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HomeMy WebLinkAboutNCC230576_NOI Application_20230314Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 3/2/2023 6:32:04 AM (NCG01 NOI Submission) Approve by Nicole Chiles 3/2/2023 9:19:04 AM (Review - NOI 130236 Lumberton CFA) • The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 7, 2023 5:00 PM. The priority is: High 3/2/2023 6:32:19 AM • The task was assigned to Nicole Chiles by round robin distribution 3/2/2023 6:32:19 AM Submit by Tev.Holloman 3/14/2023 1:35:34 PM (Payment Verification for NCC230576) 0 Carter Engineering Consultants Inc The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 13, 2023 5:00 PM. The priority is: High 3/2/2023 9:19:21 AM • Tev.Holloman assigned the task to Tev.Holloman 3/14/2023 1:32:08 PM R �o NORTH CAROUNA Environmental Quality A. Project Information Part A. Project Location and Waterbody Information Are you submitting an NOI that was rejected before? No Yes 1a. Project Name* Lumberton CFA 1b. Specific Lot Numbers This field may be used to list specifc lot numbers. 1c. Parcel ID Number(s) (PIN) List all PINs associated with this project. 939274709800 2. County* Robeson 3. Highway or Street Address* 3400 North Elm Street Street name only is acceptable if no address number assigned yet 4. City or Township* Lumberton 5. State* NC 6. Zip Code* 28358 7. Latitude* Enter the latitude in decimal degrees 34.6405 8. Longitude* Enter the longitude in decimal degrees (MUST be negative) -79.0077 U 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* 04/15/2023 Estimated Construction Project Start Date 10. Date to End* 11/09/2023 Estimated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial Classification for Development 12. Acres to be 1.20 disturbed* (including off -site borrow and waste areas) 13. Total site area 1.40 (acres) * 14. Post -construction 0.89 impervious area (Estimated) (acres) * Project Tracking ID NCC-ROBES-2023-Lumberton CFA 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 Waterbody* Unnamed tributary to Meadow Branch Creek Name of waterbody into which stormwater runoff will discharge 15b. Waterbody Index No.* 14-12-6-(2) NC Waterbody Index Number Stormwater discharges will flow to additional waters* No Yes 16a. Is this project subject to the NC Sediment Pollution Control Act?* Yes No, not subject to NC SPCA 17. Is this project funded with ARPA (American Rescue Plan Act) grant funds? No Yes This question was added to the eNOI on 1/26/2023 and will not be answered in applications submitted prior to that date. Reviewer may update if status is known. 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 Chick-fil-A, Inc. 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* R Todd If Corporation, enter Registered Agent First Name 3. Last Name* Williams If Corporation, enter Registered Agent Last Name 3b. Title Director 4. Permitee E-mail todd.williams@cfacorp.com Address * 5. Permittee 404-765-8000 Telephone No.* 6. Permittee Mailing Street Address Address * 5200 Buffington Road Address Line 2 City State / Province / Region Atlanta GA Postal / Zip Code Country 30349 USA Check box if the Yes street address the same as mailing address 7. Permittee Street Street Address Address * 5200 Buffington Road Address Line 2 City State / Province / Region Atlanta GA Postal / Zip Code Country 30349 USA 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. Proiect Site Contact Information 1. Primary Site Will Contact - First Name* 2. Primary Site Whitley Contact - Last Name* 3. Title Agent 4. Site Contact E-mail wwhitley@newsouthprop.com Address * 5. Site Contact (704)927-2888 Telephone No.* 6. Organization Name New South Properties of the Carolinas, LLC 7. Site Contact Street Address Mailing Address* 1518 E. Third Street, Suite 200 Address Line 2 City Charlotte Postal / Zip Code 28204 8. Consultant Name (Optional) Mark Campbell First and Last name 9. Consultant E-mail mark@carterengineering.net This person will be copied on all correspondence. 10. Consultant (77) 725-1200 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) todd.williams@cfacorp.com Default is legally responsible person e-mail 12. Billing Telephone (For Annual Fee correspondence) 404-765-8000 Default is legally responsible person telephone State / Province / Region NC Country USA D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Plan Approval Information ...................................................................................................................................................................... 1. Date E&SC Plan 02/22/2023 Approved * 2. E&SC Plan Project ROBES-2023-029 Number/ID * Assigned by agency or local program 3. E&SC Plan State DEQ Office Approved by* Local Program 4. State DEQ Office* Fayetteville (FRO) 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 robes-2023-029exap.pdf Approval letter or Must be PDF format Grading Permit 792.03KB 6. Signed FRO Financial Responsibility/Ownership Form FINANCIAL RESPONSIBILITYOWNERSHIP FORM 2.43MB - Lumberton.pdf Must be PDF format 7. Site Location Map Must be PDF format (limit 20 MB) 05185.SITE.LOCATION.MAP.pdf 249.96KB 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 NCG01 Notice of Intent (NOI) Certification Form Form 428.63KB (Lumberton CFA).pdf Must be PDF format This is an Express No Review Project* Yes E. Certification North Carolina General Statute 143-215.613 (1) 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 %/0P WkL./AAtS Type Name* R. Todd Williams Title Director Organization Legally Responsible Entity Chick-fil-A, Inc. Date * 03/02/2023 F. Tracking and COC Info NOI Tracking No. 130236 NC Reference No. NCG01-2023-0576 Indicates NCG01 or NCG25. Uses NOI number until approved, then uses NUMBER incremented by SP (passed from workflow if eNOI approved) Certificate of NCC230576 Coverage (COC) No.* Uses NOI number until approved, then uses NUMBER incremented by SP (formatted and passed from workflow if eNOI approved) Initial Invoice No. NCC230576-2023 Invoice Due Date 4/1/2023 Initial Fee $ 100.00 Invoice Status OPEN