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HomeMy WebLinkAboutNCC222105_NOI Application_20220607Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 6/3/2022 1:17:14 PM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 6/6/2022 6:53:13 AM (Review - NOI 93458 Bailey's Forest Phase III) F • The task was assigned to Broussard, Brooklyn C by round robin distribution 6/3/2022 1:17 PM • The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 8, 2022 5:00 PM 6/3/2022 1:17 PM by Workflow 6/6/2022 6:53:24 AM (Workflow Start Event) Submit by Selkane, Aziza 6/7/2022 9:09:29 AM (Payment Verification for NCC222105) F South Creek Construction Inc • Selkane, Aziza assigned the task to Selkane, Aziza 6/7/2022 9:08 AM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 18, 2022 5:00 PM 6/6/2022 6:53 AM �a NORTH CAROLINA, Enri--tn! C2-1;ly A. Project Information Part A. Project Location and Waterbody Information Are you submitting No an NOI that was • Yes rejected before? Previous Rejected 93370 NOI No. Prior Reviewer Name Brooklyn Broussard la. Project Name* Bailey's Forest Phase III 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) 00754359, 00754373, 00754106 2. County* Mecklenburg 3. Highway or Street 22010 Molly Harper Drive Address* Street name only is acceptable if no address number assigned yet 4. City or Township* Cornelius 5. State* NC 6. Zip Code* 28031 7. Latitude* Enter the latitude in decimal degrees 35.4650 8. Longitude* Enter the longitude in decimal degrees (MUST be negative) -80.8130 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* 06/06/2022 Estimated Construction Project Start Date 10. Date to End* 05/01/2023 Estimated Construction Project End Date 11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521) Standard Industrial Classification for Development 12. Acres to be 5.70 disturbed* (including off -site borrow and waste areas) 13. Total site area 6.50 (acres) * 14. Post -construction 1.75 impervious area (Estimated) (acres)* Project Tracking ID NCC-MECKL-2022-Bailey's Forest Phase III 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 South Prong West Branch Rocky River Waterbody * Name of waterbody into which stormwater runoff will discharge 15b. Waterbody Index 13-17-3-1 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 Bluestream Partners, LLC 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* Jacob If Corporation, enter Registered Agent First Name 3. Last Name* Palillo If Corporation, enter Registered Agent Last Name 3b. Title Manager 4. Permitee E-mail jpalillo@aol.com Address* 5. Permittee 704.363.7902 Telephone No.* 6. Permittee Mailing Street Address Address* 19520 West Catawba Avenue Address Line 2 Suite 200 City State / Province / Region Cornelius NC Postal / Zip Code Country 28031 us Check box if the Yes street address the same as mailing address 7. Permittee Street Street Address Address* 18611 Starcreek Drive Address Line 2 City State / Province / Region Cornelius NC Postal / Zip Code Country 28031-9328 us 8. Type of Ownership is only individual if an individual is named in B.A. above. Ownership* Non -Government C. Site Contact Information Part C. Project Site Contact Information ................................................................................................................................................................................................................................................................................................................................................................................................. 1. Primary Site Jacob Contact - First Name* 2. Primary Site Palillo Contact - Last Name* 3. Title 4. Site Contact E-mail jpalillo@aol.com Address* 5. Site Contact Telephone No.* 6. Organization Name 7. Site Contact Mailing Address* 704.895.0606 Street Address 18611 Starcreek Drive Address Line 2 City Cornelius Postal / Zip Code 28031-9328 8. Consultant Name (optional) Robert Hayes First and Last name 9. Consultant E-mail Robert.Hayes@bolton-menk.com This person will be copied on all correspondence. 10. Consultant 336.601.3756 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) jpalillo@aol.com Default is legally responsible person e-mail 12. Billing Telephone (For Annual Fee correspondence) 704.895.0606 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 05/23/2022 Approved * 2. E&SC Plan Project 425216 Number/ID* Assigned by agency or local program 3. E&SC Plan State DEQ Office Approved by* • Local Program 4. Local Program* Mecklenburg County 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 PCO5 Approval #425216.pdf 153.27KB Approval letter or Must be PDF format Grading Permit 6. Signed FRO Financial Responsibility/Ownership Form Bailey's Forest Phase III - Financial Responsibility 523.3KB Fo rm_s ig ned_rev 1. pdf Must be PDF format 7. Site Location Map Must be PDF format (limit 20 MB) Site Location Map.pdf 239.78KB 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. Robert Hayes has confirmed that the address used from PID # 00754359 from local Polaris 3G web site (https://polaris3g.mecklenburgcountync.gov/#mat=594690&pid=007 54359&gisid=00754359) and coordinates to match this location. 9. NOI Certification Bailey's Forest Phase III - NOI Certification Form.pdf 38.06KB 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. * If the Erosion and Sediment Control Plan approved by the delegated program is not compliant with Part II (Stormwater Pollution Prevention Plan) of the NCG010000 General Permit, I will nonetheless ensure that all conditions of Part II of the permit are met on the project at all times. * 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 Type Name* Jacob Palillo Title Manager Organization Legally Responsible Entity Bluestream Partners, LLC Date * 06/03/2022 F. Tracking and COC Info NOI Tracking No. 93458 NC Reference No. NCG01-2022-2105 Indicates NCG01 or NCG25. Uses NOI number until approved, then uses NUMBER incremented by SP (passed from workflow if eNOI approved) Certificate of NCC222105 Coverage (COC) No.* Uses NOI number until approved, then uses NUMBER incremented by SIP (formatted and passed from workflow if eNOI approved) Initial Invoice No. NCC222105-2022 Invoice Due Date 7/6/2022 Initial Fee $ 100.00 Invoice Status OPEN