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HomeMy WebLinkAboutNCC220097_NOI Application_20220106Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 1/5/2022 7:34:52 AM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 1/5/2022 8:37:47 AM (Review - Construction NOI 77573) • The task was assigned to Broussard, Brooklyn C by round robin distribution 1/5/2022 7:35 AM • The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 7, 2022 5:00 PM 1/5/2022 7:35 AM Submit by Selkane, Aziza 1/6/2022 9:03:06 AM (Payment Verification for NCC220097) P Daniel Bree • Selkane, Aziza assigned the task to Selkane, Aziza 1/6/2022 9:01 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 16, 2022 5:00 PM 1/5/2022 8:37 AM NORTH CAROLINA RrwY mrlm&tral Qualrly A. Project Information Part A. Project Location and Waterbody Information ............................................................................................................................................................................................................................................................................................................................................................................................... Are you submitting No an NOI that was • Yes rejected before? Previous Rejected 77332 NOI No. Prior Reviewer Name Brooklyn Broussard la. Project Name* 2067 SIMPLICITY ROAD 1 b. Specific Lot This field may be used to list specifc lot numbers. Numbers 1 c. Parcel ID List all PINs associated with this project. Number(s) (PIN) 5548008368000 2. County* Cabarrus 3. Highway or Street 2067 SIMPLICITY ROAD Address* Street name only is acceptable if no address number assigned yet 4. City or Township* CONCORD 5. State* NC 6. Zip Code* 28025 7. Latitude* Enter the latitude in decimal degrees 35.3329 8. Longitude* Enter the longitude in decimal degrees (MUST be negative) -80.5404 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* 01/10/2022 Estimated Construction Project Start Date 10. Date to End* 12/31/2024 Estimated Construction Project End Date 11. SIC (Primary) * Other (9999) Standard Industrial Classification for Development 12. Acres to be 36.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 60.04 (acres) * 14. Post -construction 36.00 impervious area (Estimated) (acres)* Project Tracking ID NCC-CABAR-2022-2067 SIMPLICITY ROAD 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 IRISH BUFFALO CREEK Waterbody * Name of waterbody into which stormwater runoff will discharge 15b. Waterbody Index 13-17-9-(2) No. * NC Waterbody Index Number Stormwater No discharges will flow Yes to additional waters* 16a. Is this project Yes subject to the NC No, not subject to NC SPCA Sediment Pollution Control Act?* B. Permittee Information Part B. Permittee Information - Legally Responsible 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item (6) of that permit. 1. Permittee* Legally Responsible Entity SEALAND CONTRACTORS CORP. If permittee is an individual, enter first and last name in this field. Otherwise, enter organization/business name. Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the registration here. Permittee must be the same entity that is responsible for the land -disturbing activity as listed on the NC SPCA Financial Responsibility/Ownership (FRO) Form. 2. First Name* DANIEL If Corporation, enter Registered Agent First Name 3. Last Name* BREE If Corporation, enter Registered Agent Last Name 3b. Title PRESIDENT 4. Permitee E-mail vjd@sealandcontractors.com Address* 5. Permittee 7046347584 Telephone No.* 6. Permittee Mailing Street Address Address* 1708 North Caldwell Street Address Line 2 City State / Province / Region Charlotte NC Postal / Zip Code Country 28206-3464 US Check box if the Yes street address the same as mailing address 7. Permittee Street Street Address Address* 2067 Simplicity Road Address Line 2 City State / Province / Region Concord NC Postal / Zip Code Country 28025 US 8. Type of Ownership is only individual if an individual is named in B.1. above. Ownership* Non -Government C. Site Contact Information Part C. Project Site Contact Information 1. Primary Site ERIC Contact - First Name* 2. Primary Site PRESSLEY Contact - Last Name* 3. Title MANAGER 4. Site Contact E-mail MEPRESSLEY@SEALANDCONTRACTORS Address* COM 5. Site Contact 7046224987 Telephone No.* 6. Organization Name SEALAND CONTRACTORS CORP. 7. Site Contact Street Address Mailing Address* 1708 North Caldwell Street Address Line 2 City Charlotte Postal / Zip Code 28206-3464 8. Consultant Name (optional) First and Last name 9. Consultant E-mail This person will be copied on all correspondence. 10. Consultant Telephone No. 11. Billing E-mail (For Annual Fee correspondence) vjd@sealandcontractors.com Default is legally responsible person e-mail 12. Billing Telephone (For Annual Fee correspondence) 7046347584 Default is legally responsible person telephone State / Province / Region NC Country us D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Plan Approval Information 1. Date E&SC Plan 12/20/2021 Approved * 2. E&SC Plan Project CABAR-2022-032 Number/ID* Assigned by agency or local program 3. E&SC Plan State DEQ Office Approved by* Local Program 4. State DEQ Office* Mooresville (MRO) 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 LETTER OF APPROVAL.pdf 140.01 KB Approval letter or Must be PDF format Grading Permit 6. Signed FRO Financial Responsibility/Ownership Form SIGNED FRO.pdf 81.38KB Must be PDF format 7. Site Location Map Must be PDF format (limit 20 MB) SEDIMENT & EROSION DOC.pdf 77.07KB Please do not upload entire set of E&SC plans. 8. Notes (Optional) Provide any additional information that might help the reviewer better understand how uploaded documents support the application. Include additional waterbodies if necessary. 9. NOI Certification NOI.pdf 58.05KB Form Must be PDF format This is an Express • No Review Project* Yes E. Certification North Carolina General Statute 143-215.613 (i) provides that: Any person who knowingly makes any false 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 Article; 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 Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). Under penalty of law, I certify that: * 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. * 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. * I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control Plan. * 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:* The Legally Responsible Person named on this Notice of Intent 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 b,4 ICZ 3WEC Type Name* DANIEL BREE Title PRESIDENT Organization Legally Responsible Entity SEALAND CONTRACTORS CORP Date * 01 /05/2022 F. Tracking and COC Info NOI Tracking No. 77573 NC Reference No. NCG01-2022-0097 Uses'count_numb& variable (incremented by SP) Certificate of NCC220097 Coverage (COC) No.* Uses'count_number' variable (incremented by SP) Count Number 97 Sequential number for submittal that is incremented by Stored Procedure COC Year 2022 Year of date reviewed (used to assign YY digits after "NCC" in COC no.) Initial Invoice No. NCC220097-2022 Invoice Due Date 2/4/2022 Initial Fee $ 100.00 Invoice Status OPEN