HomeMy WebLinkAboutNCC190372_NOI Signed Certification_201905235/22/2010
Resume Submission
NORTH C, ROLINA
EnWraarrw4tat Quality
Part A.
Project Location and
1. Project Name*
2. County*
Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System (NPDES) application for coverage under North Carolina's
General Permit NCGO10000: STORMWATER DISCHARGES associated with construction activities (or
NCG250000)
A. Project Information I B. Permittee Information I C. Site Contact information I D. E&SC Plan
E. Certification
Information
Flow Acura
New Hanover •
3. Highway or Street}95Z New Centre Drive
Address * Street name only is acceptable if no address number assigned yet
4. City or Township* llmington
5. State* NC
S. Zip Code* F8Z
7. LatitudeEnter the latitude in decimal degrees
4.2410
8. Longitude* Enter the longitude in decimal degrees (MUST be negative)
77.8780
If you do not know the latitude and longitude coordinates for this project, you can search the location on this map of
North Carolina (https://ncdenr.reaps.arcgis.com/apps/webappviewer/index.html?
id=9fdfc3872651444c8339d718a099a1ac). Look for the coordinates in the bottom left corner.
9. Date to Begin* 5/28/2019
Estimated Construction Project Start Date
18. Date to End* 11/0112019
,
Estimated Construction Project End Date
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11. SIC (Primary)*
12. Acres to be
disturbed*
13. Total site area
(acres) *
14. Post -
construction
impervious area
(acres)'
Project Tracking ID
Commercial (1542
Standard Industrial Classification for Development
(including off -site borrow and waste areas)
.40
(Estimated)
NCC-NEW H-2019-Flow Acura
Assigned automatically
Below you must enter waterbody information for surface waters affected by this project. Please consult
DWR's Surface Water Classifications Map Viewer (https:llncdenr.maps.arcgis.com/apps/webappviewer/index.html?
id=6e125ad7628f494694e259c80dd64265) to find waterbody name and corresponding index number. You may enter
up to 3 waterbodies.
15a. Receiving Burnt Mill/Cape Fear
Waterbody Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 19-74-63-2
Index No.* NC Waterbody Index Number
Stormwater E-6 No
discharges will flow Cal Yes
to additional waters*
16a. Is this project
subject to the NC
Sediment Pollution
Control Act? *
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* Yes
0 No, not subject to NC SPCA
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https://edocs.deq.nc.gov/Forms/form/resume/241/22237 213
5/22/2019
Resume Submission
NORTH CAROLINA
EnWronmenw? Quality
Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System (NPDES) application for coverage under North Carolina's
General Permit NCG010000: STORMWATER DISCHARGES associated with construction activities (or
NCG250000)
A. Project Information I B. Permittee Information I C. Site Contact information I D. E&SC Plan
E. Certification
Permittee Information - Legally Responsible Entity and Individual
Important: The person who signs the N01 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 NCGO10000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
1. Organization Flow 4951 New Centre, LLC
Name
2. First Name*
.W .
Don
If Corporation, enter Registered Agent First Name
3. Last Name's
FFlows.,�..,........w.�:v.�,.�m,�,��..�,.,�.-��
If Corporation, enter Registered Agent Last Name
3b. Title's
wner�.����w�,9.�.-....-.---.
4. Permitee E-mail
Fflow@flowauto-com
Address
5. Permittee F36--766:iOTO
Telephone No.
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6. Permittee Mailing Street Address
Address* FOQ West 5th Street��-�,M��
Address Line 2
�uite 1800
City State / Province 1 Region
Fin'-ston-Salem FC --
Postal / Zip Code Country
F7101-2728 U S
Check box if the n Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 0Q West 5th Street
Address Line 2
Suite 1800
City State 1 Province 1 Region
Fin`Ston-Z-Iem---
NCT
Postal 1 Zip Code Country
Vim -2728 US�
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5/22/2019
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NORTH CAfWUNA
EnAronm nfaf Quality
Pala C.
Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System (NPDES) application for coverage under North Carolina's
General Permit NGG010000: STORMWATER DISCHARGES associated with construction activities (or
NCG250000)
A. Project Information I B. Permittee Information I C. Site Contact information I D. E&SC Plan
E. Certification
Project Site Contact Information
1. Type of Non -Government V
Ownership *
2. Primary Site Chance
Contact - First
Name*
3. Primary Site Barnes
Contact - Last
Name*
4. Title �uperintendent
5. Site Contact E-
pbarnes@magnoliaconstruction.com
mail Address
6. Site Contact F36-345-3591
Telephone No.*
7. Organization Magnolia Construction
Name Magnolia�
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8. Site Contact
Mailing Address
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Street Address
14 South Stratford Road
Address Line 2
uite
City
F5tOri-Salem
State 1 Province 1 Region
Postal 1 Zip Code Country
F ---- Fug -----
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3 p
NORTH CA€ OLINA
l nvlrnnm0tr141 Quality
Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System (NPDES) application for coverage under North Carolina's
General Permit NCG010000: STORMWATER DISCHARGES associated with construction activities (or
NCG250000)
A. Project Information I B. Permittee Information I C. Site Contact information I D. E&SC Plan
E. Certification
Erosion & Sediment Control (E&SC) Plan Approval Information
.,,�:............_
1. Date E&SC Plan f
Approved* 0511512019
2. E&SC Plan Project GP 63-94 REvision #4
NumberllD * Assignees by agency or local program
3. E&SC Plan 0 State DEQ Office
Approved by* C) Local Program
4. Local Program* New Hanover County V
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form
(https://files.nc.gov/ncdeq/Energy%20Mineral%20and%2OLand%20Resources/Stormwater/NPDES%2OGeneral%2OPe
eNOI-Certification-Form-20190507-DEMLR-SW.pdf) is required for a complete application.
5. E&SC Plan Upload
Approval Flow Acura Land Disturbing Permit.pdf (IFormslha... 219.53KB )(
letter/documentation *
Must be PDF format
6. NOI Certification E Upload
Form * Must be PDF format
YOU MUST MAIL THE ORIGINAL SIGNED NOI CERTIFICATION FORM (click on this link)
(https:Miles. nc.govincdeq/Energy%20Mineral%20and%20Land°/o2OResources/Stormwater/NPDES%20General
eNOI-Certification-Form-20190507-DEMLR-SW.pdf) to The Stormwater Program at the address on the form for the
application to fulfill federal application requirements. The Certification Form should be signed by the same person (or
authorized responsible person within the same organization) as in Section B (Permittee Information).
This is an Express * No
Review Project* 0 Yes
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Resume Submission
NORTH CAROLINA
Envtrammental Quality
Construction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System (NPDES) application for coverage under North Carolina's
General Permit NCGO10000: STORMWATER DISCHARGES associated with construction activities (or
NCG250000)
A. Project Information I B. Permittee Information I C. Site Contact information D. E&SC Plan
E. Certification
North Carolina General Statute 143-215.6B (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document fled 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:
* G, 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.
he 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.
(/will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
IV' If the Erosion and Sediment Control Plan approved by the delegated program
is not compliant with Part II (Stormwater Pollution Prevention Plan) of the
NCG010000 General Permit, I will nonetheless ensure that all conditions of
Part II of the permit are met on the project at all times.
t-U/1hereby 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 Responsible Person named on this Notice of Intent
0 Authorized Responsible Person*
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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 NCGO10000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
Signature * Sign
p m.
Type Name* Q(\0. ` ✓ �s_ 14/`
Title * MEu_�.�.�.��,.,,,�.,�
Organization*
Date Date captured on form submission
i eW.
Submit Save as Draft
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