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HomeMy WebLinkAboutNCC200064_NOI Application_20200107Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 1/6/2020 4:26:59 PM (NCG01 NOI Submission) Approve by Clark, Paul 1/7/2020 8:29:24 AM (Review- Construction NOI 20266) • The task was assigned to Clark, Paul by round robin distribution 1/6/2020 4:27 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 8, 2020 5:00 PM 1/6/2020 4:27 PM Submit by McCoy, Suzanne 1/7/2020 11:29:26 AM (Payment Verification for NCC200064) * Jack Sipe Const. • McCoy, Suzanne assigned the task to McCoy, Suzanne 1/7/2020 11:28 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 18, 2020 5:00 PM 1/7/2020 8:29 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information 1. Project Name * Greater Shekinah Glory Church 2. County* Catawba 3. Highway or Street 3741 Section House Road Address * Street narre only is acceptable if no address number assigned yet 4. City or Township* Hickory 5. State * NC 6. Zip Code * 28601 7. Latitude * Enter the latitude in decirral degrees 35.7360 8. Longitude* Enter the longitude in decir al degrees (M. ST be negative) -81.2480 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 Estinated Construction Project Start Date 10. Date to End* 06/30/2020 Estimated Construction Project End Cute 11. SIC (Primary) * Residential, Other than SFE (1522) Standard Industrial aassification for Ceveloprrent 12. Acres to be 3.21 disturbed* (including off -site borrow and waste areas) 13. Total site area 25.48 (acres) * 14. Post- 1.77 construction (Estimated) impervious area (acres) * NCC Project NCC-CATAW-2019-Greater Shekinah Glory Church 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. 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 Herman Branch Wate rbody* Narre of waterbody into which storrrwater runoff w ill discharge 15b. Waterbody 11-76-1 Index No.* NCWaterbody Index Nirrber Stormwater V No discharges will flow r Yes to additional wate rs * 16a. Is this project F Yes subject to the NC r No, not subject to NC SPCA Sediment Pollution Control Act?* B. Permittee Information Part B. ^ Fternittee 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 Greater Shekinah Glory Ministries Name * 2. First Name* Kathy IF Corporation, enter Pegistered Agent First Barre 3. Last Name* Johnson If Corporation, enter Faegistered Agent Last %rre 3b. Title Pastor 4. Permitee E-mail preacherlady7@hotmail.com Address * 5. Permittee 828-381-7130 Telephone No.* 6. Permittee Mailing Street Address Address* 3066 South Highway 127 Address Line 2 city Hickory Fbstal / Zip Code 28602-5404 Check box if the street address the same as mailing address 7. Permittee Street Address* V Yes Street Address 3066 South Highway 127 Address Line 2 Cty Hickory F bstal / Zip Code 28602-5404 State / Frovince / Faegion NC Country us State / Frovince / Fbgion NC Country us C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Type of Non -Government Ownership * 2. Primary Site Gary Contact - First Name * 3. Primary Site Pierce Contact - Last Name * 4. Title General Manager 5. Site Contact E- Gary@jacksipeconstruction.com mail Address* 6. Site Contact 828-244-1558 Telephone No.* 7. Organization Jack Sipe Construction Company Name 8. Site Contact Street Address Mailing Address* P.O. Box2576 Address Line 2 City Hickory Fbstal / Zip Code 28603 9. Consultant Name (Optional) First and Last narre 10. Consultant E- This person will be copied on all correspondence. mail 11. Consultant Telephone No. State / Rovince / Fbgion 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 CBPR-05-2019-31929 Number/ID * Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* Catawba County 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 Greater Shekinah Glory Church approve with Approval 68.42KB modifications June 6 2019 with acres (002).pdf letter/documentation Mist be R7Fforrrat 6. NOI Certification NOI Certification Form GSG.pdf 743.16KB Form Mist be R7Ffornat This is an Express F 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 Article; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Artcle; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the Commission implementing this Artcle 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 [�it��rf ,� �?IclrfrJcir Type Name* Kathy B. Johnson Title Pastor Organization Greater Shekinah Glory Ministries Date * 01 /06/2020 F. Tracking and COC Info NOI Tracking No. 20266 NC Reference No. NCG01-2020-0064 Uses 'count number' variable (incremrented by SP) Certificate of NCC200064 Coverage (COC) Uses 'count number' variable (incremented by SP) No.* Count Number 64 Sequential number for submittal that is incremented by Stored Frocedure COC Year 2020 Year of date reviewed (used to assign YY digits after "NOC' in COCno.)