HomeMy WebLinkAboutNCC190250_NOI Application_20190510 Action History (UTC-05:00) Eastern Time(US&Canada)
Submit by Anonymous User 5/10/2019 1:35:21 PM(NCG01 NOI Submission)
Approve by Morman,Alaina 5/10/2019 2:48:32 PM(Review-Construction NOI 10907)
• The task was assigned to Morman,Alaina by round robin distribution 5/10/2019 1:35 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: May 14,2019 5:00 PM
5/10/2019 1:35 PM
Submit by Morman,Alaina 5/10/2019 2:49:01 PM(Payment Verification-NCG01-2019-0250)
• The task was assigned to Morman,Alaina.The due date is: May 13,2019 5:00 PM 5/10/2019 2:48 PM
1 sees �' � ••. -• i •• i i• i
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NORTH CAROLINA
Ernvlronmental QUII
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name* Pluris Webb Creek WWTP
2. County* Onslow
3. Highway or Street 250 Zachary Lane
Address* Street narra only is acceptable if no address nurrber assigned yet
4. City or Township* Hubert
5. State* NC
6.Zip Code* 28539
7. Latitude* Enter the latitude in decirral degrees
34.6703
8. Longitude* Enter the longitude in decirral degrees(WISTbe negative)
-77.2020
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* 06/24/2019
Estimated Construction Project Start Date
10. Date to End* 06/30/2020
Estimated Construction Project End Date
11. SIC(Primary)* Commercial(1542)
Standard Industrial gassification for Developrrant
12.Acres to be 3.39
disturbed* (including off-site borrow and waste areas)
13.Total site area 8.73
(acres)*
14. Post- 0.42
construction (Estimated)
impervious area
(acres)*
NCC Project NCC-ONSLO-2019-Pluris Webb Creek WWTP
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 Parrot Swamp
Wate rbody* Nacre of waterbody into which stormuater runoff will discharge
15b.Waterbody 19-41-16-4
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 Pluris Webb Creek, LLC
Name*
2. First Name* Maurice
ff Corporation,enter Registered Agent First l\b e
3. Last Name* Gallarda
ff Corporation,enter Registered Agent Last Barre
3b.Title Manager
4. Permitee E-mail mgallarda@plurisusa.com
Address*
5. Permittee 2122203412
Telephone No.*
6. Permittee Mailing Street Address
Address* 150 Turtle Creek Boulevard
Address Line 2
Suite 207
City State/Province/Region
Dallas TX
Postal/Zip Code Country
75207 us
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 150 Turtle Creek Boulevard
Address Line 2
Suite 207
City State/Province/Region
Dallas TX
Pastal/Zip Code Country
75207 us
C. Site Contact Information
Part C.
Project Site Contact Information
....................................................................................................................
1.Type of Non-Government
Ownership*
2. Primary Site Randy
Contact-First
Name*
3.Primary Site Hoffer
Contact-Last
Name*
4.Title Regional Manager
5.Site Contact E- rhoffer@plurisusa.com
mail Address*
6.Site Contact 9103270374
Telephone No.*
7.Organization Pluris Webb Creek, LLC
Name
8.Site Contact Street Address
Mailing Address* 1095 North Carolina 210
Address Line 2
aty State/Province/Region
Sneads Ferry NC
Rbstal/Zip Code Country
28460-9140 us
D. E&SC Plan
Part D.
Erosion&Sediment Control(E&SC)Ran Approval Information
....................................................................................................................................................................................................................................... .............................................................................................
1. Date E&SC Plan 05/08/2019
Approved*
2. E&SC Plan Project ONSLO-2019-043
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* Wilmington(WiRO)
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 ONSLO-2019-043 Approval 5-8-2019.pdf 305.77KB
Approval Mist be RDF format
letter/documentation
6. NOI Certification EC Form Webb Creek WWTP 2019.pdf 478.42KB
Form Mast be RDFfornat
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
Type Name* Randy Hoffer
Title Regional Manager
Organization Pluris Webb Creek, LLC
Date* 05/10/2019
F. Tracking and COC Info
NOI Tracking No. 10907
NC Reference No. NCG01-2019-0250
Uses'count number variable(incremented by SP)
Certificate of NCC190250
Coverage (COC) Uses'count number variable(increrrentedbySP)
No.*
Count Number 250
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed(used to assign YY digits after"NGC'in OOCno.)