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HomeMy WebLinkAboutNCC200843_NOI Application_20200303Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 3/2/2020 12:01:57 PM (NCG01 NOI Submission) Approve by Garcia, Lauren V 3/2/2020 2:59:56 PM (Review- Construction NOI 22637) • The task was assigned to Garcia, Lauren V by round robin distribution 3/2/2020 12:02 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 4, 2020 5:00 PM 3/2/2020 12:02 PM Submit by McCoy, Suzanne 3/3/2020 6:53:19 AM (Payment Verification for NCC200843) * Ryan newell • McCoy, Suzanne assigned the task to McCoy, Suzanne 3/3/2020 6:52 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 13, 2020 5:00 PM 3/2/2020 3:00 PM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information la. Project Name* HAYWOOD HABITAT FOR HUMANITY 1 b. Specific Lot This field may be used to list specifc lot nunbers. Numbers 2. County* Haywood 3. Highway or Street Sylvan Street Address* Street name only is acceptable if no address number assigned yet 4. City or Township* Waynesville 5. State * NC 6. Zip Code* 28786 7. Latitude* Enter the latitude in decimal degrees 35.4970 8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative) -83.0000 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* 02/24/2020 Estimated Construction Project Start Rate 10. Date to End * 05/20/2022 Estimated Construction Project End Late 11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521) Standard Industrial Classification for Development 12. Acres to be 2.94 disturbed* (including off -site borrow and waste areas) 13. Total site area 2.94 (acres)* 14. Post- 0.39 construction (Estirrated) impervious area (acres) * NCC Project NCC-HAYWO-2020-HAYWOOD HABITAT FOR HUMANITY Tracking ID Assigned autorraticaly 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 Shingle Cove Branch Waterbody* Ibrre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 5-16-12 Index No.* NCWaterbody Index Number 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. ^ 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 Haywood Habitat for Humanity Name * If perrrittee is an individual (i.e., organization does not apply), enter first and last narre in this field. 2. First Name* Ryan IF Corporation, enter Fbgistered Agent First Barre 3. Last Name* Newell IF Corporation, enter Faegistered Agent Last %rre 3b. Title Construction Manager 4. Permitee E-mail rnewell@haywoodhabitat.org Address * 5. Permittee 8285582144 Telephone No.* 6. Permittee Mailing Street Address Address* PO Box283 Address Line 2 331 Walnut Street Suite 1 City State / Province / Faegion Waynesville North Carolina F ostal / Zip Code Country 28786 United States Check box if the r Yes street address the same as mailing address 7. Permittee Street Street Address Address* 331 Walnut Street Suite 1 Address Line 2 City State / Province / Fegion Waynesville NC Flostal / Zip Code Country 28786-3254 US 8. Type of Non -Government Ownership* C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Ryan Contact - First Name * 2. Primary Site Nevvell Contact - Last Name * 3. Title Construction Manager 4. Site Contact E- rnewell@hayvvoodhabitat.org mail Address* 5. Site Contact 8287346616 Telephone No. 6. Organization Haywood Habitat for Humanity Name 7. Site Contact Street Address Mailing Address* PO Box283 Address Line 2 city Waynesville Fbstal / Zip Code 28786 8. Consultant Name (Optional) Cody Batchelder First and Last narre 9. Consultant E-mail cbatchelder@cdcgo.com This person will be copied on all correspondence. 10. Consultant 8282525388 Telephone No. State / Rovince / Region North Carolina Country United States D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 06/26/2019 Approved * 2. E&SC Plan Project HAYWO 2019-004 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 * Asheville (ARO) 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 DEQ Letter of Approval.PDF 511.43KB Approval letter or Mist beRDFforml Grading Permit Site Map (Optional) Helpful for linear project review Mast be RDFform3t Notes (Optional) Provide any additional information that night help the reviewer better understand how uploaded documents support the application. Include additional w aterbodies for linear projects if necessary. 6. NOI Certification ncg01 NOI 1.PDF 218.59KB Form Mast be RDFformat 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 * Ryan Newell Title Construction Manager Organization Haywood Habitat for Humanity Date * 03/02/2020 F. Tracking and COC Info NOI Tracking No. 22637 NC Reference No. NCG01-2020-0843 Uses 'count number' variable (incremrented by SP) Certificate of NCC200843 Coverage (COC) Uses 'count number' variable (incremented by SP) No.* Count Number 843 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.)