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HomeMy WebLinkAboutNCC202311_NOI Application_20200609Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 6/2/2020 11:33:45 AM (NCG01 NOI Submission) Approve by Clark, Paul 6/3/2020 8:49:47 AM (Review- Construction NOI 26481) • The task was assigned to Clark, Paul by round robin distribution 6/2/2020 11:34 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 4, 2020 5:00 PM 6/2/2020 11:34 AM Submit by McCoy, Suzanne 6/9/2020 10:54:22 AM (Payment Verification for NCC202311) * Michael Brandon Love • McCoy, Suzanne assigned the task to McCoy, Suzanne 6/9/2020 10:53 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: July 15, 2020 5:00 PM 6/3/2020 8:50 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting f• No an NOI that was r Yes rejected before? 1a. Project Name * Lumberton Memorial Park 1 b. Specific Lot This field nay be used to list specifc lot nunbers. Numbers 2. County* Robeson 3. Highway or Street Elizabethtown Road Address* Street narre only is acceptable if no address number assigned yet 4. City or Township* Lumberton 5. State * NC 6. Zip Code * 28358 7. Latitude* Enter the latitude in decinal degrees 34.6216 8. Longitude* Enter the longitude in decir al degrees (NALIST be negative) -79.0093 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* 07/01/2020 Estimated Construction Project Start Date 10. Date to End* 07/01/2021 Estinated Construction Project End fate 11. SIC (Primary) * Other (9999) Standard Industrial aassification for Leveloprrent 12. Acres to be 1.62 disturbed* (including off -site borrow and waste areas) 13. Total site area 1.62 (acres) * 14. Post- 0.25 construction (Estirrated) impervious area (acres) * NCC Project NCC-ROBES-2020-Lumberton Memorial Park 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 Lumber River Waterbody* Narre of waterbody into which stormroater runoff will discharge 15b. Waterbody 14-(13) 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. ^ Fbrnittee 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 * City of Lumberton It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. 2. First Name * Brandon IF Corporation, enter Faegistered Agent First Wre 3. Last Name* Love It Corporation, enter F;bgistered Agent Last %ne 3b. Title Deputy City Manager 4. Permitee E-mail blove@ci.lumberton.nc.us Address* 5. Permittee 910-671-3805 Telephone No.* 6. Permittee Mailing Street Address Address* P.O. Box 1388 Address Line 2 City State / Rovince / F;bgion Lumberton NC Fbstal / Zip Code Country 28358 us Check box if the F Yes street address the same as mailing address 7. Permittee Street Street Address Address* 500 North Cedar Street Address Line 2 City State / Frovince / Faegion Lumberton NC Fbstal / Zip Code Country 28358-5545 us 8. Type of Government - Municipal Ownership* C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Brandon Contact - First Name * 2. Primary Site Love Contact - Last Name * 3. Title Deputy City Manager 4. Site Contact E- blove@ci.lumberton.nc.us mail Address* 5. Site Contact 910-671-3805 Telephone No. 6. Organization City of Lumberton Name 7. Site Contact Street Address Mailing Address* P.O. Box 1388 Address Line 2 city Lumberton Fbstal / Zip Code 28358 8. Consultant Name (Optional) Del Crawford First and Last nacre 9. Consultant E-mail admin@crawforddsn.com This person will be copied on all correspondence. 10. Consultant 910-221-0033 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 01/25/2020 Approved * 2. E&SC Plan Project ROBES-2019-012 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 * Fayetteville (FRO) 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 robes012apMod.pdf Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Helpful for linear project review (Optional) Mast be FCFfornat. Rease do not upload entire set of E&SCplans. 98.72KB 7. Notes (Optional) Frovide 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_ NOI _Lumberton_Memorial_Park.pdf 795.74KB Form Mist be RDFfornat This is an Express r 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 Amwx �Pg Type Name * Brandon Love Title Deputy City Manager Organization Legally Plesponsible Entity City of Lumberton Date * 06/02/2020 F. Tracking and COC Info NOI Tracking No. 26481 NC Reference No. NCG01-2020-2311 Uses 'count number' variable (incremrented by SP) Certificate of NCC202311 Coverage (COC) Uses 'count number' variable (incremented by SP) No.* Count Number 2311 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.)