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HomeMy WebLinkAboutNCC190587_NOI Application_20190611Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 6/11/2019 3:25:23 PM (NCG01 NOI Submission) Approve by Clark, Paul 6/12/2019 8:30:11 AM (Review- Construction NOI 12062) In Please note that the person listed in Part B - Alan Lewis is different than the person signing the eNO1 certification - Ken Beuley, but they are both authorized people within TKC CCL)",, LLC. • The task was assigned to Clark, Paul by round robin distribution 6/11/2019 3:25 PM • The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 13, 2019 5:00 PM 6/11/2019 3:25 PM Submit by Clark, Paul 6/12/2019 8:30:55 AM (Payment Verification - NCG01-2019-0587) • The task was assigned to Clark, Paul. The due date is: June 13, 2019 5:00 PM 6/12/2019 8:30 AM STME NORTH CAROLINA Ernvlronmentol qualily A. Project Information Part A. Project Location and Waterbody Inforrration 1. Project Name * Project Heidi 2. County* Johnston 3. Highway or Street Brewer Road and Highway 96 Address * Street name only is acceptable if no address nurrber assigned yet 4. City or Township * Four Oaks 5. State * NC 1r-G)a�T7i)MIlia Iif_TiIa10141 6. Zip Code* 27524 7. Latitude * Enter the latitude in decirral degrees 35.4430 8. Longitude * Enter the longitude in decirral degrees (WISTbe negative) -78.4075 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* 06/10/2019 Estimated Construction Project Start Date 10. Date to End* 03/11/2020 Estimated Construction Project End Date 11. SIC (Primary)* Industrial (1541) Standard Industrial aassification for Development 12. Acres to be 23.70 disturbed* (including off -site borrow and waste areas) 13. Total site area 30.94 (acres)* 14. Post- 12.37 construction (Estimated) impervious area (acres) * NCC Project NCC-JOHNS-2019-Project Heidi 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 Tributary to Juniper Swamp Wate rbody* Nacre of waterbody into which stormuater runoff will discharge 15b. Waterbody 27-52-6-6 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 TKC CCLXXV, LLC Name * 2. First Name* Alan ff Corporation, enter Registered Agent First l\b e 3. Last Name * Lewis Y Corporation, enter Registered Agent Last Barre 3b. Title Partner 4. Permitee E-mail alan@thekeithcorp.com Address* 5. Permittee 7043656000 Telephone No.* 6. Permittee Mailing Street Address Address* 4500 Cameron Valley Parkway, Suite 400 Address Line 2 City State / Province / Region Charlotte NC Pbstal / Zip Code Country 28211 us Check box if the r% Yes street address the same as mailing address 7. Permittee Street Street Address Address* 4500 Cameron Valley Parkway, Suite 400 Address Line 2 City State / Province / Region Charlotte NC Pastal / Zip Code Country 28211 us C. Site Contact Information Part C. Roiect Site Contact Information 1. Type of Non -Government Ownership* 2. Primary Site Dave Contact - First Name * 3. Primary Site Featherston Contact - Last Name * 4. Title Project Manager 5. Site Contact E- dfeatherston@thekeithcorp.com mail Address* 6. Site Contact 7046444471 Telephone No.* 7. Organization The Keith Corporation Name 8. Site Contact Street Address Mailing Address* 4500 Cameron Valley Parkway, Suite 400 Address Line 2 oty State / Province / Region Charlotte NC Fbstal / Zip Code Country 28211 us D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Ran Approval Information ....................................................................................................................................................................................................................................... 1. Date E&SC Plan 05/31/2019 Approved * 2. E&SC Plan Project JOHNS-2019-027 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 * Raleigh (RRO) 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 JOHNS-2019-027 LOA MOD 20190531 acres Approval 73.02KB approved.pdf letter/documentation Mist be RJF format 6. NOI Certification noi-SIGNED.pdf 65.4KB Form Mist be RJFformat 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 * Ken Beuley Title Director of Development / CFO Organization The Keith Corporation Date * 06/ 11 /2019 F. Tracking and COC Info NOI Tracking No. 12062 NC Reference No. NCG01-2019-0587 Uses 'count number variable (incremrented by SP) Certificate of NCC190587 Coverage (COC) Uses 'count _nunber'variable (increrrented bySP) No. * Count Number 587 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.)