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HomeMy WebLinkAboutNCC190034_NOI Application_20190411 Action History (UTC-05:00) Eastern Time(US&Canada) Submit by Anonymous User 4/11/2019 9:29:14 AM(NCG01 NOI Submission) Approve by Morman,Alaina 4/12/2019 10:59:10 AM(Review-Construction NOI 10024) • The task was assigned to Morman,Alaina by round robin distribution 4/11/2019 9:29 AM • The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:April 15,2019 5:00 PM 4/11/2019 9:29 AM Submit by Morman,Alaina 4/12/2019 10:59:55 AM(Payment Verification-NCG01-2019-0034) • The task was assigned to Morman,Alaina.The due date is:April 15,2019 5:00 PM 4/12/2019 10:59 AM 1 sees �' � ••. -• i •• i i• i IY sell NORTH CAROLINA Ernvlronmental QUII A. Project Information Part A. Project Location and Waterbody Information 1. Project Name* Woodland Heights Middle School 2. County* Iredell 3. Highway or Street 288 Forest Lake Blvd Address* Street narra only is acceptable if no address nurrber assigned yet 4. City or Township* Mooresville 5. State* INC 6.Zip Code* 28117 7. Latitude* Enter the latitude in decirral degrees 35.3409 8. Longitude* Enter the longitude in decirral degrees(MJSTbe negative) -80.5523 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* 04/08/2019 Estimated Construction Project Start Date 10. Date to End* 04/30/2020 Estimated Construction Project End Date 11. SIC(Primary)* Other(0000) Standard Industrial aassification for Developrrent 12.Acres to be 25.46 disturbed* (including off-site borrow and waste areas) 13.Total site area 52.32 (acres)* 14. Post- 12.36 construction impervious area (acres)* NCC Project NCC-IREDE-2019-Woodland Heights Middle School Tracking ID Assigned autorratically 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 Catawba River Wate rbody* Nacre of waterbody into which stormuater runoff will discharge 15b.Waterbody 11-(75) Index No.* NCWaterbody Index Nunber 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. Perrrittee 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 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 Iredell Statesville Schools Name* 2. First Name* Rob ff Corporation,enter Registered Agent First l\b e 3. Last Name* Jackson ff Corporation,enter Registered Agent Last Barre 4. Permitee E-mail rjackson@iss.k12.nc.us Address* 5. Permittee 704-873-3755 Telephone No.* 6. Permittee Mailing Street Address Address* 549 North Race Street Address Line 2 City State/Province/Region Statesville NC Rbstal/Zip Code Country 28677-3915 US Check box if the V Yes street address the same as mailing address 7. Permittee Street Street Address Address* 549 North Race Street Address Line 2 City State/Province/Region Statesville NC Postal/Zip Code Country 28677-3915 us C. Site Contact Information Part C. Project Site Contact Information .................................................................................................................... 1.Type of Non-Government Ownership* 2. Primary Site Rob Contact-First Name* 3.Primary Site Jackson Contact-Last Name* 4.Title Director of Construction 5.Site Contact E- rjackson@iss.k12.nc.us mail Address* 6.Site Contact 704-873-3755 Telephone No.* 7.Organization Iredell Statesville Schools Name 8.Site Contact Street Address Mailing Address* 549 North Race Street Address Line 2 City State/Province/Region Statesville NC Rbstal/Zip Code Country 28677-3915 us D. E&SC Plan Part D. Erosion&Sediment Control(E&SC)Ran Approval Information ............................................................................................................................................................ 1. Date E&SC Plan 04/05/2019 Approved* 2. E&SC Plan Project IREDE-2019-001 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* Mooresville(MRO) 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 jm-04052019.pdf 1.11 MB Approval Wst be FDFforrrat letter/documentation 6. NOI Certification NOI FORM-04052019110448.pdf 419.3KB 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* Important:The person who signs this Certification above and signs the NOI Certification Form should be the same person(or authorized responsible person within the same organization)as listed in Section B(Permittee Information) of this form. *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 AM Type Name* Rob Jackson Date* 04/11/2019 F. Tracking and COC Info NOI Tracking No. 10024 NC Reference No. NCG01-2019-0034 Uses'count_nunber variable(incremented by SP) Certificate of NCC190034 Coverage (COC) Uses'count nunber variable(increrrentedbySP) No.* Count Number 34 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.)