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HomeMy WebLinkAboutNCC211860_NOI Application_20210329Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 3/23/2021 1:47:25 PM (NCG01 NOI Submission) Approve by Clark, Paul 3/25/2021 11:07:33 AM (Review- Construction NO148401) • Gamble, Aana C reassigned the task to Clark, Paul 3/24/2021 8:40 AM • The task was assigned to Gamble, Aana C by round robin distribution 3/23/2021 1:48 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 25, 2021 5:00 PM 3/23/2021 1:48 PM Submit by Selkane, Aziza 3/29/2021 2:20:33 PM (Payment Verification for NCC211860) p There were 4 checks used to pay this permit, each check is for $25. The four checks used are 283415, 283416, 283417, and 283419. All checks vere received from County of Columbus. • Selkane, Aziza assigned the task to Selkane, Aziza 3/29/2021 2:17 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 6, 2021 5:00 PM 3/25/2021 11:07 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 48112 NOI No. Prior Reviewer Paul Clark Name 1a. Project Name * Columbus County -Water and Sewer Districts I, II, III & V - Water System Improve 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) 0261.00-83-9440.000 2. County* Columbus 3. Highway or Street Various - US Hwy 74/76, SR Address* 1311,1401,1317,1558,1585,1586,1457,1749 & N. Lakes Road Street name only is acceptable if no address number assigned yet 4. City or Township* Chadbourn, Cerro Gordo, Nakina 5. State * NC 6. Zip Code* 28472 7. Latitude* Enter the latitude in decimal degrees 34.2849 8. Longitude * Enter the longitude in decimal degrees (MBTbe negative) -78.8378 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* 04/05/2021 Estimated Construction Project Start Date 10. Date to End* 12/31/2021 Estimated Construction Project End Cate 11. SIC (Primary)* Other (9999) Standard Industrial aassification for Development 12. Acres to be 8.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 50.00 (acres) * 14. Post- 0.01 construction (Estimated) impervious area (acres) * NCC Project NCC-COLUM-2021-Columbus County -Water and Sewer Districts I, Tracking ID II, III & V - Water System Improve Assigned automatically 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 Water Branch Waterbody* Narreof waterbody into which stormwater runoff will discharge 15b. Waterbody 14-27-2 Index No. * NCWaterbody Index Number Stormwater F No discharges will flow 17 Yes to additional wate rs * 15c. Additional Pine Log Branch Receiving Waterbody narre Waterbody 15d. Waterbody 15-4-8-7 Index No. NCWaterbody Index Number 15e. Additional Mill Branch Receiving Waterbody narre Waterbody 15f. Waterbody 15-4-4 Index No. NCWaterbody Index Number 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 * Columbus County IF 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 * Ricky IF Corporation, enter Faegistered Agent First %rre 3. Last Name* Bullard IF Corporation, enter Fbgistered Agent Last %rre 3b. Title Chairman, Columbus County Board of Commissioners 4. Permitee E-mail gedwards@columbusco.org Address* 5. Permittee 910-640-6600 Telephone No.* 6. Permittee Mailing Street Address Address* 111 Washington Street Address Line 2 City Whiteville Fbstal / Zip Code 28472 Check box if the street address the same as mailing address 7. Permittee Street Address* F Yes Street Address 111 Washington Street Address Line 2 city Whiteville Fbstal / Zip Code 28472 State / Ffovince / Fbgion NC Country United States State / Frovince / Region NC Country United States 8. Type of Ojvnership is only individual if an individual is naned in B.1. above. Ownership* Government -County C. Site Contact Information Part C. Roject Site Contact Inforrration ..................................................................................................................................................................................................................................... 1. Primary Site Gail Contact - First Name * 2. Primary Site Edwards Contact - Last Name * 3. Title Assistant to County Manager / CFO 4. Site Contact E- gedwards@columbusco.org mail Address* 5. Site Contact 910-640-6600 Telephone No. 6. Organization Columbus County, North Carolina Name 7. Site Contact Street Address Mailing Address* 111 Washington Street Address Line 2 city State / Rovince / Region Whiteville NC Fbstal / Zip Code Country 28472 United States 8. Consultant Name (Optional) W Landon Younce PE / Green Engineering, PLLC First and Last narre 9. Consultant E-mail I.younce@greeneng.com This person will be copied on all correspondence. 10. Consultant 252-237-5365 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) gedwards@columbusco.org Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 910-640-6600 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 11/18/2020 Approved * 2. E&SC Plan Project COLUM-2021-005 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 COLUM-2021-005 EandS Approval WD 1 II III and V Approval letter or 289.71KB 11-18-2020.pdf Grading Permit Mast be FCFfon-rat 6. Site Location Map Wst be RDFforrret (lint 201VB) COLUM Co Location Map WD 1 11 111 V.pdf 1.51 MB 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. eNO1 no. 48112........ Part A- Nos. 15c. 15d - water with index no. 15-4-8-7 is Pine Log Formerly Rejected due to Branch on NC Surface Water Classifications Map. Site location map indicates other water(s) that may be impacted, please note those as well. 3 Waters have now been reflected on the updated form. There are more.......... Uncles Branch, Index No. 14-27-3.......... Grissett Swamp (Lake Tabor), Index No. 15-17-1-(1) (in Tabor City)......... and Sand Pit Branch, Index No. 15-13-1-2 (in Nakina) 8. NOI Certification NOI Certification- Col.Cnty- Water and Sewer District Form I,II,III & V-Water System Improvements- 497.34KB 03232021132943. pdf Mist be RDFformat This is an Express r 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* Ricky Bullard Title Chairman, Columbus County Board of Commissioners Organization Legally Plesponsible Entity Columbus County, North Carolina Date * 03/23/2021 F. Tracking and COC Info NOI Tracking No. 48401 NC Reference No. NCG01-2021-1860 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC211860 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 1860 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. NCC211860-2021 Invoice Due Date 4/24/2021 Initial Fee $ 100.00 Invoice Status OPEN