HomeMy WebLinkAboutNCC192505_NOI Application_20191107Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/24/2019 1:05:13 PM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 10/24/2019 2:41:09 PM (Review- Construction NOI 17657)
• The task was assigned to McCoy, Suzanne by round robin distribution 10/24/2019 1:05 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 28, 2019 5:00
PM. The priority is: High 10/24/2019 1:05 PM
Submit by Garcia, Lauren V 11/7/2019 7:43:05 AM (Payment Verification for NCC192505)
* Shawntrelle D Kast
• Garcia, Lauren V assigned the task to Garcia, Lauren V 11/7/2019 7:42 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 5, 2019 5:00 PM.
The priority is: High 10/24/2019 2:41 PM
STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Q241 NSWG4 Boat Support Facility
2. County* Craven
3. Highway or Street Roosevelt Blvd
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township * Cherry Point
5. State * NC
1r-G)a�T7i)Mfi1if_TiIa10141
6. Zip Code* 28533-0006
7. Latitude * Enter the latitude in decirral degrees
34.9415
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-76.8562
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* 11/04/2019
Estimated Construction Project Start Date
10. Date to End* 11 /04/2020
Estimated Construction Project End Date
11. SIC (Primary)* Industrial (1541)
Standard Industrial aassification for Development
12. Acres to be 2.00
disturbed* (including off -site borrow and waste areas)
13. Total site area
21.50
(acres)*
14. Post-
4.26
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-CRAVE-2019-Q241 NSWG4 Boat Support Facility
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 Neuse
Wate rbody* Barre of waterbody into which stormuater runoff will discharge
15b. Waterbody 27-(104)
Index No.* NC Waterbody Index Narrber
Stormwater W No
discharges will flow F Yes
to additional
wate rs *
16a. Is this project F 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 WAS Cherry Point
Name *
2. First Name* Charles
ff Corporation, enter Registered Agent First l\brre
3. Last Name * Schulz
If Corporation, enter Registered Agent Last Barre
3b. Title Deputies Facilities Director
4. Permitee E-mail charles.e.schulz@usmc.mil
Address*
5. Permittee 2524663148
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box8006
Address Line 2
City
Cherry Point
Postal / Zip Code
28533-0006
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
r Yes
Street Address
Building 1 C Street
Address Line 2
City
Cherry Point
Fbstal / Zip Code
28533-0006
State / Province / Region
NC
Country
United States
State / Province / Region
NC
Country
United States
C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Government - Federal
Ownership*
2. Primary Site Nathan
Contact - First
Name *
3. Primary Site Arnett
Contact - Last
Name *
4. Title Environmental Engineer
5. Site Contact E- nathan.arnett@usmc.mil
mail Address*
6. Site Contact 2524665271
Telephone No.*
7. Organization MCAS Environmental Affairs Department
Name
8. Site Contact Street Address
Mailing Address* Building 4223
Address Line 2
city
Cherry Point
R>stal / Zip Code
28533-0006
9. Consultant Name (optional)
First and Last narre
10. Consultant E- This person will be copied on all correspondence.
mail
11. Consultant
Telephone No.
State / Province / Pegion
NC
Country
United States
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 08/01/2019
Approved *
2. E&SC Plan Project Crave-2020-003
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 * Washington (WaRO)
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 ES Crave-2020-003 Boat Support Facility.pdf 103.12KB
Approval Mast be FDFfornat
letter/documentation
6. NOI Certification Q241 signed.pdf 35.49KB
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
C5,cta�f�
Type Name *
Charles E. Schulz
Title
Deputy Facilities Director by Direction of the Commanding Officer
Organization
MCAS Cherry Point
Date *
10/24/2019
F. Tracking and COC Info
NOI Tracking No. 17657
NC Reference No. NCG01-2019-2505
Uses 'count number variable (incremrented by SP)
Certificate of NCC192505
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 2505
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.)