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HomeMy WebLinkAboutNCC210951_NOI Application_20210318Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 2/16/2021 8:02:27 AM (NCG01 NOI Submission) Approve by Clark, Paul 2/16/2021 3:47:17 PM (Review- Construction NOI 44619) • The task was assigned to Clark, Paul by round robin distribution 2/16/2021 8:03 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: February 18, 2021 5:00 PM 2/16/2021 8:03 AM Submit by Selkane, Aziza 3/18/2021 9:19:29 AM (Payment Verification for NCC210951) * David A Geiger • Selkane, Aziza assigned the task to Selkane, Aziza 3/18/2021 9:17 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 30, 2021 5:00 PM 2/16/2021 3:47 PM .• 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 * Beaver Creek Subdivision -Phase 1 B 1 b. Specific Lot This field rray be used to list specifc lot nunbers. Numbers 1 c. Parcel ID List all Rus associated w ith this project. Number(s) (PIN) 274300352321 2. County* Nash 3. Highway or Street Claude Lewis Road Address* Street name only is acceptable if no address nunber assigned yet 4. City or Township* Dry Wells TWSP 5. State * NC 6. Zip Code* 27554 7. Latitude* Enter the latitude in decinal degrees 35.7688 8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative) -78.1801 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* 03/15/2021 Estir ated Construction Project Start Rate 10. Date to End * 02/15/2023 Estirrated Construction Project End Cate 11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521) Standard Industrial aassification for Development 12. Acres to be 15.68 disturbed* (including off -site borrow and waste areas) 13. Total site area 27.12 (acres) * 14. Post- 4.60 construction (Estirreted) impervious area (acres) * NCC Project NCC-NASH-2021-Beaver Creek Subdivision -Phase 1B 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. 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 Beaverdam Creek Waterbody* Narreof waterbody into which storrrwater runoff will discharge 15b. Waterbody 27-86-3-8 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. ^ 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 Legally Pesponsible Entity Name * Little Bear Creek Properties, 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 * David If Corporation, enter Faegistered Agent First %rre 3. Last Name* Geiger It Corporation, enter Pbegistered Agent Last %rre 3b. Title Owner 4. Permitee E-mail davidj@littlebear-creek.com Address* 5. Permittee 919-612-5531 Telephone No.* 6. Permittee Mailing Street Address Address* 755 Ranch Road Address Line 2 Clayton Fbstal / Zip Code 27520 Check box if the V Yes street address the same as mailing address State / Frovince / Fbgion NC Country USA 7. Permittee Street Street Address Address* 755 Ranch Road Address Line 2 city State / Frovince / Faegion Clayton NC Fbstal / Zip Code Country 27520 USA 8. Type of Ownership is only individual if an individual is naned in B.1. above. Ownership* Non -Government C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site David Contact - First Name * 2. Primary Site Geiger Contact - Last Name * 3. Title Owner 4. Site Contact E- davidj@littlebear-creek.com mail Address* 5. Site Contact 919-612-5531 Telephone No. 6. Organization Little Bear Creek Properties, LLC Name 7. Site Contact Street Address Mailing Address* 755 Ranch Road Address Line 2 City Clayton Fbstal / Zip Code 27520 8. Consultant Name (Optional) Steve Janowski, PE First and Last nacre 9. Consultant E-mail sjanowski@riversandassociates.com This person will be copied on all correspondence. 10. Consultant 252-714-3002 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) davidj@littlebear-creek.com Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 919-612-5531 Default is legally responsible person telephone 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 02/11/2021 Approved * 2. E&SC Plan Project NASH-2021-011 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 * Raleigh (RRO) 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 NASH-2021-011_20210211_LOA.pdf 266.28KB Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Mist be RDFforrret (lint 20 NB) USGS Topo.pdf 14.49MB Rease do not upload entire set of E&SC plans. 7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies if necessary. 8. NOI Certification NCG01 Notice of Intent - Beaver Creek Phase Form 1 B.pdf 791.38KB Mast be FDFfon-rat 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 Atide; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the Commission implementing this Atcle 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 11rfGl�rr Type Name * David Geiger Title Owner Organization Legally Responsible Entity Little Bear Creek Properties, LLC Date * 02/16/2021 F. Tracking and COC Info NOI Tracking No. 44619 NC Reference No. NCG01-2021-0951 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC210951 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 951 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. NCC210951-2021 Invoice Due Date 3/18/2021 Initial Fee $ 100.00 Invoice Status OPEN