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HomeMy WebLinkAboutNCC204905_NOI Application_20201029Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 10/28/2020 5:22:06 PM (NCG01 NOI Submission) Approve by Meloy, Michael 10/29/2020 7:39:52 AM (Review- Construction NOI 34465) • The task was assigned to Meloy, Michael by round robin distribution 10/28/2020 5:22 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 30, 2020 5:00 PM 10/28/2020 5:22 PM Submit by Selkane, Aziza 10/29/2020 12:35:17 PM (Payment Verification for NCC204905) * Jermaine Bryant U180LLC • Selkane, Aziza assigned the task to Selkane, Aziza 10/29/2020 12:34 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 10, 2020 5:00 PM 10/29/2020 7:40 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting IT No an NOI that was r Yes rejected before? 1a. Project Name * Minor Subdivision - U180LLC, Surface Hill Road 1 b. Specific Lot This field rray be used to list specifc lot numbers. Numbers 2. County* Mecklenburg 3. Highway or Street 9536 Surface Hill Road Address* Street narre only is acceptable if no address number assigned yet 4. City or Township* Mint Hill 5. State * NC 6. Zip Code * 28227 7. Latitude* Enter the latitude in decimal degrees 35.2020 8. Longitude* Enter the longitude in decimal degrees (M.JST be negative) -80.6452 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* 11/04/2020 Estimated Construction Project Start Date 10. Date to End * 07/04/2021 Estinated Construction Project End Date 11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521) Standard Industrial Classification for Developrrent 12. Acres to be 3.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 11.94 (acres) * 14. Post- 1.81 construction (Estirreted) impervious area (acres) * NCC Project NCC-MECKL-2020-Minor Subdivision - U180LLC, Surface Hill Road 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 Clear Creek Waterbody* Ilarre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 13-17-17 Index No.* NCWaterbody Index Number 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. ^ Fbrnittee Inforrration - Legally Fa sponsible 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 * U180,LLC It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. Note: The organization name must match the business entity name registered with the NC Secretary of State. You can verify the registration here. 2. First Name * Jermaine If Corporation, enter Faegistered Agent First %rre 3. Last Name* Bryant It Corporation, enter Pbegistered Agent Last %rre 3b. Title Member 4. Permitee E-mail U180info@gmail.com Address* 5. Permittee 980-272-7907 Telephone No.* 6. Permittee Mailing Street Address Address* 1801 East 5th St Address Line 2 Suite 104 City State / Frovince / Fbgion Charlotte NC Fbstal / Zip Code Country 28204 USA Check box if the V Yes street address the same as mailing address 7. Permittee Street Street Address Address* 1801 East 5th St Address Line 2 Suite 104 City State / Frovince / Region Charlotte NC Fbstal / Zip Code Country 28204 USA 8. Type of Non -Government Ownership* C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Jermaine Contact - First Name * 2. Primary Site Bryant Contact - Last Name * 3. Title Owner 4. Site Contact E- ul80llc@gmail.com mail Address* 5. Site Contact 980-272-7907 Telephone No. 6.Organization U180,LLC Name 7. Site Contact Street Address Mailing Address* 1801 East 5th St Address Line 2 Suite 104 city Charlotte Postal / Zip Code 28204 8. Consultant Name (Optional) Kevin Westra First and Last narre 9. Consultant E-mail kwestra@benesch.com This person will be copied on all correspondence. 10. Consultant 704-496-6297 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 10/21/2020 Approved * 2. E&SC Plan Project EPM# 412296 Number/ID * Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* Mecklenburg County 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 PCO5_Approval_ltr_#412296.pdf 62.13KB Approval letter or Mist beRDFformat Grading Permit 6. Site Location Map Helpful for linear project review (Optional) Mast be FCFfornat. Rease do not upload entire set of E&SCplans. 7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies for linear projects if necessary. 8. NOI Certification NCGO1 NOI.pdf 446.85KB Form Mist be RDFfornat 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 i9!,WW"'t ,e!" Type Name* Jermaine Bryant Title Manager Organization Legally Ibsponsible Entity U180LLC Date * 10/28/2020 F. Tracking and COC Info NOI Tracking No. 34465 NC Reference No. NCG01-2020-4905 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC204905 Coverage (COC) Uses 'count number' variable (increrrented by SP) No.* Count Number 4905 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. NCC204905-2020 Invoice Due Date 11/28/2020 Initial Fee $ 100.00 Invoice Status OPEN