HomeMy WebLinkAboutNCC191667_NOI Application_20190830Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/29/2019 12:23:00 PM (NCG01 NOI Submission)
Approve by Lucas, Annette 8/30/2019 10:55:15 AM (Review- Construction NOI 15420)
• The task was assigned to Lucas, Annette by round robin distribution 8/29/2019 12:23 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 2, 2019 5:00
PM 8/29/2019 12:23 PM
Submit by McCoy, Suzanne 8/30/2019 1:13:03 PM (Payment Verification for NCC191667)
* Glandon Forest
• McCoy, Suzanne assigned the task to McCoy, Suzanne 8/30/2019 1:12 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 11, 2019 5:00 PM
8/30/2019 10:55 AM
STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Dollar General Ernul
2. County* Craven
3. Highway or Street 5615 N US Hwy 17
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Vanceboro
5. State * NC
1r-i)iTiT7i1)MF11f_TiIa10141
6. Zip Code* 28586
7. Latitude * Enter the latitude in decirral degrees
35.2497
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-77.0894
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* 11/11/2019
Estimated Construction Project Start Date
10. Date to End* 04/20/2020
Estimated Construction Project End Date
11. SIC (Primary)* Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be 1.50
disturbed* (including off -site borrow and waste areas)
13. Total site area
1.91
(acres)*
14. Post-
0.80
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-CRAVE-2019-Dollar General Ernul
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 Fisher Swamp
Wate rbody* Nacre of waterbody into which stormuater runoff will discharge
15b. Waterbody 27-97-8-3
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 Glandon Forest Equity
Name *
2. First Name* George
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Barnes
ff Corporation, enter Registered Agent Last Barre
3b. Title member -manager
4. Permitee E-mail gbarnes@vanguardpg.com
Address*
5. Permittee 919-459-2603
Telephone No.*
6. Permittee Mailing Street Address
Address* 3825 Barrett Drive
Address Line 2
Suite 100
City
Raleigh
Rastal / Zip Code
27609
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
fJ Yes
Street Address
3825 Barrett Drive
Address Line 2
Suite 100
City
Raleigh
Rastal / Zip Code
27609
State / Province / Region
NC
Country
USA
State / Province / Region
NC
Country
USA
C. Site Contact Information
Part C.
Roiect Site Contact hforrration
1. Type of Individual
Ownership*
2. Primary Site Ashley
Contact - First
Name *
3. Primary Site Davis
Contact - Last
Name *
4. Title Project manager
5. Site Contact E- adavis@vanguardpg.com
mail Address*
6. Site Contact 9194592603
Telephone No.*
7. Organization Glandon Forest Equity
Name
8. Site Contact Street Address
Mailing Address* 3825 Barrett Drive Suite 100
Address Line 2
city
Raleigh
Fbstal / Zip Code
27609
State / Rovince / Region
North Carolina
Country
USA
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 08/16/2019
Approved *
2. E&SC Plan Project Crave-2020-002
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 * Washington (WaRO)
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 8.16.19 Erosion Control Plan Approval_DG Ernul,
Approval 1.68MB
NC. pdf
letter/documentation
Mast be R7F forrrat
6. NOI Certification NOI Ernul.pdf 38.12KB
Form Mist be RDF format
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 *
George Barnes
Title
member -manager
Organization
Glandon Forest Equity
Date *
08/29/2019
F. Tracking and COC Info
NOI Tracking No. 15420
NC Reference No. NCG01-2019-1667
Uses 'count number variable (incremrented by SP)
Certificate of NCC191667
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 1667
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.)