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HomeMy WebLinkAboutNCC214565_NOI Application_20210812 Action History (UTC-05:00)Eastern Time(US&Canada) Subrrit by Anonymous User 8/10/2021 12:07:00 PM(NCG01 NOI Submission) Approve by Broussard, Brooklyn C 8/11/2021 7:06:43 AM(Review-Construction NOI 61822) • The task was assigned to Broussard, Brooklyn C by round robin distribution 8/10/2021 12:08 PM • The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:August 12,2021 5:00 PM 8/10/2021 12:08 PM Submit by Selkane,Aziza 8/12/2021 10:37:16 AM(Payment Verification for NCC214565) * Shawntrelle D Kast • Selkane,Aziza assigned the task to Selkane,Aziza 8/12/2021 10:35 AM • The task was assigned to DEMLR NCG01 Payment Team.The due date is: September 22,2021 5:00 PM 8/11/2021 7:07 AM �ThF1 1Construction Stormwater: Notice of Intent (NOI) National Pollutant Discharge Eliminatio em 'D application for•• - .•-under NorthCarolina's General Permit 1 1111:STORIMATER DISCHARGES associated with construction activities(or NORTH CAROLINA Enrlrnnmenfu�Qr�arlry A. Project Information Part A. Project Location and Waterbody Information Are you submitting f•No an NOI that was r Yes rejected before? 1a. Project Name* Pave Gravel Parking Lots Bldg 4849 and 4631 1 b.Specific Lot This field rray be used to list specifc lot numbers. Numbers NA 1 c. Parcel ID List all Ris associated w ith this project. Number(s)(PIN) NA 2. County* Craven 3. Highway or Street Duffy Road and Range Road Address* Street name only is acceptable if no address number assigned yet 4.City or Township* Cherry Point 5. State* NC 6.Zip Code* 28533-0006 7. Latitude* Enter the latitude in decirral degrees 34.9184 8. Longitude* Enter the longitude in decimal degrees(MJSTbe negative) -76.8844 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* 09/01/2021 Estimated Construction Project Start Late 10. Date to End* 08/01/2022 Estimated Construction Project End Date 11.SIC(Primary)* Industrial(1541) Standard Industrial Oassification for Development 12.Acres to be 2.38 disturbed* (including off-site borrow and waste areas) 13.Total site area 2.38 (acres)* 14. Post- 2.38 construction (Estimated) impervious area (acres)* Project Tracking ID NCC-CRAVE-2021-Pave Gravel Parking Lots Bldg 4849 and 4631 Assigned automatically(not used) 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 Slocum Creek Waterbody* Name of waterbody into which stormwater runoff will discharge 15b.Waterbody 27-112 Index No.* NC Waterbody Index N rrber Stormwater V 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. ^ Fternittee 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* WAS Cherry Point It pernittee is an individual(i.e.,organization does not apply),enter first and last narre in this field. Note:The organization name must match the business entity name registered with the NC Secretary of State. You can verify the registration here. 2. First Name* Anthony If Corporation,enter Faegistered Agent First Wre 3. Last Name* Ference It Corporation,enter Pbegistered Agent Last%rre 3b.Title Deputy Facilities Director By direction of the Commanding Officer 4. Permitee E-mail anthony.ference@usmc.mil Address* 5. Permittee 252-466-3807 Telephone No.* 6. Permittee Mailing Street Address Address* P.O. Box8006 Address Line 2 City State/Frovince/Fbgion Cherry Point NC Fbstal/Zip Code Country 28533-0006 United States Check box if the F Yes street address the same as mailing address 7. Permittee Street Street Address Address* Building 1 C Street Address Line 2 City State/Frovince/Region Cherry Point NC Fbstal/Zip Code Country 28533-0006 US 8.Type of Ownership is only individual if an individual is naned in B.1.above. Ownership* Government- Federal C. Site Contact Information Part C. ^ Roject Site Contact Inforrration ....................................................................................................................................................................................................................................................................................................................................................................................... 1. Primary Site Nathan Contact-First Name* 2. Primary Site Arnett Contact-Last Name* 3.Title Environmental Engineer 4.Site Contact E- nathan.arnett@usmc.mil mail Address* 5.Site Contact 252-466-5271 Telephone No.* 6.Organization MCAS EAD Name 7.Site Contact Street Address Mailing Address* Building 4223 Address Line 2 City State/Rovince/Region Cherry Point NC Postal/Zip Code Country 28533-0006 us 8. Consultant Name (Optional) First and Last nacre 9. Consultant E-mail This person will be copied on all correspondence. 10. Consultant Telephone No. 11. Billing E-mail (For Annual Fee correspondence) a nthony.ference@usmc.mil Default is legally responsible person a-rrail 12. Billing (For Annual Fee correspondence) Telephone 252-466-3807 Default is legally responsible person telephone D. E&SC Plan Part D. ^ Erosion&Sediment Control(E&SC)Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 07/29/2021 Approved* 2. E&SC Plan Project Crave-2022-001 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* Washington (WaRO) Documentation of E&SC Plan approval and the signed Notice of Intent(NOI)Certification Form is required for a complete application. Please also upload a site map showing the overall extent of the project(for linear projects, can include the beginning point and end point coordinates in the"Notes"box below). 5. E&SC Plan Crave-2022-001 Pave Gravel Parking Lots Bldg Approval letter or 1.55MB 4849&4631 -07292021.pdf Grading Permit Mast be FDFforrrat 6.Site Location Map Wst be RDFfornat(linit 201VB) B4849 and 4631 map.pdf 51.12KB Rease do not upload entire set of E&SC plans. 7. Notes(Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support the application.Include additional waterbodies if necessary. 8. NOI Certification Bldg 4849 and 4631 signed.pdf 83.1KB Form Mist be RDFfornat This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.66(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 knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case underthis 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 guiltyofa Class 2 misdemeanor which mayinclude 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 Legally Responsible Person named on this Notice of Intent f Authorized Responsible Person*(signing on behalf of Legally Responsible Person named in Part B) 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* Anthony A. Ference Title Deputies Facilities Director By Direction of the Commanding Officer Organization Legally Responsible Entity MCAS Cherry Point Date* 08/10/2021 F. Tracking and COC Info NOI Tracking No. 61822 NC Reference No. NCG01-2021-4565 Uses'count_nurrber'variable(increrrented by SP) Certificate of NCC214565 Coverage (COC) Uses'count_nurrber'variable(increrrented by SP) No.* Count Number 4565 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2021 Year of date reviewed(used to assign YY digits after"NOC'in COCno.) Initial Invoice No. NCC214565-2021 Invoice Due Date 9/10/2021 Initial Fee $ 100.00 Invoice Status OPEN