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HomeMy WebLinkAboutNCC230076_NOI Application_20230111Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 1/10/2023 11:00:41 AM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 1/10/2023 11:32:37 AM (Review - NOI 122103 Holly Springs Road Widening, Phase 2) • The task was assigned to Broussard, Brooklyn C by round robin distribution 1/10/2023 11:01 AM • The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 13, 2023 5:00 PM. The priority is: High 1/10/2023 11:01 AM by Workflow 1/10/2023 11:32:43 AM (Workflow Start Event) Submit by Holloman, Tevye L 1/11/2023 9:28:19 AM (Payment Verification for NCC230076) F Deborah Abbene • Holloman, Tevye L assigned the task to Holloman, Tevye L 1/11/2023 9:27 AM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 21, 2023 5:00 PM. The priority is: High 1/10/2023 11:32 AM a NORTH CAROLINA, Enri--tn! C2-1;ly A. Project Information Part A. Project Location and Waterbody Information ................................................................................................................... . Are you submitting No an NOI that was • Yes rejected before? Previous Rejected 122052 NOI No. Prior Reviewer Name Brooklyn Broussard la. Project Name* Holly Springs Road Widening, Phase 2 1 b. Specific Lot This field may be used to list specifc lot numbers. Numbers 1 c. Parcel ID List all PINs associated with this project. Number(s) (PIN) 659640275 659645089 659548281 659976851 659976360 659437194 659640275 659640275 659640275 659975667 659963715 659640275 659640275 659640275 659640275 659640275 659640275 659547068 659436729 659434714 659435767 659640275 659640275 659640275 659640275 659337723 659752038 659740616 659640275 659640275 bbUb4U2/b 659642267 659741830 659964944 659869842 659434812 659648488 659640275 659640275 659978417 659640275 659532926 659643091 659634981 659857892 659640275 659648250 659970135 659868136 659868503 659436729 659975527 659974591 659962669 659640275 659640275 659640275 659640275 659640275 659976212 659657014 659963897 659960953 659962611 659349104 659535893 659631955 659431418 659741803 659856858 659545052 659973368 659972213 659534409 659531934 659438951 659975165 659640275 659640275 659640275 659640275 659646327 659435896 659964245 659720523 659955204 659432768 659640275 659533926 659534903 659544002 FSAMWA 659975028 659974081 659434910 659640275 659640275 659647175 2. County* Wake 3. Highway or Street Holly Springs Rd. Address* Street name only is acceptable if no address number assigned yet 4. City or Township* Holly Springs 5. State* INC 6. Zip Code* 27540 7. Latitude* Enter the latitude in decimal degrees 35.6553 8. Longitude* Enter the longitude in decimal degrees (MUST be negative) -78.8196 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* 12/26/2022 Estimated Construction Project Start Date 10. Date to End* 04/18/2025 Estimated Construction Project End Date 11. SIC (Primary)* Highway (1611) Standard Industrial Classification for Development 12. Acres to be 25.57 disturbed* (including off -site borrow and waste areas) 13. Total site area 25.57 (acres) * 14. Post -construction 7.99 impervious area (Estimated) (acres)* Project Tracking ID NCC-WAKE-2022-Holly Springs Road Widening, Phase 2 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 Middle Creek Waterbody * Name of waterbody into which stormwater runoff will discharge 15b. Waterbody Index 27-43-15-(1) No. * NC Waterbody Index Number Stormwater discharges will flow to additional waters* 16a. Is this project subject to the NC Sediment Pollution Control Act?* No Yes Yes No, not subject to NC SPCA B. Permittee Information Part B. Permittee Information - Legally Responsible Entity and Individual ........................................................................................................................................................................ Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application form must 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item (6) of that permit. 1. Permittee* Legally Responsible Entity Town of Holly Springs If permittee is an individual, enter first and last name in this field. Otherwise, enter organization/business name. Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the registration here. Permittee must be the same entity that is responsible for the land -disturbing activity as listed on the NC SPCA Financial Responsibility/Ownership (FRO) Form. 2. First Name* Kendra If Corporation, enter Registered Agent First Name 3. Last Name* Parrish If Corporation, enter Registered Agent Last Name 3b. Title Executive Director - Utilities & Infrastructure 4. Permitee E-mail kendra.parrish@hollyspringsnc.gov Address* 5. Permittee 919-557-3935 Telephone No.* 6. Permittee Mailing Street Address Address* 128 S Main St Address Line 2 City State / Province / Region Holly Springs NC Postal / Zip Code Country 27540-9092 US Check box if the Yes street address the same as mailing address 7. Permittee Street Street Address Address* 128 S Main St Address Line 2 City State / Province / Region Holly Springs NC Postal / Zip Code Country 27540-9092 US 8. Type of Ownership is only individual if an individual is named in B.1. above. Ownership* Government - Municipal C. Site Contact Information Part C. Project Site Contact Information 1. Primary Site Tim Contact - First Name* 2. Primary Site Athy Contact - Last Name* 3. Title 4. Site Contact E-mail tim.athy@hollyspringsnc.gov Address* 5. Site Contact Telephone No.* 6. Organization Name 7. Site Contact Mailing Address* 8. Consultant Name 919-577-3128 Street Address 128 South Main Street Address Line 2 City Holly Springs Postal / Zip Code 27540-9092 (Optional) First and Last name 9. Consultant E-mail This person will be copied on all correspondence. 10. Consultant Telephone No. 11. Billing E-mail (For Annual Fee correspondence) kendra.parrish@hollyspringsnc.gov Default is legally responsible person e-mail 12. Billing Telephone (For Annual Fee correspondence) 919-557-3935 Default is legally responsible person telephone State / Province / Region NC Country us D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Plan Approval Information 1. Date E&SC Plan 12/16/2022 Approved * 2. E&SC Plan Project WAKE-2021-048 Number/ID* Assigned by agency or local program 3. E&SC Plan State DEQ Office Approved by* Local Program 4. State DEQ Office* Raleigh (RRO) 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 WAKE-2021-048_20221216_LOA_Revision-1.pdf 259.4KB Approval letter or Must be PDF format Grading Permit 6. Signed FRO Financial Responsibility/Ownership Form Financial Responsibility Ownership form Sedimentation Pollution Control —Express Permitting 1.28MB 1.13.21.pdf Must be PDF format 7. Site Location Map Must be PDF format (limit 20 MB) 2022-012-22 Project_Map.pdf 71.57KB Please do not upload entire set of E&SC plans. 8. Notes (Optional) Provide any additional information that might help the reviewer better understand how uploaded documents support the application. Include additional waterbodies if necessary. 9. NOI Certification 2023-01-06 Signed_NOI.pdf 393.81KB Form Must be PDF format This is an Express No Review Project* Yes E. Certification North Carolina General Statute 143-215.613 (i) provides that: Any person who knowingly makes any false 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 Article; 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 Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). Under penalty of law, I certify that: * 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. * 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. * I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control Plan. * 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:* The Legally Responsible Person named on this Notice of Intent 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* Kendra Parrish Title Executive Director - Utilities & Infrastructure Organization Legally Responsible Entity Town of Holly Springs Date * 01 /10/2023 F. Tracking and COC Info NOI Tracking No. 122103 NC Reference No. NCG01-2023-0076 Indicates NCG01 or NCG25. Uses NOI number until approved, then uses NUMBER incremented by SP (passed from workflow if eNOI approved) Certificate of NCC230076 Coverage (COC) No.* Uses NOI number until approved, then uses NUMBER incremented by SIP (formatted and passed from workflow if eNOI approved) Initial Invoice No. NCC230076-2023 Invoice Due Date 2/9/2023 Initial Fee $ 100.00 Invoice Status OPEN