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HomeMy WebLinkAboutNCC191186_NOI Application_20190731Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 7/31/2019 3:09:03 PM (NCG01 NOI Submission) Approve by Lucas, Annette 7/31/2019 5:27:42 PM (Review- Construction NOI 14346) • The task was assigned to Lucas, Annette by round robin distribution 7/31/2019 3:09 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 2, 2019 5:00 PM 7/31/2019 3:09 PM Submit by Lucas, Annette 7/31/2019 5:54:44 PM (Payment Verification - NCC191186: FMS 2nd Addition) • The task was assigned to Lucas, Annette. The due date is: August 1, 2019 5:00 PM 7/31/2019 5:27 PM STME NORTH CAROLINA Ernvlronmentol qualily A. Project Information Part A. Project Location and Waterbody Inforrration 1. Project Name * FMS 2nd Addition 2. County* Lincoln 3. Highway or Street 2001 Kawai Road Address * Street name only is acceptable if no address nurrtrer assigned yet 4. City or Township* Lincolnton 5. State * NC 1 r-i) iTiT 2,G) M 111 f_TiI a 10141 6. Zip Code* 28092 7. Latitude * Enter the latitude in decirral degrees 35.4289 8. Longitude * Enter the longitude in decirral degrees (MIST be negative) -81.2738 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* 08/09/2019 Estimated Construction Project Start Date 10. Date to End* 12/31 /2019 Estimated Construction Project End Date 11. SIC (Primary)* Industrial (1541) Standard Industrial aassification for Development 12. Acres to be 1.90 disturbed* (including off -site borrow and waste areas) 13. Total site area 22.17 (acres)* 14. Post- 3.90 construction (Estimated) impervious area (acres) * NCC Project NCC-LINCO-2019-FMS 2nd Addition 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 Indian Creek Wate rbody* Nhrre of waterbody into which stormuater runoff will discharge 15b. Waterbody 11-129-8-(6.5) Index No. * NCWaterbody Index Nanber 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 FMS Enterprises USA, Inc. Name * 2. First Name* Harlon ff Corporation, enter Registered Agent First l\b e 3. Last Name * Ward ff Corporation, enter Registered Agent Last Barre 3b. Title Plant Manager 4. Permitee E-mail fmsus3@bellsouth.net Address* 5. Permittee 704-735-4249 Telephone No.* 6. Permittee Mailing Street Address Address* 2001 Kawai Road Address Line 2 City State / Province / Region Lincolnton NC Postal / Zip Code Country 28092-6976 US Check box if the r% Yes street address the same as mailing address 7. Permittee Street Street Address Address* 2001 Kawai Road Address Line 2 City State / Province / Region Lincolnton NC Pastal / Zip Code Country 28092-6976 US C. Site Contact Information Part C. Roiect Site Contact Information 1. Type of Non -Government Ownership* 2. Primary Site Harlon Contact - First Name * 3. Primary Site Ward Contact - Last Name * 4. Title Plant Manager 5. Site Contact E- fmsus3@bellsouth.net mail Address* 6. Site Contact 704-735-4249 Telephone No.* 7. Organization FMS Enterprises USA, Inc. Name 8. Site Contact Street Address Mailing Address* 2001 Kawai Road Address Line 2 city Lincolnton Rbstal / Zip Code 28092-6976 State / Province / Region NC Country US D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Ran Approval Information ....................................................................................................................................................................................................................................... 1. Date E&SC Plan 07/30/2019 Approved * 2. E&SC Plan Project 19-COM-10 Number/ID* Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by r Local Program 4. Local Program* Lincoln County 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 Sediment Erosion Control Plan Approval.pdf 565.57KB Approval Mist be FDFfornat letter/documentation 6. NOI Certification NOI Certification Form.pdf 335.9KB Form Mist be R7Ffornat This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.6B (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. * V 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. * V 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. * I7 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* Harlon Ward Title Plant Manager Organization FMS Enterprises USA, Inc. Date * 07/31 /2019 F. Tracking and COC Info NOI Tracking No. 14346 NC Reference No. NCG01-2019-1186 Uses 'count _nunber'variable (increrrented by SP) Certificate of NCC191186 Coverage (COC) Uses'count_nunber'variable (incremented by SF) No. * Count Number 1186 Sequential nunber for subrrittal that is increrrented by Stored Procedure COC Year 2019 Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)