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HomeMy WebLinkAboutNCC214938_NOI Application_20210830Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 8/30/2021 7:55:53 AM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 8/30/2021 8:08:41 AM (Review- Construction NOI 63233) . The task was assigned to Broussard, Brooklyn C by round robin distribution 8/30/2021 7:56 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 1, 2021 5:00 PM. The priority is: High 8/30/2021 7:56 AM Submit by Miller, Ariyelle L 8/30/2021 10:52:44 AM (Payment Verification for NCC214938) * Island Pet Mobile Services • Miller, Ariyelle L assigned the task to Miller, Ariyelle L 8/30/2021 10:47 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 11, 2021 5:00 PM. The priority is: High 8/30/2021 8:09 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 63165 NOI No. Prior Reviewer Brooklyn Broussard Name 1a. Project Name * Island Pet Veterinary Hospital & Animal House 1 b. Specific Lot This field may be used to list specifc lot nunbers. Numbers Lot 1 1 c. Parcel ID List all RW associated w ith this project. Number(s) (PIN) 538405086660000 2. County* Carteret 3. Highway or Street 110 Golphin Dolphin Drive Address* Street name only is acceptable if no address number assigned yet 4. Cityor Township* Cape Carteret 5. State * NC 6. Zip Code* 28584 7. Latitude* Enter the latitude in decimal degrees 34.6922 8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative) -77.0688 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* 09/01/2021 Estimated Construction Project Start Date 10. Date to End* 09/01/2022 Estimated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial Classification for Development 12. Acres to be 2.50 disturbed* (including off -site borrow and waste areas) 13. Total site area 2.51 (acres) * 14. Post- 0.73 construction (Estimated) impervious area (acres) * Project Tracking ID NCC-CARTE-2021-Island Pet Veterinary Hospital & Animal House 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 Deer Creek Waterbody* Narreof waterbody into which stormwater runoff will discharge 15b. Waterbody 20-36-1 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 * THIRD EY EHOLDINGS 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 * MICHELLE If Corporation, enter Faegistered Agent First %rre 3. Last Name* COX It Corporation, enter Pbegistered Agent Last %rre 3b. Title PRESIDENT 4. Permitee E-mail ipvhmanagers@gmail.com Address* 5. Permittee 2527028299 Telephone No.* 6. Permittee Mailing Street Address Address* 209 West B McLean Drive Address Line 2 City CAPE CARTERET Fbstal / Zip Code 28584 Check box if the street address the same as mailing address 7. Permittee Street Address* F Yes Street Address 209 West B McLean Drive Address Line 2 City CAPE CARTERET Fbstal / Zip Code 28584 State / Frovince / Fbgion NC Country us State / Frovince / Faegion NC Country us 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 MICHELLE Contact - First Name * 2. Primary Site COX Contact - Last Name * 3. Title PRESIDENT 4. Site Contact E- ipvhmanagers@gmail.com mail Address* 5. Site Contact 2527028299 Telephone No. 6. Organization THIRD EYE HOLDINGS Name 7. Site Contact Street Address Mailing Address* 7904 SOUND DR Address Line 2 City EMERALD ISLE Fbstal / Zip Code 28594 8. Consultant Name (Optional) JOHN FRESHWATER First and Last nacre 9. Consultant E-mail JOHNH2O@GMAIL.COM This person will be copied on all correspondence. 10. Consultant 2525032440 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) ipvhmanagers@gmail.com Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 2527028299 Default is legally responsible person telephone State / Rovince / Region NC Country USA D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 09/21/2020 Approved * 2. E&SC Plan Project CARTE-2021-004 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 APPROVAL LETTER.pdf 421.56KB Approval letter or Mast beRFformat Grading Permit 6. Site Location Map Wst be RDFforrrat (lint 20 NB) Erosion and Sed Control Permitting Site Plan.pdf 655.58KB Rease do not upload entire set of E&SC plans. 7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies if necessary. 8. NOI Certification CCF_001229.pdf 582.08KB Form Wst be RDFforrret This is an Express f 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 * Michelle Cox Title President Organization Legally Pesponsible Entity Third Eye Holdings LLC Date * 08/30/2021 F. Tracking and COC Info NOI Tracking No. 63233 NC Reference No. NCG01-2021-4938 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC214938 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 4938 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. NCC214938-2021 Invoice Due Date 9/29/2021 Initial Fee $ 100.00 Invoice Status OPEN