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HomeMy WebLinkAboutNCC190375_NOI Application_20190524 Action History (UTC-05:00) Eastern Time(US&Canada) Submit by Anonymous User 5/24/2019 12:31:07 PM(NCG01 NOI Submission) Approve by Lucas,Annette 5/24/2019 2:14:55 PM(Review-Construction NOI 11386) In Good luck with your project. Please be certain to send in the original NOI Certification Form with original signature. • The task was assigned to Lucas,Annette by round robin distribution 5/24/2019 12:31 PM • The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: May 28,2019 5:00 PM 5/24/2019 12:31 PM Submit by Lucas,Annette 5/24/2019 2:28:18 PM(Payment Verification-NCG01-2019-0375) • The task was assigned to Lucas,Annette.The due date is: May 27, 2019 5:00 PM 5/24/2019 2:15 PM E, • 1 • • 1 III • 1 1 sees �' � ••. -• i •• i i• i IY sell NORTH CAROLINA Environmental QUII A. Project Information Part A. Project Location and Waterbody Information 1. Project Name* Former Dicey Mills 2. County* Cleveland 3. Highway or Street 430 Neisler Street Address* Street narre only is acceptable if no address nurrber assigned yet 4. City or Township* Shelby 5. State* NC 6.Zip Code* 28152 7. Latitude* Enter the latitude in decirral degrees 35.2880 8. Longitude* Enter the longitude in decirral degrees(MUST be negative) -81.5690 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* 06/28/2019 Estimated Construction Project End Date 11. SIC(Primary)* Other(0000) Standard Industrial aassification for Developrrent 12.Acres to be 3.40 disturbed* (including off-site borrow and waste areas) 13.Total site area 21.98 (acres)* 14. Post- 0.00 construction (Estimated) impervious area (acres)* NCC Project NCC-CLEVE-2019-Former Dicey Mills 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 First Broad River Wate rbody* Nacre of waterbody into which stormuater runoff will discharge 15b.Waterbody 9-50-(28) 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 Dicey Mills, Inc. Name* 2. First Name* David If Corporation,enter Registered Agent First l\brre 3. Last Name* Neisler If Corporation,enter Registered Agent Last Barre 3b.Title Secretary 4. Permitee E-mail dcndicey@aol.com Address* 5. Permittee 704-734-5418 Telephone No.* 6. Permittee Mailing Street Address Address* PO Box 1090 Address Line 2 City State/Province/Region Shelby NC Postal/Zip Code Country 28151 United States Check box if the r Yes street address the same as mailing address 7. Permittee Street Street Address Address* 430 Neisler Street Address Line 2 City State/Province/Region Shelby NC Pastal/Zip Code Country 28152 USA C. Site Contact Information Part C. Project Site Contact Inforrration ............................................................................................. 1.Type of Individual Ownership* 2. Primary Site Brett Contact-First Name* 3.Primary Site Lawrence Contact-Last Name* 4.Title Project Geologist 5.Site Contact E- BLawrence@harthickman.com mail Address* 6.Site Contact 704-400-5467 Telephone No.* 7.Organization Hart&Hickman, PC Name 8.Site Contact Street Address Mailing Address* 2923 South Tryon St Address Line 2 Suite 100 City State/Province/Plegion Charlotte NC Fbstal/Zip Code Country 28203 United States D. E&SC Plan Part D. Erosion&Sediment Control(E&SC)Ran Approval Information ....................................................................................................................................................................................................................................... ............................................................................................. 1. Date E&SC Plan 04/29/2019 Approved* 2. E&SC Plan Project CLEVE-2019-015 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 Approval Letter 2019-04-26.pdf 1.9MB Approval Mist be RDFforrrat letter/documentation 6. NOI Certification NOI Certification Form(signed).pdf 1.37MB Form Mist 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* David C. Neisler Title Secretary Organization Dicey Mills Inc. Date* 05/24/2019 F. Tracking and COC Info NOI Tracking No. 11386 NC Reference No. NCG01-2019-0375 Uses'count number variable(incremented by SP) Certificate of NCC190375 Coverage (COC) Uses'count_nunber'variable(increrrented bySP) No.* Count Number 375 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.)