Loading...
HomeMy WebLinkAboutNCC203241_NOI Application_20200811Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 7/29/2020 7:46:33 AM (NCG01 NOI Submission) Approve by Clark, Paul 7/29/2020 8:16:48 AM (Review- Construction NOI 29010) • The task was assigned to Clark, Paul by round robin distribution 7/29/2020 7:47 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: July 31, 2020 5:00 PM 7/29/2020 7:47 AM Submit by Selkane, Aziza 8/11/2020 4:08:37 PM (Payment Verification for NCC203241) * Keystone Group, Inc • Selkane, Aziza assigned the task to Selkane, Aziza 8/11/2020 4:07 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 9, 2020 5:00 PM 7/29/2020 8:17 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting r No an NOI that was r Yes rejected before? Previous Rejected 28869 NOI No. Prior Reviewer Paul Clark Name 1a. Project Name * TRELLISES NORTH 1 b. Specific Lot This field may be used to list specifc lot nunbers. Numbers 201-221 246-253 2. County* Guilford 3. Highway or Street 7913 Clinard Farms Rd Address* Street narre only is acceptable if no address nunber assigned yet 4. City or Township* HIGHPOINT 5. State * NC 6. Zip Code * 27265 7. Latitude * Enter the latitude in decirral degrees 36.0570 8. Longitude* Enter the longitude in decimal degrees (MJSTbe negative) -79.9840 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* 07/23/2020 Estinated Construction Project Start Date 10. Date to End* 07/23/2021 Estimated Construction Project End Date 11. SIC (Primary)* Residential, Other than SFE (1522) Standard Industrial aassification for Leveloprrent 12. Acres to be 6.18 disturbed* (including off -site borrow and waste areas) 13. Total site area 6.18 (acres) * 14. Post- 4.05 construction (Estimated) impervious area (acres) * NCC Project NCC-GUILF-2020-TRELLISES NORTH 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. 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 West Fork Deep River Waterbody* Nara of waterbody into which stormwater runoff will discharge 15b. Waterbody 17-3-(0.3) Index No.* NC Waterbody Index N r ber Stormwater V No discharges will flow r Yes to additional wate rs * 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. ^ Fternittee 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 Legally Pesponsible Entity Name * Keystone Group, Inc. It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. 2. First Name * Scott IF Corporation, enter Faegistered Agent First %rre 3. Last Name* Wallace It Corporation, enter F;bgistered Agent Last %ne 3b. Title Manager 4. Permitee E-mail swallace@gokeystone.com Address* 5. Permittee 336-856-0111 Telephone No.* 6. Permittee Mailing Street Address Address* 3708 Allianc Dr Address Line 2 City State / Rovince / F;bgion Greensboro NC Fbstal / Zip Code Country 27407 us Check box if the F Yes street address the same as mailing address 7. Permittee Street Street Address Address* 3708 Allianc Dr Address Line 2 City State / Frovince / Region Greensboro NC Fbstal / Zip Code Country 27407 us 8. Type of Non -Government Ownership* C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Sandy Contact - First Name * 2. Primary Site Cline Contact - Last Name * 3. Title 4. Site Contact E- svvallace@gokeystone.com mail Address* 5. Site Contact 336-601-2400 Telephone No. 6. Organization Name 7. Site Contact Street Address Mailing Address* 3708 Alliance Drive Address Line 2 city Greensboro Fbstal / Zip Code 27407-2016 8. Consultant Name (Optional) First and Last nacre 9. Consultant E-mail This person will be copied on all correspondence. 10. Consultant Telephone No. State / Rovince / Region NC Country US D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 07/23/2020 Approved * 2. E&SC Plan Project EN 20 0160 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. 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 LDP permit.pdf 112.56KB Approval letter or Mist beRDFformat Grading Permit 6. Site Location Map Helpful for linear project review (Optional) Pages from TR North Approved CD for COC_2.pdf 6.51 MB Mast be RDF format. Rease do not upload entire set of E&SC plans. 7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies for linear projects if necessary. Rejection eNO1 no. 28869 8. NOI Certification NCGO1 Notice of Intent (NOI) Cert Form.pdf 87.38KB Form Mast be RFformat This is an Express r 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. Scott Wallace Title Manager Organization Legally Ibsponsible Entity kgrant@gokeystone.cojm Date * 07/29/2020 F. Tracking and COC Info NOI Tracking No. 29010 NC Reference No. NCG01-2020-3241 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC203241 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 3241 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2020 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC203241-2020 Invoice Due Date 8/28/2020 Initial Fee $ 100.00 Invoice Status OPEN