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HomeMy WebLinkAboutNCC210346_NOI Application_20210127Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 1/20/2021 1:30:37 PM (NCG01 NOI Submission) Approve by Gamble, Aana C 1/20/2021 2:17:19 PM (Review- Construction NOI 41438) • The task was assigned to Gamble, Aana C by round robin distribution 1/20/2021 1:31 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 22, 2021 5:00 PM 1/20/2021 1:31 PM Submit by McCoy, Suzanne 1/27/2021 2:00:39 PM (Payment Verification for NCC210346) * SJM Deep River LLC • McCoy, Suzanne assigned the task to McCoy, Suzanne 1/27/2021 2:00 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 3, 2021 5:00 PM 1/20/2021 2:18 PM .• 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 41123 NOI No. Prior Reviewer Not Sure or Not Listed Name 1a. Project Name * Mini Storage Facility 1 b. Specific Lot This field may be used to list specffc lot numbers. Numbers 1 c. Parcel ID List all R% associated w ith this project. Number(s) (PIN) 1634800000022 2. County* Davidson 3. Highway or Street 366 Kennedy Rd Address* Street name only is acceptable if no address number assigned yet 4. City or Township* Thomasville 5. State * NC 6. Zip Code* 27360 7. Latitude* Enter the latitude in decimal degrees 35.8518 8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative) -80.0688 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* 02/15/2021 Estimated Construction Project Start late 10. Date to End * 02/14/2022 Estimated Construction Project End late 11. SIC (Primary)* Commercial (1542) Standard Industrial Classification for Development 12. Acres to be 5.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 5.06 (acres) * 14. Post- 2.00 construction ([ timated) impervious area (acres) * NCC Project NCC-DAVID-2021-Mini Storage Facility 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 Hamby Creek Waterbody* %rreof waterbody into which stormwater runoff will discharge 15b. Waterbody 12-119-7-4 Index No. * NCWaterbody Index Nurrber 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. ^ Fbrnittee 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 * Franklin English 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 * Franklin If Corporation, enter Faegistered Agent First %rre 3. Last Name* English It Corporation, enter Pbegistered Agent Last %rre 3b. Title owner 4. Permitee E-mail fre9813@aol.com Address* 5. Permittee 336-741-6516 Telephone No.* 6. Permittee Mailing Street Address Address* 3405 Garrell Street Address Line 2 City Archdale Fbstal / Zip Code 27263-2633 Check box if the street address the same as mailing address 7. Permittee Street Address* F Yes Street Address 3405 Garrell Street Address Line 2 City Archdale Fbstal / Zip Code 27263-2633 State / Frovince / Pegion NC Country us State / Frovince / Faegion NC Country us 8. Type of Ownership is only individual if an individual is naned in B.1. above. Ownership* Individual C. Site Contact Information Part C. Roject Site Contact Inforrration ........................................................................................................................................................................................................................................................................... 1. Primary Site Franklin Contact - First Name * 2. Primary Site English Contact - Last Name * 3. Title 4. Site Contact E- fre9813@aol.com mail Address* 5. Site Contact 336-741-6516 Telephone No. 6. Organization Name 7. Site Contact Street Address Mailing Address* 3405 Garrell Street Address Line 2 Oty State / Rovince / Region Archdale NC Fbstal / Zip Code Country 27263-2633 us 8. Consultant Name (Optional) Christian Vestal First and Last narre 9. Consultant E-mail christian@summeyengineering.com This person will be copied on all correspondence. 10. Consultant 336-328-0902 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) fre9813@aol.com Default is legally responsible person e-n-ail (older NOts rray not populate) 12. Billing (For Annual Fee correspondence) Telephone 336-741-6516 Default is legally responsible person telephone (older NOLs rray not populate) D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 01/08/2021 Approved * 2. E&SC Plan Project DAVID-2021-024 Number/ID * Assigned by agency or local program 3. E&SC Plan r State DEQ Office Approved by* r Local Program 4. State DEQ Office * Winston-Salem (WSRO) Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can include the beginning point and end point coordinates in the "Notes" box below). 5. E&SC Plan Permit Approval_1.pdf Approval letter or Mist beRDFformat Grading Permit 6. Site Location Map Mist be RDFforrret (lint 20 NB) 366 Kennedy Rd property map.pdf Rease do not upload entire set of E&SC plans. 1.08MB 279.94KB 7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies if necessary. 8. NOI Certification NOI Certification Form_1(1).pdf 63.27KB Form Wst be RDFforrret 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 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:* IT The Legally Responsible Person named on this Notice of Intent f Authorized Responsible Person* (signing on behalf of Legally Responsible Person named in Part B) 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 * Franklin English Title owner Organization Legally Plesponsible Entity Franklin English Date * 01 /20/2021 F. Tracking and COC Info NOI Tracking No. 41438 NC Reference No. NCG01-2021-0346 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC210346 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 346 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2021 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC210346-2021 Invoice Due Date 2/19/2021 Initial Fee $ 100.00 Invoice Status OPEN