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HomeMy WebLinkAboutNCC203262_NOI Application_20200731Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 7/28/2020 8:25:46 AM (NCG01 NOI Submission) Approve by Clark, Paul 7/30/2020 7:52:00 AM (Review- Construction NOI 28918) • Farkas, Jim J reassigned the task to Clark, Paul 7/29/2020 3:15 PM . The task was assigned to Farkas, Jim J by round robin distribution 7/28/2020 8:25 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: July 30, 2020 5:00 PM 7/28/2020 8:25 AM Submit by Selkane, Aziza 7/31/2020 8:11:00 AM (Payment Verification for NCC203262) * Town of Granite Quarry • Selkane, Aziza assigned the task to Selkane, Aziza 7/31/2020 8:10 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 10, 2020 5:00 PM 7/30/2020 7:52 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 28834 NOI No. Prior Reviewer Paul Clark Name 1a. Project Name * Town of Granite Quarry Leaf & Limb Site 1 b. Specific Lot This field may be used to list specffc lot numbers. Numbers 2. County* Rowan 3. Highway or Street 1040 Mar Rock Address * Street narre only is acceptable if no address number assigned yet 4. City or Township* Granite Quarry 5. State * NC 6. Zip Code * 28072 7. Latitude * Enter the latitude in decimal degrees 35.6038 8. Longitude* Enter the longitude in decimal degrees (M. ST be negative) -80.4428 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* 07/31/2020 Estimated Construction Project Start Date 10. Date to End* 08/03/2020 Estimated Construction Project End Cute 11. SIC (Primary) * Other (9999) Standard Industrial Classification for Ceveloprrent 12. Acres to be 1.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 7.53 (acres) * 14. Post- 1.00 construction (Estimated) impervious area (acres) * NCC Project NCC-ROWAN-2020-Town of Granite Quarry Leaf & Limb Site Tracking ID 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 Church Creek Waterbody* fume of waterbody into which stormwater runoff will discharge 15b. Waterbody 12-115.5 Index No.* NCWaterbody Index Ninber 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. ^ Fl rnittee 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 * Town of Granite Quarry It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. 2. First Name * Jason IF Corporation, enter Faegistered Agent First Wre 3. Last Name* Hord It Corporation, enter F;bgistered Agent Last %ne 3b. Title Maintenance Supervisor 4. Permitee E-mail jhord@granitequarrync.gov Address* 5. Permittee 7042795596 Telephone No.* 6. Permittee Mailing Street Address Address* PO Box351 Address Line 2 city State / Rovince / Pbegion Granite Quarry NC Fbstal / Zip Code Country 28072 USA Check box if the F Yes street address the same as mailing address 7. Permittee Street Street Address Address* 143 N. Salisbury Ave Address Line 2 city State / Ftovince / Region Granite Quarry NC Fbstal / Zip Code Country 28072 USA 8. Type of Government - Municipal Ownership* C. Site Contact Information Part C. Roject Site Contact Information .............................................................................................................................................................................................................................................................................................................................................................................................. 1. Primary Site Jason Contact - First Name * 2. Primary Site Hord Contact - Last Name * 3. Title Maintenance Supervisor 4. Site Contact E- jhord@granitequarrync.gov mail Address* 5. Site Contact 7042795596 Telephone No.* 6. Organization Town of Granite Quarry Name 7. Site Contact Street Address Mailing Address* PO Box351 Address Line 2 city Granite Quarry Fbstal / Zip Code 28072 8. Consultant Name (Optional) First and Last nave 9. Consultant E-mail This person will be copied on all correspondence. 10. Consultant Telephone No. State / Frovince / Pegion NC Country USA D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 07/22/2020 Approved * 2. E&SC Plan Project ROWAN-2020-007 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 * Mooresville (MRO) 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 Erosion Control Approval - Leaf and Limb.pdf 214.82KB 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. 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 NCG01- NOI.pdf 83.66KB 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 Atide; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the Commission implementing this Atcle 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 ['/rzJC¢r ���r•`t� Type Name * Jason Hord Title Maintenance Supervisor Organization Legally Responsible Entity Town of Granite Quarry Date * 07/28/2020 F. Tracking and COC Info NOI Tracking No. 28918 NC Reference No. NCG01-2020-3262 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC203262 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 3262 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2020 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC203262-2020 Invoice Due Date 8/29/2020 Initial Fee $ 100.00 Invoice Status OPEN