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HomeMy WebLinkAboutNCC214535_NOI Application_20210811 Action History (UTC-05:00)Eastern Time(US&Canada) Subrrit by Anonymous User 8/9/2021 10:39:07 AM(NCG01 NOI Submission) Approve by Broussard, Brooklyn C 8/9/2021 11:01:54 AM(Review-Construction NOI 61669) • The task was assigned to Broussard, Brooklyn C by round robin distribution 8/9/2021 10:40 AM • The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:August 11,2021 5:00 PM.The priority is: High 8/9/2021 10:40 AM Submit by McCoy, Suzanne 8/11/2021 12:41:25 PM(Payment Verification for NCC214535) * WS Parks Contracting LLC • McCoy,Suzanne assigned the task to McCoy, Suzanne 8/11/2021 12:40 PM • The task was assigned to DEMLR NCG01 Payment Team.The due date is: September 20,2021 5:00 PM.The priority is: High 8/9/2021 11:02 AM �ThF1 1Construction Stormwater: Notice of Intent (NOI) National Pollutant Discharge Eliminatio em 'D application forcoverage under NorthCarolina's General Permit 1 1111:STORIMATER DISCHARGES associated with construction activities(or NORTH CAROLINA Enrlrnnmenfu�Qr�arlry 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 61656 NOI No. Prior Reviewer Brooklyn Broussard Name 1a. Project Name* Dogwood Family Campground 1 b.Specific Lot This field may be used to list specifc lot nunbers. Numbers 1 c. Parcel ID List all RNs associated w ith this project. Number(s)(PIN) 631904623812000 631904724461000 2.County* Carteret 3. Highway or Street 815 Lake Rd. Address* Street name only is acceptable if no address nunber assigned yet 4.City or Township* Newport 5.State* NC 6.Zip Code* 28570 7. Latitude* Enter the latitude in decinal degrees 34.8100 8. Longitude* Enter the longitude in decimal degrees(MJSTbe negative) -76.9390 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* 08/11/2021 Estimated Construction Project Start Date 10. Date to End* 03/31/2022 Estimated Construction Project End Cate 11.SIC(Primary)* Commercial (1542) Standard Industrial Classification for Development 12.Acres to be 10.20 disturbed* (including off-site borrow and waste areas) 13.Total site area 18.02 (acres)* 14. Post- 2.60 construction (Estimated) impervious area (acres)* Project Tracking ID NCC-CARTE-2021-Dogwood Family Campground Assigned automatically(not used) 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 Little Run Waterbody* Name of waterbody into which stormwater runoff will discharge 15b.Waterbody 21-2-1 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. ^ Fl rnittee 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* LS Family Investments, 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* William If Corporation,enter Faegistered Agent First%rre 3. Last Name* Parks It Corporation,enter F;bgistered Agent Last%rre 3b.Title Member/Manager 4. Permitee E-mail wsparkscontracting@ec.rr.com Address* 5. Permittee 252-659-2032 Telephone No.* 6. Permittee Mailing Street Address Address* PO Box699 Address Line 2 City State/Frovince/Region Newport NC Fbstal/Zip Code Country 28570 Carteret Check box if the F Yes street address the same as mailing address 7. Permittee Street Street Address Address* 308 Nine Foot rd. Address Line 2 City State/Frovince/Faegion Newport NC Postal/Zip Code Country 28570 Carteret 8.Type of ONnership 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 Shawn Contact-First Name* 2. Primary Site Parks Contact-Last Name* 3.Title Member/Manager 4.Site Contact E- wsparkscontracting@ec.rr.com mail Address* 5.Site Contact 252-659-2032 Telephone No.* 6.Organization WS Parks Contracting, LLC Name 7.Site Contact Street Address Mailing Address* PO Box699 Address Line 2 CRY State/Rovince/Region Newport NC Postal/Zip Code Country 28570 Carteret 8. Consultant Name (Optional) Gary MacConnell First and Last nacre 9. Consultant E-mail gary.macconnell@macconnellandassoc.com This person will be copied on all correspondence. 10. Consultant 919-467-1239 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) wsparkscontracting@ec.rr.com Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 252-659-2032 Default is legally responsible person telephone D. E&SC Plan Part D. ^ Erosion&Sediment Control(E&SC)Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 05/06/2021 Approved* 2. E&SC Plan Project CARTE-2021-013 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* Wilmington (WiRO) 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 Erosion&Sedimentation Permit Approval 5-6- Approval letter or 239.23KB 2021.pdf Grading Permit Mast be FDFforrrat 6.Site Location Map Mist be RDFfornat(linit 201VB) E&SC-Site Location Map.pdf 1.44MB 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 E&SC-NOI Certification Form.pdf 833.13KB Form Mist be RDFfornat This is an Express f No Review Project* r Yes E. Certification North Carolina General Statute 143-215.66(1) provides that: Anyperson who knowinglymakes any false statement,representation,or certification in anyapplication,record,report,plan,or other documentfiled 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 underthis 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 guiltyofa Class 2 misdemeanor which mayinclude 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:* 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 4 /�x C til Type Name* W. Shawn Parks Title Member/Manager Organization Legally Pesponsible Entity LS Family Investments, LLC Date* 08/09/2021 F. Tracking and COC Info NOI Tracking No. 61669 NC Reference No. NCG01-2021-4535 Uses'count_nurrber'variable(increrrented by SP) Certificate of NCC214535 Coverage (COC) Uses'count_nurrber'variable(increrrented by SP) No.* Count Number 4535 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. NCC214535-2021 Invoice Due Date 9/8/2021 Initial Fee $ 100.00 Invoice Status OPEN