HomeMy WebLinkAboutNCC191309_NOI Application_20190823Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/9/2019 10:44:32 AM (NCG01 NOI Submission)
Approve by Georgoulias, Bethany 8/9/2019 11:30:59 AM (Review- Construction NOI 14682)
• The task was assigned to Georgoulias, Bethany by round robin distribution 8/9/2019 10:44 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 13, 2019 5:00
PM 8/9/2019 10:44 AM
Submit by EADS\smccoy2 8/23/2019 1:32:23 PM (Payment Verification for NCC191309)
* County of Anson.
• EADS\smccoy2 assigned the task to EADS\smccoy2 8/23/2019 1:32 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 23, 2019 5:00 PM
8/9/2019 11:31 AM
STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Anson County - Perimeter and Wildlife Fence
2. County* Anson
3. Highway or Street Airport Road
Address * Street name only is acceptable if no address nurrber assigned yet
4. City or Township* Wadesboro
5. State * NC
1r-G)a�T2,G)M111i(-_ToIa10141
6. Zip Code* 28170
7. Latitude * Enter the latitude in decirral degrees
35.0229
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-80.0779
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*
09/16/2019
Estimated Construction Project Start Date
10. Date to End*
04/16/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Other (0000)
Standard Industrial aassification for Development
12. Acres to be
7.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area
8.00
(acres)*
14. Post-
0.00
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-ANSON-2019-Anson County - Perimeter and Wildlife Fence
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 Hurricane Creek
Wate rbody* Nacre of waterbody into which stormuater runoff will discharge
15b. Waterbody 13-20-17
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.
Fbrrrittee 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 Anson County
Name *
2. First Name* Barron
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Monroe
ff Corporation, enter Registered Agent Last Barre
3b. Title County Manager
4. Permitee E-mail bmonroe@co.anson.nc.us
Address*
5. Permittee 704-994-3200
Telephone No.*
6. Permittee Mailing Street Address
Address* 101 S. Green Street
Address Line 2
City
Wadesboro
Postal / Zip Code
28170
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
fJ Yes
Street Address
101 S. Green Street
Address Line 2
City
Wadesboro
Fbstal / Zip Code
28170
State / Province / Region
NC
Country
us
State / Province / Region
NC
Country
us
C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Government - County
Ownership*
2. Primary Site Jared
Contact - First
Name *
3. Primary Site Penny
Contact - Last
Name *
4. Title Project Manager
5. Site Contact E- jared.penny@mbakerintl.com
mail Address*
6. Site Contact 919-814-5717
Telephone No.*
7. Organization Michael Baker Engineering Inc.
Name
8. Site Contact Street Address
Mailing Address* 8000 Regency Parkway
Address Line 2
oty
Cary
Rbstal / Zip Code
27518
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 06/06/2019
Approved *
2. E&SC Plan Project ANSON-2019-006
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 * Fayetteville (FRO)
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 NCDEQ_PermitApproval_ 6-6-19.pdf 88.16KB
Approval Mist be FDF format
letter/documentation
6. NOI Certification NCG01-eNO1-SIGNED_ Certification -Form -
Form 355.37KB
20190507-DEMLR-SW. pdf
Mist be FDFforrrat
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
UWA,!. *W('ll
Type Name *
Barron S. Monroe II
Title
County Manager
Organization
Anson County
Date *
08/09/2019
F. Tracking and COC Info
NOI Tracking No. 14682
NC Reference No. NCG01-2019-1309
Uses 'count number variable (incremrented by SP)
Certificate of NCC191309
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 1309
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.)