HomeMy WebLinkAboutNCC191576_NOI Application_20190826Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/23/2019 4:41:24 PM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 8/26/2019 8:35:57 AM (Review- Construction NOI 15252)
• The task was assigned to McCoy, Suzanne by round robin distribution 8/23/2019 4:41 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 27, 2019 5:00
PM. The priority is: High 8/23/2019 4:41 PM
Submit by McCoy, Suzanne 8/26/2019 3:09:49 PM (Payment Verification for NCC191576)
* Transcontinental Gas Pipe Line Cc LLC
• McCoy, Suzanne assigned the task to McCoy, Suzanne 8/26/2019 3:08 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 9, 2019 5:00
PM. The priority is: High 8/26/2019 8:36 AM
117-8) sT.:2,G) M F1Ii f_T1II a 10141
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Piedmont -Marshall Interconnection
2. County* Lincoln
3. Highway or Street June Dellinger Rd
Address * Street narre only is acceptable if no address nurrber assigned yet
4. City or Township* Catawba Springs
5. State * NC
6. Zip Code* 28164
7. Latitude * Enter the latitude in decirral degrees
35.4148
8. Longitude * Enter the longitude in decirral degrees (MUST be negative)
-81.0331
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*
08/26/2019
Estimated Construction Project Start Date
10. Date to End*
11 /30/2019
Estimated Construction Project End Date
11. SIC (Primary)*
Other (0000)
Standard Industrial aassification for Development
12. Acres to be
1.25
disturbed*
(including off -site borrow and waste areas)
13. Total site area
1.25
(acres)*
14. Post-
0.14
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-LINCO-2019- Pied mont-Marshall Interconnection
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 Killian Creek
Wate rbody* Nhrre of waterbody into which stormuater runoff will discharge
15b. Waterbody 11-119-2-(0.5)
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 Fbsponsible 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 Williams Gas Pipeline Transco
Name *
2. First Name* Scott
ff Corporation, enter Registered Agent First 1\brre
3. Last Name * Hallam
ff Corporation, enter Registered Agent Last Barre
3b. Title SVP Atlantic -Gulf
4. Permitee E-mail scott.hallam@williams.com
Address*
5. Permittee 713-215-2100
Telephone No.*
6. Permittee Mailing Street Address
Address* 2800 Post Oak Boulevard
Address Line 2
Suite 900
City State / Province / Region
Houston Texas
Pastal / Zip Code Country
77056 United States
Check box if the r% Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 2800 Post Oak Boulevard
Address Line 2
Suite 900
City State / Province / Region
Houston Texas
Pastal / Zip Code Country
77056 United States
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 Medley
Contact - Last
Name *
4. Title Chief Inspector
5. Site Contact E- Julius. Medley@Wlliams.com
mail Address*
6. Site Contact 704-975-2638
Telephone No.*
7. Organization
Williams Gas Pipeline - Transco
Name
8. Site Contact
Street Address
Mailing Address*
604 Linwood Road
Address Line 2
city
Mooresville
Fbstal / Zip Code
28115
State / Province / Region
NC
Country
United States
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.............................................................................................................................................................
1. Date E&SC Plan
07/31/2019
Approved *
2. E&SC Plan Project
Lincoln Co. - Piedmont - Marshall
Number/ID
Interconnection
Assigned by agency or local program
3. E&SC Plan
r 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 NC —Piedmont Marshall IC_SESCP approval.pdf 1.69MB
Approval Wst be FDF format
letter/documentation
6. NOI Certification NC: Piedmont Marshall IC_SESCP NOI NCG01
Form 302.47KB
Certification Form_signed_SHallam.pdf
Mist be FDF format
This is an Express r No
Review Project* r Yes
h
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 * Scott Hallam
Title SVP Atlantic -Gulf
Organization Williams Gas Pipeline Transco
Date * 08/23/2019
F. Tracking and COC Info
NOI Tracking No. 15252
NC Reference No. NCG01-2019-1576
Uses 'count _nunber'variable (increrrented by SP)
Certificate of NCC191576
Coverage (COC) Uses'count_nunber'variable (incremented by SF)
No. *
Count Number 1576
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.)