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HomeMy WebLinkAboutNCC215300_NOI Application_20210927Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 9/20/2021 5:25:59 PM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 9/24/2021 11:53:14 AM (Review- Construction NOI 65304) • The task was assigned to Broussard, Brooklyn C by round robin distribution 9/20/2021 5:26 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 22, 2021 5:00 PM. The priority is: High 9/20/2021 5:26 PM Submit by Selkane, Aziza 9/27/2021 11:13:54 AM (Payment Verification for NCC215300) * Schoolhouse Development LLC • Selkane, Aziza assigned the task to Selkane, Aziza 9/27/2021 11:12 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 5, 2021 5:00 PM. The priority is: High 9/24/2021 11:53 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 65057 NOI No. Prior Reviewer Brooklyn Broussard Name 1a. Project Name * American Leadership Academy 1 b. Specific Lot This field rray be used to list specifc lot numbers. Numbers 1 c. Parcel ID List all R% associated w ith this project. Number(s) (PIN) 17JO8004 2. County* Johnston 3. Highway or Street 3770 US Hwy 70 Bus. Address* Street name only is acceptable if no address number assigned yet 4. CityorTownship* Clayton 5. State * NC 6. Zip Code* 27520 7. Latitude* Enter the latitude in decimal degrees 35.5621 8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative) -78.3877 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* 10/01/2021 Estimated Construction Project Start Date 10. Date to End* 08/01/2022 Estimated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial Classification for Development 12. Acres to be 30.50 disturbed* (including off -site borrow and waste areas) 13. Total site area 47.87 (acres) * 14. Post- 18.97 construction (Estirrated) impervious area (acres) * Project Tracking ID NCC-JOHNS-2021-American Leadership Academy 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 Poplar Creek Waterbody* %rreof waterbody into which storrrwater runoff will discharge 15b. Waterbody 27-41-1 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. 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 must 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. Permittee * Legally Pesponsible Entity Johnston CD, LLC It pernittee is an individual, enter first and last narre in this field. Otherwise, enter organization/business narre. Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the registration here. 2. First Name * Scott If Corporation, enter Faegistered Agent First Wre 3. Last Name* Brand It Corporation, enter F;bgistered Agent Last %rre 3b. Title Owner / Manager 4. Permitee E-mail jim@schooldev.us Address* 5. Permittee 702-528-1514 Telephone No.* 6. Permittee Mailing Street Address Address* 3115 East Lion Lane Address Line 2 Suite 300 Cty Salt Lake City Fbstal / Zip Code 84121 Check box if the street address the same as mailing address 7. Permittee Street Address* V Yes Street Address 3115 East Lion Lane Address Line 2 Suite 300 city Salt Lake City Fbstal / Zip Code 84121 State / Ffovince / Fbgion Utah Country us State / Frovince / Region Utah 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 Jim Contact - First Name * 2. Primary Site Way Contact - Last Name * 3. Title Principal Project Manager 4. Site Contact E- jim@schooldev.us mail Address* 5. Site Contact 702-528-1514 Telephone No. 6. Organization Johnston CD, LLC Name 7. Site Contact Street Address Mailing Address* 10320 Durant Road Address Line 2 Suite 101 city Raleigh Fbstal / Zip Code 27614-6466 8. Consultant Name (Optional) David PoWen First and Last narre 9. Consultant E-mail dpowlen@littleonline.com This person will be copied on all correspondence. 10. Consultant 7045613472 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) jim@schooldev.us Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 702-528-1514 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 09/15/2021 Approved * 2. E&SC Plan Project JOHNS-2022-017 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 JOHNS-2022-017_20210915_LOA.pdf 317.48KB Approval letter or Mast beRDFformal Grading Permit 6. Signed FRO Financial Pesponsibility/Ojvnership Form Financial Responsibility Form —ALA Johnston.pdf 1.07MB Mast be RDFfornal 7. Site Location Map Mast be RDFforrrat (lirrit 20IVB) Site Location Map ALA Johnston.pdf 216.47KB Rease do not upload entire set of E&SC plans. 8. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support the application. Include additional w aterbodies if necessary. 9. NOI Certification Johnston NC DEMLR NOI 9-16-21.pdf 362.98KB Form Mast be R7Ffon-rat 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 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 5,C077—� Type Name * Scott Brand Title Onwer/Manager Organization Legally Plesponsible Entity Johnston CD LLC Date * 09/20/2021 F. Tracking and COC Info NOI Tracking No. 65304 NC Reference No. NCG01-2021-5300 Uses 'count_nunber' variable (increrrented by SP) Certificate of NCC215300 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 5300 Sequential nunber for subnittal 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. NCC215300-2021 Invoice Due Date 10/24/2021 Initial Fee $ 100.00 Invoice Status OPEN