII1T7i1)MI-11f_T1IIa10141
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * RFM and Gwaltney Farms, LLC
2. County* Avery
3. Highway or Street Beech Mountain Parkway
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township * Banner Elk
5. State * NC
6. Zip Code* 28604
7. Latitude * Enter the latitude in decirral degrees
36.1748
8. Longitude * Enter the longitude in decirral degrees (UST be negative)
-81.8674
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 *
05/21 /2019
Estimated Construction Project Start Date
10. Date to End*
10/15/2019
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
2.50
disturbed*
(including off -site borrow and waste areas)
13. Total site area 48.40
(acres)*
14. Post- 4.98
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-AVERY-2019-RFM and Gwaltney Farms, LLC
Tracking ID Assigned automatically
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. You may
enter up to 3 waterbodies.
15a. Receiving Whitehead Creek
Waterbody* Nbrre of waterbody into which stormvwater runoff will discharge
15b. Waterbody 8-22-10
Index No. * NCWaterbody Index Nmber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Elk River
Receiving Waterbody narre
Waterbody
15d. Waterbody 8-22-(3)
Index No. NCWaterbody Index Number
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbodyIndex Namber
Index No.
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.
P rrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
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 RFM and Gwaltney Farms, LLC
Name *
2. First Name* William
ff Corporation, enter Registered Agent First l\brre
3. Last Name * Wakeman
Y Corporation, enter Registered Agent Last Barre
3b. Title President
4. Permitee E-mail whwakeman@insuretech.net
Address*
5. Permittee 8635293465
Telephone No.*
6. Permittee Mailing Street Address
Address* 306 East Main Street
Address Line 2
Suite 200
City
Lakeland
Postal / Zip Code
33801-5023
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
306 East Main Street
Address Line 2
Suite 200
City
Lakeland
Postal / Zip Code
33801-5023
State / Province / Region
FL
Country
us
State / Province / Region
FL
Country
us
C. Site Contact Information
Part C.
Roiect Site Contact hforrration
1. Type of Individual
Ownership*
2. Primary Site Michael
Contact - First
Name *
3. Primary Site Warnock
Contact - Last
Name *
4. Title Project Manager
5. Site Contact E- Michael.warnock@drepllc.com
mail Address*
6. Site Contact 8636408529
Telephone No.*
7. Organization
Diversified Real Estate Partners, L.L.C.
Name
8. Site Contact
Street Address
Mailing Address*
306 East Main Street
Address Line 2
Suite 200
aty
Lakeland
Rbstal / Zip Code
33801-5023
State / Rovince / Plegion
FL
Country
us
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 05/23/2019
Approved *
2. E&SC Plan Project AVERY 2019-004
Number/ID* Assigned by agency or local program
3. E&SC Plan f• 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.
5. E&SC Plan LOAM & COPA 5-23-19 (1).pdf 129.07KB
Approval 14-27 Red Fox ESCP plan 2019-04-23.pdf 10.6MB
letter/documentation
01-13 Red Fox ESCP plan 2019-04-23.pdf 10.61 MB
Mist be PDF format
6. NOI Certification NOI- Wakeman RFM.pdf 61.45KB
Form Mist be FDFforrrat
This is an Express r No
Review Project* f• Yes
E. Certification
North Carolina General Statute 143-215.613 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
rJ 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.
* I7 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
r Authorized Responsible Person*
Important: The person who signs this Certification above and signs the NOI Certification Form should be the same
person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information)
of this form. *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
444-# 4OZ- F— W-4 'd-14
Type Name * Michael E Warnock
Title Project Manager
Organization Diversified Real Estate Partners, L.L.C. for RFM & Gwaltney Farms,
LLC
Date * 06/20/2019
F. Tracking and COC Info
NOI Tracking No. 12680
NC Reference No. NCG01-2019-0682
Uses 'count number variable (incremrented by SP)
Certificate of NCC190682
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 682
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)