HomeMy WebLinkAboutNCC202693_NOI Application_20200626Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/24/2020 1:15:42 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 6/25/2020 1:51:41 PM (Review- Construction NOI 27425)
• Clark, Paul reassigned the task to Morman, Alaina 6/24/2020 3:07 PM
* for you .)
• The task was assigned to Clark, Paul by round robin distribution 6/24/2020 1:16 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 26, 2020 5:00 PM
6/24/2020 1:16 PM
Submit by McCoy, Suzanne 6/26/2020 11:15:22 AM (Payment Verification for NCC202693)
* laura minor
• McCoy, Suzanne assigned the task to McCoy, Suzanne 6/26/2020 11:14 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 6, 2020 5:00 PM
6/25/2020 1:51 PM
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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 27385
NOI No.
Prior Reviewer Alaina Morman
Name
1a. Project Name * Monroe Police Station
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
2. County* Union
3. Highway or Street 309-310 West Crowell Street
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* Monroe
5. State * NC
6. Zip Code * 28112
7. Latitude * Enter the latitude in decimal degrees
34.9839
8. Longitude* Enter the longitude in decinal degrees (M. ST be negative)
-80.5534
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* 07/06/2020
Estimated Construction Project Start Date
10. Date to End* 07/06/2021
Estimated Construction Project End Cute
11. SIC (Primary) * Other (9999)
Standard Industrial Classification for Ceveloprrent
12. Acres to be 10.05
disturbed* (including off -site borrow and waste areas)
13. Total site area 10.05
(acres) *
14. Post- 6.23
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-UNION-2020-Monroe Police Station
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 Bearskin Creek
Wate rbody* %rre of waterbody into which stormwater runoff will discharge
15b. Waterbody 13-17-36-6
Index No.* NCWaterbody Index Number
Stormwater rJ No
discharges will flow r- 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. ^
Fl rnittee 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 Monroe
IF pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name * Brian
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Borne
IF Corporation, enter F;bgistered Agent Last %ne
3b. Title Assistant City Manager
4. Permitee E-mail bborne@monroenc.org
Address*
5. Permittee 704-292-1705 EXT. 6040
Telephone No.*
6. Permittee Mailing Street Address
Address* P.O. Box69
Address Line 2
Cty
Monroe
Fbstal / Zip Code
28111
Check box if the F Yes
street address the
same as mailing
address
State / Rovince / Pbegion
NC
Country
us
7. Permittee Street
Street Address
Address*
300 West Crowell Street
Address Line 2
City
State / Frovince / Region
Monroe
NC
Fbstal / Zip Code
Country
28112
us
8. Type of
Government - Municipal
Ownership*
C. Site Contact Information
Part C.
Roject Site Contact Information
..............................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Brian
Contact - First
Name *
2. Primary Site Borne
Contact - Last
Name *
3. Title
4. Site Contact E- bborne@monroenc.org
mail Address*
5. Site Contact 704-292-1705 EXT. 6040
Telephone No.*
6. Organization
Name
7. Site Contact Street Address
Mailing Address* P.O. Box69
Address Line 2
city
Monroe
Fbstal / Zip Code
28111
8. Consultant Name (Optional)
First and Last nave
9. Consultant E-mail This person will be copied on all correspondence.
10. Consultant
Telephone No.
State / Frovince / Fegion
NC
Country
us
D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 04/29/2020
Approved *
2. E&SC Plan Project UNION-2020-063
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 * Mooresville (MRO)
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 1845-Monroe PD Erosion Control Approval
Approval letter or 474.23KB
04.29.2020.pdf
Grading Permit
Mast be FDFforrrat
6. Site Location Map Helpful for linear project review
(Optional) Mast be FCFfornat. Rease do not upload entire set of E&SCplans.
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 Xerox Scan_ 06182020133354.pdf 501.45KB
Form Mist be RDFformat
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 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 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 * Brian Borne
Title Assistant City Manager
Organization Legally Responsible Entity
City of Monroe
Date * 06/24/2020
F. Tracking and COC Info
NOI Tracking No. 27425
NC Reference No. NCG01-2020-2693
Uses 'count number' variable (incremrented by SP)
Certificate of NCC202693
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2693
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.)