Loading...
HomeMy WebLinkAboutNCC213945_NOI Application_20210706Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 7/2/2021 8:53:04 AM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 7/2/2021 9:16:26 AM (Review- Construction NOI 58234) • The task was assigned to Broussard, Brooklyn C by round robin distribution 7/2/2021 8:55 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: July 6, 2021 5:00 PM 7/2/2021 8:55 AM Submit by Selkane, Aziza 7/6/2021 11:39:41 AM (Payment Verification for NCC213945) * Mary Caidness • Selkane, Aziza assigned the task to Selkane, Aziza 7/6/2021 11:38 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 13, 2021 5:00 PM 7/2/2021 9:17 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 * Sosne Residence and Farm 1 b. Specific Lot This field nay be used to list specifc lot nunbers. Numbers 1 c. Parcel ID List all R% associated w ith this project. Number(s) (PIN) 18591443533 2. County* Avery 3. Highway or Street 431 Old Turnpike Rd Address* Street name only is acceptable if no address nunber assigned yet 4. City or Township* Banner Elk 5. State * NC 6. Zip Code* 28604 7. Latitude* Enter the latitude in decinal degrees 36.1698 8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative) -81.8636 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* 07/07/2021 Estinated Construction Project Start Rate 10. Date to End * 10/07/2021 Estinated Construction Project End Cate 11. SIC (Primary)* Residential, Other than SFE (1522) Standard Industrial aassification for Development 12. Acres to be 5.77 disturbed* (including off -site borrow and waste areas) 13. Total site area 62.57 (acres) * 14. Post- 0.50 construction (Estimated) impervious area (acres) * NCC Project NCC-AVERY-2021-Sosne Residence and Farm 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 UT-Shawneehaw Creek Waterbody* Name of waterbody into which stormwater runoff will discharge 15b. Waterbody 8-22-7 Index No. * NCWaterbody Index Narrber 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 * LDE Family Farms, 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 * Adam If Corporation, enter Faegistered Agent First %rre 3. Last Name* Sosne It Corporation, enter Pbegistered Agent Last %rre 3b. Title Member/Manager 4. Permitee E-mail adam@mcadamshomes.net Address* 5. Permittee 910-264-4824 Telephone No.* 6. Permittee Mailing Street Address Address* 6626-C Gordon Road Address Line 2 City Wilmington Fbstal / Zip Code 28411 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* 6626-C Gordon Road Address Line 2 City State / Frovince / Faegion Wilmington NC Fbstal / Zip Code Country 28411 USA 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 Jeff Contact - First Name * 2. Primary Site Harbinson Contact - Last Name * 3. Title Architect 4. Site Contact E- jeff@harinsonarchitects.com mail Address* 5. Site Contact 336-692-5577 Telephone No. 6. Organization Name 7. Site Contact Street Address Mailing Address* 1311 Brookstown Avenue Southwest Address Line 2 City Winston-Salem Postal / Zip Code 27101-1124 8. Consultant Name (Optional) Carrie Caviness First and Last nacre 9. Consultant E-mail carrie.caviness.1@gmail.com This person will be copied on all correspondence. 10. Consultant 919-656-4543 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) adam@mcadamshomes.net Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 910-264-4824 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 07/01/2021 Approved * 2. E&SC Plan Project Avery-2-21-002 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 * Asheville (ARO) 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 LOAwM (7-1-2021).pdf Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Mist be RDFforrret (lint 20 NB) 797.62KB Overview Map - Walker Pond_07.02.2021.pdf 4.1 MB 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 NOI Cert Form_ Sosne_07.02.2021.pdf 425.56KB Form Must be RDF format 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 Type Name * Adam Sosne Title Member/Manager Organization Legally Plesponsible Entity LDE Family Farms, LLC. Date * 07/02/2021 F. Tracking and COC Info NOI Tracking No. 58234 NC Reference No. NCG01-2021-3945 Uses 'count_nurber' variable (increrrented by SP) Certificate of NCC213945 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 3945 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. NCC213945-2021 Invoice Due Date 8/1/2021 Initial Fee $ 100.00 Invoice Status OPEN