HomeMy WebLinkAboutNCC192282_NOI Application_20191011Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/10/2019 11:38:02 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 10/10/2019 11:58:52 AM (Review- Construction NOI 17000)
In Correct project number. ONSLO-2020-015. The submitted project number is sufficient to identify the
site.
• Georgoulias, Bethany reassigned the task to Garcia, Lauren V 10/10/2019 11:40 AM
* LG -1 think this is the one you were waiting for resubmittal of.
• The task was assigned to McCoy, Suzanne by round robin distribution 10/10/2019 11:38 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 14, 2019 5:00
PM. The priority is: High 10/10/2019 11:38 AM
Submit by McCoy, Suzanne 10/11/2019 7:58:48 AM (Payment Verification for NCC192282)
* Joel Smith
• McCoy, Suzanne assigned the task to McCoy, Suzanne 10/11/2019 7:58 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 21, 2019 5:00
PM. The priority is: High 10/10/2019 11:58 AM
STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Piney Green Rd
2. County* Onslow
3. Highway or Street Piney Green Rd
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Jacksonville
5. State * NC
117-8) TiT 7i1) M F1Ii f_TiI a 10141
6. Zip Code* 28540
7. Latitude * Enter the latitude in decirral degrees
34.7158
8. Longitude * Enter the longitude in decirral degrees (WISTbe negative)
-77.3205
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* 10/17/2019
Estimated Construction Project Start Date
10. Date to End* 02/27/2020
Estimated Construction Project End Date
11. SIC (Primary)* Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be 10.70
disturbed* (including off -site borrow and waste areas)
13. Total site area
10.70
(acres)*
14. Post-
0.00
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-ONSLO-2019-Piney Green Rd
Tracking ID
Assigned autorratically
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 Northeast Creek
Waterbody* Nbrre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 19-16-(0.5)
Index No. * NCWaterbody Index Number
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Little Northeast Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 19-16-2
Index No. NCWaterbody Index Narrber
15e. Additional Mott Creek
Receiving Waterbody narre
Waterbody
15f. Waterbody 19-16-3
Index No. NCWaterbody Index Narrber
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.
Perrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
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 Piedmont Natural Gas/Duke Energy
Name *
2. First Name* Joseph
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Keily
If Corporation, enter Registered Agent Last Barre
3b. Title Distribution Project Specialist
4. Permitee E-mail joe.keily2@duke-energy.com
Address*
5. Permittee 910-358-0537
Telephone No.*
6. Permittee Mailing Street Address
Address* 401 Executive Parkway
Address Line 2
City
New Bern
Postal / Zip Code
28562-9795
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
fJ Yes
Street Address
401 Executive Parkway
Address Line 2
City
New Bern
Fbstal / Zip Code
28562-9795
State / Province / Region
NC
Country
us
State / Province / Region
NC
Country
us
C. Site Contact Information
Part C.
Proiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Joseph
Contact - First
Name *
3. Primary Site Keily
Contact - Last
Name *
4. Title DPS
5. Site Contact E-
joe.keily2@duke-energy.com
mail Address*
6. Site Contact
910-358-0537
Telephone No.*
7. Organization
Piedmont Natural Gas
Name
8. Site Contact
Street Address
Mailing Address*
401 Executive Parkway
Address Line 2
city
New Bern
R>stal / Zip Code
28562-9795
9. Consultant Name (optional)
Joel Smith
First and Last narre
10. Consultant E- joel.smith@eli-Ilc.com
mail This person will be copied on all correspondence.
11. Consultant (919)234-1974
Telephone No.
State / Province / Region
NC
Country
us
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 10/01/2019
Approved *
2. E&SC Plan Project ONSLO-2020-15
Number/ID* Assigned by agency or local program
3. E&SC Plan f• 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.
5. E&SC Plan ONSLO-2020-015 Approval 10-01-2019.pdf 272.05KB
Approval Mist be R7Ffornat
letter/documentation
6. NOI Certification PDF File NOI Form.pdf 495.77KB
Form Mist be RDFfornat
This is an Express r No
Review Project* r Yes
E. Certification
North Carolina General Statute 143-215.613 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes 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 deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
rJ 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.
* I7 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:* r The Responsible Person named on this Notice of Intent
r Authorized Responsible Person*
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
01 r {�
Type Name *
Joseph Keily
Title
Distribution Project Specialist
Organization
Piedmont Natural Gas
Date *
10/10/2019
F. Tracking and COC Info
NOI Tracking No. 17000
NC Reference No. NCG01-2019-2282
Uses 'count number variable (incremrented by SP)
Certificate of NCC192282
Coverage (COC) Uses 'count nunber variable (increrrentedbySP)
No. *
Count Number 2282
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)