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HomeMy WebLinkAboutNCC203525_NOI Application_20200814Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 8/13/2020 4:06:15 PM (NCG01 NOI Submission) Approve by Gwinn, Matt 8/14/2020 9:56:08 AM (Review- Construction NOI 29896) . The task was assigned to Gwinn, Matt by round robin distribution 8/13/2020 4:07 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 17, 2020 5:00 PM 8/13/2020 4:07 PM Submit by Selkane, Aziza 8/14/2020 12:34:29 PM (Payment Verification for NCC203525) * Visa • Selkane, Aziza assigned the task to Selkane, Aziza 8/14/2020 12:34 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 25, 2020 5:00 PM 8/14/2020 9:56 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 27078 NOI No. Prior Reviewer Jim Farkas Name 1a. Project Name* St. Joseph Church 1 b. Specific Lot This field may be used to list specffc lot numbers. Numbers 2. County* Randolph 3. Highway or Street Vision Drive Address * Street narre only is acceptable if no address number assigned yet 4. City or Township* Asheboro 5. State * NC 6. Zip Code * 27203 7. Latitude * Enter the latitude in decimal degrees 35.7350 8. Longitude* Enter the longitude in decimal degrees (MJSTbe negative) -79.8174 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* 09/30/2020 Estimated Construction Project Start late 10. Date to End* 09/30/2021 Estimated Construction Project End late 11. SIC (Primary) * Other (9999) Standard Industrial Classification for lkveloprrent 12. Acres to be 11.41 disturbed* (including off -site borrow and waste areas) 13. Total site area 102.31 (acres) * 14. Post- 3.47 construction (Estirrated) impervious area (acres) * NCC Project NCC-RANDO-2020-St. Joseph Church Tracking ID Assignedautonatically 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 Haskett Creek Wate rbody* %rre of waterbody into which stornwater runoff will discharge 15b. Waterbody 17-12 Index No.* NCWaterbody Index Nurrber Stormwater rJ No discharges will flow r- Yes to additional wate rs * 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. ^ 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 Pesponsible Entity Name * Peter J. Jugis, Bishop, Roman Catholic Diocese of Charlotte It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. 2. First Name * Joe IF Corporation, enter Faegistered Agent First %rre 3. Last Name* Dodge It Corporation, enter F;bgistered Agent Last %ne 3b. Title General Counsel 4. Permitee E-mail jfdodge@charlottediocese.org Address* 5. Permittee 704-370-3346 Telephone No.* 6. Permittee Mailing Street Address Address* 1123 South Church Street Address Line 2 City State / Rovince / Pbegion Charlotte NC Fbstal / Zip Code Country 28203-4003 us Check box if the V Yes street address the same as mailing address 7. Permittee Street Street Address Address* 1123 South Church Street Address Line 2 City State / Frovince / Faegion Charlotte NC Fbstal / Zip Code Country 28203-4003 us 8. Type of Non -Government Ownership* C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Father Philip Contact - First Name * 2. Primary Site Kollithanath Contact - Last Name * 3. Title Pastor 4. Site Contact E- frphilipk@triad.rr.com mail Address* 5. Site Contact 336-687-7003 Telephone No. 6. Organization St. Joseph Catholic Church Name 7. Site Contact Street Address Mailing Address* 512 W Wainman Ave. Address Line 2 City Asheboro Postal / Zip Code 27203 8. Consultant Name (Optional) Jordan Young First and Last nacre 9. Consultant E-mail Jordan@greenmountainengineers.com This person will be copied on all correspondence. 10. Consultant 3362522781 Telephone No. State / Rovince / Region NC Country us D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 05/12/2020 Approved * 2. E&SC Plan Project Rando-2020-011 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 GRADING PERMIT.pdf 450.39KB Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Helpful for linear project review (Optional) 19-011-ST JOSEPH-COVER.pdf 2.24MB Mast be RDF format. Rease do not upload entire set of E&SCplans. 7. Notes (Optional) Rovide 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 NOI Certification Form Joe Dodge 2020-06-17.pdf 240.32KB Form Wst be RDF formal 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 Type Name * Joe Dodge Title General Counsel Organization Legally Responsible Entity Peter J Jugis, Bishop, Roman Catholic Diocese of Charlotte Date * 08/13/2020 F. Tracking and COC Info NOI Tracking No. 29896 NC Reference No. NCG01-2020-3525 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC203525 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 3525 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. NCC203525-2020 Invoice Due Date 9/13/2020 Initial Fee $ 100.00 Invoice Status OPEN