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HomeMy WebLinkAboutNCC200954_NOI Application_20200312Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 3/11/2020 8:41:23 AM (NCG01 NOI Submission) Approve by Clark, Paul 3/11/2020 9:23:19 AM (Review- Construction NOI 22970) • The task was assigned to Clark, Paul by round robin distribution 3/11/2020 8:41 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 13, 2020 5:00 PM 3/11/2020 8:41 AM Submit by McCoy, Suzanne 3/12/2020 10:31:23 AM (Payment Verification for NCC200954) * Farmington Square LLC • McCoy, Suzanne assigned the task to McCoy, Suzanne 3/12/2020 10:30 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 22, 2020 5:00 PM 3/11/2020 9:23 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW Quallly A. Project Information Part A. Project Location and Waterbody Information la. Project Name* Farmington Square Retail 1 b. Specific Lot This field may be used to list specifc lot numbers. Numbers 2. County* Wake 3. Highway or Street 2802 and 2818 New Birch Drive Address* Street name only is acceptable if no address nunber assigned yet 4. CityorTownship* Raleigh 5. State * NC 6. Zip Code* 27610 7. Latitude* Enter the latitude in decinal degrees 35.7460 8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative) -78.6000 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* 03/10/2020 Estimated Construction Project Start Date 10. Date to End * 03/10/2022 Estinated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial aassification for Development 12. Acres to be 2.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 2.15 (acres)* 14. Post- 1.60 construction (Estirated) impervious area (acres) * NCC Project NCC-WAKE-2020-Farmington Square Retail Tracking ID Assignedautorratically 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 Little Arm Branch Wate rbody* Name of waterbody into which storrrwater runoff w ill discharge 15b. Waterbody 27-34-11-2 Index No. * NC Waterbody Index Minter 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 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 Farmington Square LLC Name * If perrrittee is an individual (i.e., organization does not apply), enter first and last narre in this field. 2. First Name* Trent If Corporation, enter Plegistered Agent First Barre 3. Last Name* Ragland If Corporation, enter Faegistered Agent Last Wre 3b. Title Manager 4. Permitee E-mail trent@raglandpropertiesinc.com Address * 5. Permittee 919-815-9694 Telephone No.* 6. Permittee Mailing Street Address Address* 3725 National Drive Address Line 2 Suite 150 City State / Ftovince / Region Raleigh NC Fostal / Zip Code Country 27612 USA Check box if the rJ Yes street address the same as mailing address 7. Permittee Street Street Address Address* 3725 National Drive Address Line 2 Suite 150 City State / Ffovince / Fbgion Raleigh NC Fbstal / Zip Code Country 27612 USA 8. Type of Non -Government Ownership* C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Trent Contact - First Name * 2. Primary Site Ragland Contact - Last Name * 3. Title 4. Site Contact E- trent@raglandpropertiesinc.com mail Address* 5. Site Contact 919-815-9694 Telephone No. 6. Organization Name 7. Site Contact Street Address Mailing Address* 3725 National Drive Address Line 2 Suite 150 City Raleigh Fbstal / Zip Code 27612 8. Consultant Name (Optional) Peter Cnossen First and Last narre 9. Consultant E-mail peter@jonescnossen.com This person will be copied on all correspondence. 10. Consultant (919) 387-1174 Telephone No. State / Rovince / Region NC Country USA D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 02/13/2020 Approved * 2. E&SC Plan Project LDG-006308-2019 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 Raleigh 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 Approval letter or Grading Permit Site Map (Optional) FS Permits Retail.pdf Mast be FDFfornat Helpful for linear project review Mast be FDFform3t 75.58KB Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support the application. Include additional w aterbodies for linear projects if necessary. 6. NOI Certification FS NOI Certification Form.pdf 389.29KB Form Mast be FDFformat 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 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 Type Name* W. Trent Ragland, III Title Manager Organization Farmington Square, LLC Date * 03/11 /2020 F. Tracking and COC Info NOI Tracking No. 22970 NC Reference No. NCG01-2020-0954 Uses 'count number' variable (incremrented by SP) Certificate of NCC200954 Coverage (COC) Uses 'count number' variable (incremented by SP) No.* Count Number 954 Sequential number for submittal that is incremented by Stored Frocedure COC Year 2020 Year of date reviewed (used to assign YY digits after "NOC' in COCno.)