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HomeMy WebLinkAboutNCC202270_NOI Application_20200605Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 5/27/2020 10:51:44 AM (NCG01 NOI Submission) Approve by Farkas, Jim J 5/29/2020 3:10:11 PM (Review- Construction NOI 26155) . The task was assigned to Farkas, Jim J by round robin distribution 5/27/2020 10:51 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 29, 2020 5:00 PM 5/27/2020 10:51 AM Submit by Garcia, Lauren V 6/5/2020 12:11:23 PM (Payment Verification for NCC202270) * Stoltzfus Engineering Inc • Garcia, Lauren V assigned the task to Garcia, Lauren V 6/5/2020 12:09 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 10, 2020 5:00 PM 5/29/2020 3:11 PM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting IT No an NOI that was r Yes rejected before? 1a. Project Name * J & J Tree Farms, LLC LCID Landfill 1 b. Specific Lot This field rray be used to list specifc lot numbers. Numbers 2. County* Rockingham 3. Highway or Street 4358 Ellisboro Road Address* Street narre only is acceptable if no address number assigned yet 4.CityorTownship* Stokesdale 5. State * NC 6. Zip Code * 27357 7. Latitude* Enter the latitude in decimal degrees 36.2686 8. Longitude* Enter the longitude in decimal degrees (M.JST be negative) -80.0070 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* 06/01/2020 Estimated Construction Project Start Date 10. Date to End* 07/01/2022 Estimated Construction Project End Date 11. SIC (Primary) * Other (9999) Standard Industrial aassification for Leveloprrent 12. Acres to be 3.40 disturbed* (including off -site borrow and waste areas) 13. Total site area 324.61 (acres) * 14. Post- 1.00 construction (Estirrated) impervious area (acres) * NCC Project NCC-ROCKI-2020-J & J Tree Farms, LLC LCID Landfill 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 Belews Creek Waterbody* %rre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 22-27-(7.5) Index No.* NCWaterbody Index Number Stormwater V No discharges will flow r 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. ^ Fbrnittee 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 Responsible Entity Name * J & J Tree Farms, LLC It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. 2. First Name * Eeron IF Corporation, enter Registered Agent First %rre 3. Last Name* Dellosa It Corporation, enter F;bgistered Agent Last %ne 3b. Title Managing Member 4. Permitee E-mail galvanized.nc@gmail.com Address* 5. Permittee 336-312-5706 Telephone No.* 6. Permittee Mailing Street Address Address* 4358 Ellisboro Road Address Line 2 226 Highland Drive City State / Frovince / Fbgion Stokesdale NC Fbstal / Zip Code Country 27357 United States Check box if the V Yes street address the same as mailing address 7. Permittee Street Street Address Address* 4358 Ellisboro Road Address Line 2 226 Highland Drive City State / Frovince / Region Stokesdale NC Fbstal / Zip Code Country 27357 United States 8. Type of Non -Government Ownership C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Eeron Contact - First Name * 2. Primary Site Dellosa Contact - Last Name * 3. Title Managing Member 4. Site Contact E- galvanized.nc@gmail.com mail Address* 5. Site Contact 336-312-5706 Telephone No. 6. Organization J & J Tree Farms, LLC Name 7. Site Contact Street Address Mailing Address* Eeron Address Line 2 Dellosa city Stokesdale Fbstal / Zip Code 27357 8. Consultant Name (Optional) Bruce Nooe First and Last nacre 9. Consultant E-mail bruce@seiengineering.com This person will be copied on all correspondence. 10. Consultant 3369040207 Telephone No. State / Rovince / Region NC Country United States D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 05/05/2020 Approved * 2. E&SC Plan Project Rocki-2020-016 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 * Winston-Salem (WSRO) Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a complete application. For linear projects, please also upload a site map showing the overall extent of the project or include the beginning point and end point coordinates in the "Notes" box below. 5. E&SC Plan Rocki-2020-016.pdf Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Helpful for linear project review (Optional) Mast be FCFfornat. Rease do not upload entire set of E&SCplans. 2.27MB 7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies for linear projects if necessary. 8. NOI Certification SignedCertNCG01.pdf 822.45KB Form Mist be RDFfornat This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.6E (i) 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:* r The Responsible Person named on this Notice of Intent f 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 Type Name * Eeron H. Dellosa Title Managing Member Organization Legally Responsible Entity J & J Tree Farms, LLC Date * 05/27/2020 F. Tracking and COC Info NOI Tracking No. 26155 NC Reference No. NCG01-2020-2270 Uses 'count number' variable (incremrented by SP) Certificate of NCC202270 Coverage (COC) Uses 'count number' variable (incremented by SP) No.* Count Number 2270 Sequential number for submittal that is incremented by Stored Frocedure COC Year 2020 Year of date reviewed (used to assign YY digits after "NOC' in COCno.)