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HomeMy WebLinkAboutNCC203409_NOI Application_20200811Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 8/6/2020 12:13:59 PM (NCG01 NOI Submission) Approve by Clark, Paul 8/10/2020 8:09:46 AM (Review- Construction NOI 29565) • The task was assigned to Clark, Paul by round robin distribution 8/6/2020 12:14 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 10, 2020 5:00 PM 8/6/2020 12:14 PM Submit by Selkane, Aziza 8/11/2020 9:04:58 AM (Payment Verification for NCC203409) * Todd Davis • Selkane, Aziza assigned the task to Selkane, Aziza 8/11/2020 9:04 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 21, 2020 5:00 PM 8/10/2020 8:09 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting r No an NOI that was r Yes rejected before? Previous Rejected 28615 NOI No. Prior Reviewer Jim Farkas Name 1a. Project Name * Oasis Church Grading Only 1 b. Specific Lot This field rray be used to list specifc lot numbers. Numbers 2. County* Wake 3. Highway or Street 1828 Ralph Stephens Rd Address * Street narre only is acceptable if no address number assigned yet 4. City or Township* Holly Springs 5. State * NC 6. Zip Code * 27540 7. Latitude * Enter the latitude in decimal degrees 35.6336 8. Longitude* Enter the longitude in decimal degrees (MJSTbe negative) -78.8396 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* 07/27/2020 Estimated Construction Project Start Date 10. Date to End* 07/28/2021 Estimated Construction Project End Cute 11. SIC (Primary)* Commercial (1542) Standard Industrial Classification for Developrrent 12. Acres to be 5.50 disturbed* (including off -site borrow and waste areas) 13. Total site area 8.29 (acres) * 14. Post- 9.04 construction (Estimated) impervious area (acres) * NCC Project NCC-WAKE-2020-Oasis Church Grading Only Tracking ID Assigned automatically 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. Please enter only immediate receiving waterbodies - not waters downstream of those unless the project extends there. You may enter up to 3 waterbodies if needed. 15a. Receiving Basal Creek Wate rbody* %rre of waterbody into which stormwater runoff will discharge 15b. Waterbody 27-43-15-3 Index No.* NCWaterbody Index Nunber Stormwater rJ No discharges will flow Pf 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. ^ F2rnittee Inforrration - Legally Fbsponsible Entity and Individual 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 Legally Pesponsible Entity Name * Holly Springs Foursquare Church, dba Oasis Church It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. 2. First Name * Todd IF Corporation, enter Faegistered Agent First %rre 3. Last Name* Davis It Corporation, enter F;bgistered Agent Last %ne 3b. Title Executive Pastor 4. Permitee E-mail todd.davis@oasischurchnc.com Address* 5. Permittee 919-946-2135 Telephone No.* 6. Permittee Mailing Street Address Address* 1828 Ralph Stephens Rd Address Line 2 aty State / Rovince / F;bgion Holly Springs NC Fbstal / Zip Code Country 27540 USA Check box if the F Yes street address the same as mailing address 7. Permittee Street Street Address Address* 1828 Ralph Stephens Rd Address Line 2 city State / Frovince / Region Holly Springs NC Fbstal / Zip Code Country 27540 USA 8. Type of Non -Government Ownership* C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Todd Contact - First Name * 2. Primary Site Davis Contact - Last Name * 3. Title Executive Pastor 4. Site Contact E- todd.davis@oasischurchnc.com mail Address* 5. Site Contact 919-946-2135 Telephone No. 6. Organization Oasis Church Name 7. Site Contact Street Address Mailing Address* 1828 Ralph Stephens Road Address Line 2 City Holly Springs Fbstal / Zip Code 27540 8. Consultant Name (Optional) Brian Duncan- The Spaulding Group First and Last nacre 9. Consultant E-mail brian@spaulding-group.com This person will be copied on all correspondence. 10. Consultant 919-422-2691 Telephone No. State / Rovince / Region NC Country us D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 05/13/2020 Approved * 2. E&SC Plan Project 19-05-02 Number/ID * Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* Town of Holly Springs Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a complete application. For linear projects, please also upload a site map showing the overall extent of the project or include the beginning point and end point coordinates in the "Notes" box below. 5. E&SC Plan Erosion Control Approval Letter.pdf 1.91VIB Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Helpful for linear project review (Optional) 926-18 COOOO.pdf 559.38KB Mast be RDFformat. Rease do not upload entire set of E&SCplans. 7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies for linear projects if necessary. 8. NOI Certification NCG01-eNO1-Certification-Form-20190919-DEMLR- Form 878.06KB SW_encrypted_.pdf Mast be R7Ffon-rat This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.66 (1) provides that: Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other document filed or required to be maintained under this Article or a rule implementing this Atide; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the Commission implementing this Atcle shall be guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). Under penalty of law, I certify that: 17 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. * 17 I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control Plan. * rJ 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. * 17 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 f Authorized Responsible Person* Important: The person who electronically signs this Certification above must be the same person who signs the NOI Certification Form. If that person is signing on behalf of the Permittee, that individual must be an authorized responsible person within the same organization as the Permittee. *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* Todd Davis Title Executive Pastor Organization Legally Iesponsible Entity Holly Springs Foursquare Church, dba Oasis Church Date * 08/06/2020 F. Tracking and COC Info NOI Tracking No. 29565 NC Reference No. NCG01-2020-3409 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC203409 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 3409 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2020 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC203409-2020 Invoice Due Date 9/9/2020 Initial Fee $ 100.00 Invoice Status OPEN