HomeMy WebLinkAboutNCC191361_NOI Application_20190815Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/13/2019 5:05:59 PM (NCG01 NOI Submission)
Approve by Clark, Paul 8/13/2019 5:42:31 PM (Review- Construction NOI 14823)
• The task was assigned to Clark, Paul by round robin distribution 8/13/2019 5:06 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 15, 2019 5:00
PM 8/13/2019 5:06 PM
Submit by McCoy, Suzanne 8/15/2019 10:26:02 AM (Payment Verification for NCC191361)
• McCoy, Suzanne assigned the task to McCoy, Suzanne 8/15/2019 10:25 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 27, 2019 5:00 PM
8/13/2019 5:42 PM
STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Avondale Trace Apartments
2. County* Guilford
3. Highway or Street West Wendover Avenue
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* High Point
5. State * NC
1r-8)ff&T7i)MfiIi(-_ToIa10141
6. Zip Code* 27265
7. Latitude * Enter the latitude in decirral degrees
36.0368
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-79.9464
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*
08/19/2019
Estimated Construction Project Start Date
10. Date to End*
08/19/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Other
than SFE (1522)
Standard Industrial Gassification for Development
12. Acres to be
5.40
disturbed*
(including off -site borrow and waste areas)
13. Total site area
7.58
(acres)*
14. Post-
2.12
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-GUILF-2019-Avondale Trace Apartments
Tracking ID
Assigned autorratically
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 East fork Deep River
Wate rbody* Wfe of waterbody into which storawater runoff will discharge
15b. Waterbody 17-2-(0.3)
Index No.* NC Waterbody Index Nanber
Stormwater rJ No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project r Yes
subject to the NC f No, not subject to NC SPCA
Sediment Pollution
Control Act?*
B. Permittee Information
Part B.
Perrrittee 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 Wynnefield Properties, Inc.
Name *
2. First Name* Craig
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Stone
Y Corporation, enter Registered Agent Last Barre
3b. Title President
4. Permitee E-mail craig.stone@wynnefieldproperties.com
Address*
5. Permittee (336) 454-6134
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box395
Address Line 2
City
Jamestown
Postal / Zip Code
27282
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
r Yes
Street Address
5614 Riverdale Drive
Address Line 2
City
Jamestown
Rastal / Zip Code
27282-9113
State / Province / Region
NC
Country
us
State / Province / Region
NC
Country
us
C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Government - Municipal
Ownership*
2. Primary Site Matt
Contact - First
Name *
3. Primary Site Raab
Contact - Last
Name *
4. Title
5. Site Contact E- matt.raab@\&ynnefieldproperties.com
mail Address*
6. Site Contact (336) 880-3300
Telephone No.*
7. Organization
Wynnefield Properties, Inc.
Name
8. Site Contact
Street Address
Mailing Address*
5614 Riverdale Drive
Address Line 2
aty
Jamestown
Fbstal / Zip Code
27282-9113
State / Province / Region
NC
Country
us
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 07/25/2019
Approved *
2. E&SC Plan Project EN-19-0078
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 High Point
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 ec-apprval-Itr.pdf 1.81 MB
Approval Mist be PCFfornat
letter/documentation
6. NOI Certification noi-cert-signed.pdf 420.35KB
Form Mist be RDFfornet
This is an Express r No
Review Project* r Yes
E. Certification
North Carolina General Statute 143-215.6B (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.
* V 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.
* V 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.
* I7 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
7
Type Name* Craig Stone
Title President
Organization Wynnefield Properties, Inc.
Date * 08/13/2019
F. Tracking and COC Info
NOI Tracking No. 14823
NC Reference No. NCG01-2019-1361
Uses 'count _nunber'variable (increrrented by SP)
Certificate of NCC191361
Coverage (COC) Uses'count_nunber'variable (incremented by SF)
No. *
Count Number 1361
Sequential nunber for subrrittal that is increrrented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)