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HomeMy WebLinkAboutNCC200139_NOI Application_20200114Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 1/10/2020 4:59:28 PM (NCG01 NOI Submission) Approve by McCoy, Suzanne 1/13/2020 8:05:54 AM (Review- Construction NOI 20479) • The task was assigned to McCoy, Suzanne by round robin distribution 1/10/2020 4:59 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 14, 2020 5:00 PM 1/10/2020 4:59 PM Submit by McCoy, Suzanne 1/14/2020 7:19:37 AM (Payment Verification for NCC200139) * Hope H Turnbull • McCoy, Suzanne assigned the task to McCoy, Suzanne 1/14/2020 7:18 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 24, 2020 5:00 PM 1/13/2020 8:06 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information 1. Project Name * Fairfield Inn & Suites Wallace 2. County* Duplin 3. Highway or Street Hwy 41 & River Place Address * Street narre only is acceptable if no address number assigned yet 4. City or Township* Wallace 5. State * NC 6. Zip Code * 28466 7. Latitude * Enter the latitude in decimal degrees 34.7555 8. Longitude* Enter the longitude in decinal degrees (M. ST be negative) -77.9486 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* 02/01/2020 Estimated Construction Project Start Date 10. Date to End* 01/31/2021 Estimated Construction Project End Cute 11. SIC (Primary)* Commercial (1542) Standard Industrial aassification for Developrrent 12. Acres to be 4.50 disturbed* (including off -site borrow and waste areas) 13. Total site area 4.50 (acres) * 14. Post- 1.93 construction (Estimated) impervious area (acres) * NCC Project NCC-DUPLI-2020-Fairfield Inn & Suites Wallace 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 NE Cape Fear River Wate rbody* Narm of waterbody into which storrrwater runoff will discharge 15b. Waterbody 18-74-(25.5) Index No.* NCWaterbody Index N nber 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 Duplin Land Development, Inc. Name * 2. First Name* Terry IF Corporation, enter Fbgistered Agent First Barre 3. Last Name* Tate IF Corporation, enter Pegistered Agent Last %rre 3b. Title Vice President 4. Permitee E-mail tate@murfam.com Address * 5. Permittee 910-285-4171 Telephone No.* 6. Permittee Mailing Street Address Address* P.O. Box 1139 Address Line 2 city State / F rovince / Faegion Wallace NC Fbstal / Zip Code Country 28466 - 1139 US Check box if the r Yes street address the same as mailing address 7. Permittee Street Street Address Address* 5752 U.S. 117 Address Line 2 City State / Frovince / Fbgion Wallace NC Fbstal / Zip Code Country 28466-8278 US C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Type of Non -Government Ownership * 2. Primary Site Terry Contact - First Name * 3. Primary Site Tate Contact - Last Name * 4. Title Vice President 5. Site Contact E- tate@murfam.com mail Address* 6. Site Contact 910-285-4171 Telephone No.* 7. Organization Fairfield Inn & Suites Wallace Name 8. Site Contact Street Address Mailing Address* 5752 U.S. 117 Address Line 2 City Wallace Fbstal / Zip Code 28466-8278 9. Consultant Name (Optional) Phil Norris First and Last narre 10. Consultant E- pnorris@ntengineers.com mail This person will be copied on all correspondence. 11. Consultant 9102875900 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 01/03/2020 Approved * 2. E&SC Plan Project DUPLI-2020-014 Number/ID * Assigned by agency or local program 3. E&SC Plan r State DEQ Office Approved by* r Local Program 4. State DEQ Office * Wilmington (WiRO) 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 Approved State EC Permit (DUPLI-2020-014) - 01- Approval 441.12KB 03-20.pdf letter/documentation Mist be R7Ffon-rat 6. NOI Certification Fairfield NOI.pdf 290.92KB Form Mist be PDFfon-rat This is an Express F No Review Project* r Yes E. Certification North Carolina General Statute 143-215.6E (i) 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 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 * Terry A. Tate Title Vice President Organization Duplin Land Development, Inc. Date * 01 /10/2020 F. Tracking and COC Info NOI Tracking No. 20479 NC Reference No. NCG01-2020-0139 Uses 'count number' variable (incremrented by SP) Certificate of NCC200139 Coverage (COC) Uses 'count number' variable (incremented by SP) No.* Count Number 139 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.)