HomeMy WebLinkAboutNCC190019_NOI Application_20190408Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/8/2019 11:15:29 AM (NCG01 NOI Submission)
Approve by Georgoulias, Bethany 4/8/2019 2:21:22 PM (Review- Construction NOI 9954)
• The task was assigned to Georgoulias, Bethany by round robin distribution 4/8/2019 11:15 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: April 10, 2019 5:00 PM
4/8/2019 11:15 AM
Submit by Georgoulias, Bethany 4/8/2019 2:22:37 PM (Payment Verification - NCG01-2019-0019)
• The task was assigned to Georgoulias, Bethany. The due date is: April 9, 2019 5:00 PM
4/8/2019 2:21 PM
STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Five Forks Solar
2. County* Warren
3. Highway or Street 260 Robinson Ferry Rd
Address * Street name only is acceptable if no address number assigned yet
4. City or Township* Macon
5. State * NC
117-8) TiT 2,G) M 111 f_TiI a 10141
6. Zip Code* 27551
7. Latitude * Enter the latitude in decimal degrees
36.5204
8. Longitude * Enter the longitude in decimal degrees (MIST be negative)
-78.0340
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* 05/06/2019
Estimated Construction Project Start Date
10. Date to End* 03/27/2020
Estimated Construction Project End Date
11. SIC (Primary)* Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be 185.00
disturbed* (including off -site borrow and waste areas)
13. Total site area
223.87
(acres)*
14. Post-
4.12
construction
impervious area
(acres) *
NCC Project
NCC-WARRE-2019-Five Forks Solar
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. You may
enter up to 3 waterbodies.
15a. Receiving Lyons Creek
Waterbody* Narre of waterbody into which stormuater runoff will discharge
15b. Waterbody 23-15
Index No. * NCWaterbody Index Nanber
Stormwater r No
discharges will flow rj Yes
to additional
wate rs *
15c. Additional ROANOKE RIVER (Lake Gaston below
Receiving normal full power pool elevation 200 MSL)
Waterbody Waterbodynarre
15d. Waterbody 23-(12)
Index No. NCWaterbody Index Ninber
15e. Additional Waterbody nave
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Nanber
Index No.
16a. Is this project r Yes
subject to the NC f No, not subject to NC SPCA
Sediment Pollution
Control Act?*
B. Permittee Information
Part B.
Perrrittee Information - Legally Responsible Entity and Individual
.........................................................................................................................................................................
1. Organization Rosendin Electric, Inc.
Name *
2. First Name*
David
ff Corporation, enter Registered Agent First %rre
3. Last Name *
Lincoln
V Corporation, enter Registered Agent Last f brre
4. Permitee E-mail
mhart@rosendin.com
Address*
5. Permittee 657.276.0600
Telephone No.*
6. Permittee Mailing Street Address
Address* 1730 South Anaheim Way
Address Line 2
City
Anaheim
Postal / Zip Code
92805
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
1730 South Anaheim Way
Address Line 2
City
Anaheim
Postal / Zip Code
92805
State / Province / Region
CA
Country
United States
State / Province / Region
CA
Country
United States
h
C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Michael
Contact - First
Name *
3. Primary Site Hart
Contact - Last
Name *
4. Title Sr. Project Manager
5. Site Contact E- mhart@rosendin.com
mail Address*
6. Site Contact 562-239-8286
Telephone No.*
7. Organization
Rosendin Electric, Inc.
Name
8. Site Contact
Street Address
Mailing Address*
1730 South Anaheim Way
Address Line 2
city
Anaheim
Fbstal / Zip Code
92805
State / Province / Region
CA
Country
us
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 04/02/2019
Approved *
2. E&SC Plan Project WARRE-2019-005
Number/ID* Assigned by agency or local program
3. E&SC Plan f• State DEQ Office
Approved by r 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.
5. E&SC Plan WARRE-2019-005 LOA 20190402.pdf 58.54KB
Approval Mist be RDFfornat
letter/documentation
6. NOI Certification FFS NOI Signed DL 4.8.19.pdf 2.2MB
Form Mist be RDFforrrat
This is an Express f• No
Review Project* r Yes
E. Certification
North Carolina General Statute 143-215.613 (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 knowinglymakes 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 deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article 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:
rJ 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.
* I7 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
r Authorized Responsible Person*
*This form must be signed by a responsible corporate officer that 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 * David Lincoln
Date * 04/08/2019
F. Tracking and COC Info
NOI Tracking No. 9954
NC Reference No. NCG01-2019-0019
Uses 'count_nunber variable (increrrented by SP)
Certificate of NCC190019
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 19
Sequential nunber for subrrittal that is increrrented by Stored Procedure
COC Year 2019
Year of date reviewed, used to assign YY digits after "NOC' in OOC no.)