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HomeMy WebLinkAboutNCC213572_NOI Application_20210615Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 6/10/2021 3:42:39 PM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 6/11/2021 7:58:52 AM (Review- Construction NOI 55332) • The task was assigned to Broussard, Brooklyn C by round robin distribution 6/10/2021 3:43 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 14, 2021 5:00 PM 6/10/2021 3:43 PM Submit by Selkane, Aziza 6/15/2021 6:32:38 AM (Payment Verification for NCC213572) * Mungo Homes • Selkane, Aziza assigned the task to Selkane, Aziza 6/15/2021 6:31 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 23, 2021 5:00 PM 6/11/2021 7:59 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 * The Lake at Spicewood Phase 1 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) 5897-74-3860.000 2. County* Forsyth 3. Highwayor Street Spicewood Drive Address* Street name only is acceptable if no address nunber assigned yet 4. City or Township* Pfafftown 5. State * NC 6. Zip Code* 27040 7. Latitude* Enter the latitude in decinal degrees 36.1486 8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative) -80.3569 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* 06/15/2021 Estinated Construction Project Start Rate 10. Date to End * 06/17/2022 Estinated Construction Project End Cate 11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521) Standard Industrial aassification for Development 12. Acres to be 27.99 disturbed* (including off -site borrow and waste areas) 13. Total site area 185.30 (acres) * 14. Post- 8.28 construction (Estirreted) impervious area (acres) * NCC Project NCC-FORSY-2021-The Lake at Spicewood Phase 1 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 Bill Branch Waterbody* Narreof waterbody into which storrrwater runoff will discharge 15b. Waterbody 12-94-5 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 * Clayton Properties Group, Inc., DBA Shugart Homes 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 * Ken If Corporation, enter Faegistered Agent First %rre 3. Last Name* Capron It Corporation, enter Pbegistered Agent Last %rre 3b. Title Assistant Secretary 4. Permitee E-mail ken@shugarthomes.net Address* 5. Permittee 3367659661 Telephone No.* 6. Permittee Mailing Street Address Address* 221 Jonestown Road Address Line 2 City Winston Salem Fbstal / Zip Code 27104 Check box if the street address the same as mailing address 7. Permittee Street Address* V Yes Street Address 221 Jonestown Road Address Line 2 City Winston Salem Fbstal / Zip Code 27104 State / Frovince / Pegion NC Country USA State / Frovince / Faegion NC Country 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 Keith Contact - First Name * 2. Primary Site Nelson Contact - Last Name * 3. Title Project Manager 4. Site Contact E- knelson@shugarthomes.net mail Address* 5. Site Contact 336-462-1070 Telephone No. 6. Organization Name 7. Site Contact Street Address Mailing Address* 221 Jonestown Road Address Line 2 city Winston Salem Postal / Zip Code 27104 8. Consultant Name (Optional) Jodie Melo First and Last narre 9. Consultant E-mail jmelo@shugarthomes.net This person will be copied on all correspondence. 10. Consultant 336-231-6746 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) ken@shugarthomes.net Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 3367659661 Default is legally responsible person telephone State / Province / Region NORTH CAROLINA (NC) Country USA D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 06/10/2021 Approved * 2. E&SC Plan Project EN2100047 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 1699_001.pdf Approval letter or Mast beRDFformal Grading Permit 6. Site Location Map Mist be RDFforrret (lint 201VB) 65.57KB C 1.0 - SITE & UTILITY PLAN.pdf 2.03MB 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 1700_001.pdf 91.63KB 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* Ken Capron Title Assistant Secretary Organization Legally Responsible Entity Clayton Properties Group DBA Shugart Homes Date * 06/10/2021 F. Tracking and COC Info NOI Tracking No. 55332 NC Reference No. NCG01-2021-3572 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC213572 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 3572 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. NCC213572-2021 Invoice Due Date 7/11/2021 Initial Fee $ 100.00 Invoice Status OPEN