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HomeMy WebLinkAboutNCC213045_NOI Application_20210524Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 5/19/2021 12:19:09 PM (NCG01 NOI Submission) Approve by Meloy, Michael K 5/20/2021 8:39:14 AM (Review- Construction NOI 53177) • The task was assigned to Meloy, Michael K by round robin distribution 5/19/2021 12:19 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 21, 2021 5:00 PM 5/19/2021 12:19 PM Submit by McCoy, Suzanne 5/24/2021 1:00:07 PM (Payment Verification for NCC213045) * South Creek Construction Inc. • McCoy, Suzanne assigned the task to McCoy, Suzanne 5/24/2021 12:59 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 1, 2021 5:00 PM 5/20/2021 8:39 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 53008 NOI No. Prior Reviewer Paul Clark Name 1a. Project Name * Black Farms Subdivision Erosion Control Plan 1 b. Specific Lot This field any be used to list specifc lot numbers. Numbers lot1. lot 2, lot 3, lot 4 1 c. Parcel ID List all RW associated w ith this project. Number(s) (PIN) 01125116,01125115,01125114,01125113 2. County* Mecklenburg 3. Highway or Street 14901 Black Farms Rd Address* Street name only is acceptable if no address nunber assigned yet 4. CityorTownship* Huntersville 5. State * NC 6. Zip Code* 28078 7. Latitude* Enter the latitude in decimal degrees 35.4460 8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative) -80.8120 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* 05/17/2021 Estimated Construction Project Start Date 10. Date to End* 05/31/2022 Estimated Construction Project End Date 11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521) Standard Industrial aassification for Development 12. Acres to be 4.13 disturbed* (including off -site borrow and waste areas) 13. Total site area 12.96 (acres) * 14. Post- 12.96 construction (Estimated) impervious area (acres) * NCC Project NCC-MECKL-2021-Black Farms Subdivision Erosion Control Plan 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 Ramah Creek Waterbody* %rreof waterbody into which stormwater runoff will discharge 15b. Waterbody 13-17-4-4 Index No. * NCWaterbody Index Number 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. ^ 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 * South Creek Construction Inc 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 * Jacob IF Corporation, enter Faegistered Agent First %rre 3. Last Name* Palillo It Corporation, enter Pbegistered Agent Last %rre 3b. Title VP 4. Permitee E-mail jpalillo@aol.com Address* 5. Permittee 7043637902 Telephone No.* 6. Permittee Mailing Street Address Address* 18611 Starcreek Drive Address Line 2 City Cornelius Fbstal / Zip Code 28031-9328 Check box if the street address the same as mailing address 7. Permittee Street Address* F Yes Street Address 18611 Starcreek Drive Address Line 2 city Cornelius Fbstal / Zip Code 28031-9328 State / Frovince / Fbgion NC Country us State / Frovince / Faegion NC Country us 8. Type of Ojvnership 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 Jacob Contact - First Name * 2. Primary Site Palillo Contact - Last Name * 3. Title VP 4. Site Contact E- jpalillo@aol.com mail Address* 5. Site Contact 7043637902 Telephone No. 6. Organization South Creek Construction Inc Name 7. Site Contact Street Address Mailing Address* 18611 Starcreek Dr Address Line 2 City Cornelius Fbstal / Zip Code 28031 8. Consultant Name (Optional) First and Last nave 9. Consultant E-mail This person will be copied on all correspondence. 10. Consultant Telephone No. 11. Billing E-mail (For Annual Fee correspondence) jpalillo@aol.com Default is legally responsible person a-rrail 12. Billing (For Annual Fee correspondence) Telephone 7043637902 Default is legally responsible person telephone State / Rovince / Region NC Country United States D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 05/14/2021 Approved * 2. E&SC Plan Project 421813 Number/ID * Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* Town of Huntersville 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 D00051921-05192021091433.pdf 331.65KB Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Mast be RDFforrret (lint 20 NB) D00051921-05192021091440. pdf 655.21 KB 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 D00051921-05192021091426.pdf 1.11VIB 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 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 Amide 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 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 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 OA-40 �a'11.1rr1 Type Name* Jacob J palillo Title VP Organization Legally Ibsponsible Entity South Creek Construction Inc Date * 05/19/2021 F. Tracking and COC Info NOI Tracking No. 53177 NC Reference No. NCG01-2021-3045 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC213045 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 3045 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. NCC213045-2021 Invoice Due Date 6/19/2021 Initial Fee $ 100.00 Invoice Status OPEN