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HomeMy WebLinkAboutNCC190157_NOI Application_20190502Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 5/2/2019 9:16:05 AM (NCG01 NOI Submission) Approve by Lucas, Annette 5/2/2019 9:22:10 AM (Review- Construction NOI 10582) In Dear Mr. Knox.' Thanks for using our new e-NOI form, good luck with your project. Sincerely, Annette Lucas • The task was assigned to Lucas, Annette by round robin distribution 5/2/2019 9:16 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 6, 2019 5:00 PM 5/2/2019 9:16 AM Submit by Lucas, Annette 5/2/2019 9:22:55 AM (Payment Verification - NCG01-2019-0157) • The task was assigned to Lucas, Annette. The due date is: May 3, 2019 5:00 PM 5/2/2019 9:22 AM 1 r-i) iTiT 7i) M Ilia f_TiI a 10141 NORTH CAROLINA Ernvlronmentol qualily A. Project Information Part A. Project Location and Waterbody Inforrration 1. Project Name * Tires Plus 2. County* Burke 3. Highway or Street 1252 Burkemont Ave Address * Street name only is acceptable if no address nurrber assigned yet 4. City or Township* Morganton 5. State * NC 6. Zip Code* 28655 7. Latitude * Enter the latitude in decirral degrees 35.7148 8. Longitude * Enter the longitude in decirral degrees (WISTbe negative) -81.6927 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* 11 /29/2019 Estimated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial aassification for Development 12. Acres to be 3.14 disturbed* (including off -site borrow and waste areas) 13. Total site area 3.46 (acres)* 14. Post- 1.46 construction impervious area (acres) * NCC Project NCC-BURKE-2019-Tires Plus 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 Silver Creek Wate rbody* Nacre of waterbody into which stormuater runoff will discharge 15b. Waterbody 11-34-(o.5) Index No. * NCWaterbody Index Number 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. Perrrittee Information - Legally Responsible Entity and Individual ..................................................................................................................................................................... h 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 Moss -Marlow Building Co Inc Name * 2. First Name* Jeff ff Corporation, enter Registered Agent First l\b e 3. Last Name * Knox ff Corporation, enter Registered Agent Last Barre 4. Permitee E-mail jknox@mossmarlow.com Address* 5. Permittee 8283282333ext327 Telephone No.* 6. Permittee Mailing Street Address Address* PO Box2423 Address Line 2 3039 Hwy 70 SW City Hickory Fbstal / Zip Code 28603 Check box if the r Yes street address the same as mailing address 7. Permittee Street Street Address Address* 3039 Address Line 2 State / Province / Region North Carolina Country United States City State / Province / Region Hickory North Carolina Postal / Zip Code Country 28602 United States C. Site Contact Information Part C. Roiect Site Contact Information 1. Type of Non -Government Ownership* 2. Primary Site Brandon Contact - First Name * 3. Primary Site Setzer Contact - Last Name * 4. Title Superintendent 5. Site Contact E- bsetzer@mossmarlow.com mail Address* 6. Site Contact 8283126569 Telephone No.* 7. Organization Moss -Marlow Building Co Inc Name 8. Site Contact Street Address Mailing Address* PO Box2423 Address Line 2 city Hickory Fbstal / Zip Code 28603 State / Rovince / Region North Carolina Country United States D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Ran Approval Information ....................................................................................................................................................................................................................................... 1. Date E&SC Plan 04/25/2019 Approved * 2. E&SC Plan Project BURKE 2019-009 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 * Asheville (ARO) 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 Approval Letter.pdf Approval Mist be RDFfornat letter/documentation 6. NOI Certification NOI Form.pdf Form Mist be R7Fformat This is an Express f• No Review Project* r Yes 70.28KB 37.92KB 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 Type Name * Jeff Knox Date * 05/02/2019 F. Tracking and COC Info NOI Tracking No. 10582 NC Reference No. NCG01-2019-0157 Uses 'count_nunber variable (increrrented by SP) Certificate of NCC190157 Coverage (COC) Uses'count_nunber'variable (increrrented by SF) No. * Count Number 157 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.)