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HomeMy WebLinkAboutNCC191557_NOI Application_20190826Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 8/22/2019 2:25:16 PM (NCG01 NOI Submission) Approve by EADS\smccoy2 8/23/2019 12:38:32 PM (Review- Construction NOI 15184) • The task was assigned to McCoy, Suzanne by round robin distribution 8/22/2019 2:25 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 26, 2019 5:00 PM 8/22/2019 2:25 PM Submit by McCoy, Suzanne 8/26/2019 1:06:07 PM (Payment Verification for NCC191557) * Bobbitt Design Build Inc. • McCoy, Suzanne assigned the task to McCoy, Suzanne 8/26/2019 1:05 PM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 6, 2019 5:00 PM 8/23/2019 12:38 PM STME NORTH CAROLINA Ernvlronmentol qualily A. Project Information Part A. Project Location and Waterbody Inforrration 1. Project Name * Hoke County Cooperative Extension Office Building 2. County* Hoke 3. Highway or Street 663 East Palmer St. Address * Street name only is acceptable if no address nurrtrer assigned yet 4. City or Township* Raeford 5. State * NC 1r-i)irIT7i)Mfi1i(-_TiIa1010 6. Zip Code* 28376 7. Latitude * Enter the latitude in decirral degrees 34.9674 8. Longitude * Enter the longitude in decirral degrees (MIST be negative) -79.2299 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* 08/22/2019 Estimated Construction Project Start Date 10. Date to End* 04/30/2020 Estimated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial aassification for Development 12. Acres to be 3.45 disturbed* (including off -site borrow and waste areas) 13. Total site area 20.04 (acres)* 14. Post- 1.39 construction (Estimated) impervious area (acres) * NCC Project NCC-HOKE-2019-Hoke County Cooperative Extension Office Tracking ID Building 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 Toneys Creek Waterbody* %rre of waterbody into which stormuater runoff will discharge 15b. Waterbody 14-10-1.2 Index No.* NC Waterbody Index Nunter Stormwater V No discharges will flow r- Yes to additional wate rs * 16a. Is this project r Yes subject to the NC f 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 Bobbitt Design Build, Inc. Name * 2. First Name* James If Corporation, enter Registered Agent First l\b e 3. Last Name * Bell Y Corporation, enter Registered Agent Last Barre 3b. Title President 4. Permitee E-mail jbell@bobbitt.com Address* 5. Permittee 919-851-1980 Telephone No.* 6. Permittee Mailing Street Address Address* 600 Germantown Road Address Line 2 City Raleigh Postal / Zip Code 27607-5144 Check box if the street address the same as mailing address 7. Permittee Street Address* fJ Yes Street Address 600 Germantown Road Address Line 2 City Raleigh Fbstal / Zip Code 27607-5144 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 Non -Government Ownership* 2. Primary Site Tim Contact - First Name * 3. Primary Site Murphy Contact - Last Name * 4. Title Project Manager 5. Site Contact E- tmurphy@bobbitt.com mail Address* 6. Site Contact 919-630-5738 Telephone No.* 7. Organization Bobbitt Design Build, Inc Name 8. Site Contact Street Address Mailing Address* 600 Germantown Road Address Line 2 city Raleigh Fbstal / Zip Code 27607-5144 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 08/06/2019 Approved * 2. E&SC Plan Project HOKE-2019-025 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 Approval Letter NCDEQ 080619.pdf 68.97KB Approval Mist be RDF format letter/documentation 6. NOI Certification NOI Cert Form HOKE-2019-025.pdf 420.71KB Form Mist be RDFformat 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 * James Bell Title President Organization Bobbitt Design Build, Inc Date * 08/22/2019 F. Tracking and COC Info NOI Tracking No. 15184 NC Reference No. NCG01-2019-1557 Uses 'count number variable (incremrented by SP) Certificate of NCC191557 Coverage (COC) Uses 'count _nunber'variable (increrrented bySP) No. * Count Number 1557 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.)