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HomeMy WebLinkAboutNCC203374_NOI Application_20200811Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 8/5/2020 5:01:02 PM (NCG01 NOI Submission) Approve by Farkas, Jim J 8/6/2020 3:42:27 PM (Review- Construction NOI 29523) . The task was assigned to Farkas, Jim J by round robin distribution 8/5/2020 5:01 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 7, 2020 5:00 PM. The priority is: High 8/5/2020 5:01 PM Submit by Selkane, Aziza 8/11/2020 11:49:55 AM (Payment Verification for NCC203374) * Gemini Construction Company • Selkane, Aziza assigned the task to Selkane, Aziza 8/11/2020 11:49 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 17, 2020 5:00 PM. The priority is: High 8/6/2020 3:42 PM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting IT No an NOI that was r Yes rejected before? 1a. Project Name * Randolph Mall Redevelopment 1 b. Specific Lot This field nay be used to list specifc lot nunbers. Numbers 2. County* Randolph 3. Highway or Street 1437 East Dixie Drive Address* Street narre only is acceptable if no address number assigned yet 4.CityorTownship* Asheboro 5. State * NC 6. Zip Code * 27203 7. Latitude* Enter the latitude in decinal degrees 35.7013 8. Longitude* Enter the longitude in decir al degrees (M.JST be negative) -79.7863 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* 06/29/2020 Estinated Construction Project Start Date 10. Date to End * 06/28/2021 Estinated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial Classification for Leveloprrent 12. Acres to be 4.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 36.72 (acres) * 14. Post- 33.00 construction (Estirrated) impervious area (acres) * NCC Project NCC-RANDO-2020-Randolph Mall Redevelopment Tracking ID Assigned autorretically 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 Gabriels Creek Waterbody* Klarre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 17-14 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. ^ 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 * Asheboro Mall, LLC It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. 2. First Name * James IF Corporation, enter Faegistered Agent First Wre 3. Last Name* Hull It Corporation, enter F;bgistered Agent Last %ne 3b. Title General Partner 4. Permitee E-mail rjohnson@hullpg.com Address* 5. Permittee 706-855-4031 Telephone No.* 6. Permittee Mailing Street Address Address* 1190 Interstate Parkway Address Line 2 City State / Rovince / F;bgion Augusta GA Fbstal / Zip Code Country 30909 us Check box if the V Yes street address the same as mailing address 7. Permittee Street Street Address Address* 1190 Interstate Parkway Address Line 2 City State / Frovince / Region Augusta GA Fbstal / Zip Code Country 30909 us 8. Type of Non -Government Ownership* C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Trevor Contact - First Name * 2. Primary Site Huggins Contact - Last Name * 3. Title Project Contact 4. Site Contact E- thuggins@geminiconstructionco.com mail Address* 5. Site Contact 706-434-1781 Telephone No. 6. Organization Gemini Construction Company, LLC Name 7. Site Contact Street Address Mailing Address* 1190 Interstate Parkway Address Line 2 city Augusta Fbstal / Zip Code 30909 8. Consultant Name (Optional) Zachary Gardner First and Last nacre 9. Consultant E-mail zach@summeyengineering.com This person will be copied on all correspondence. 10. Consultant 336-328-0902 Telephone No. State / Rovince / Region GA Country us D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 06/04/2020 Approved * 2. E&SC Plan Project RANDO-2020-020 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 * Winston-Salem (WSRO) 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 LOA - 2020-06-04 - Randolph Mall.pdf 6.83MB 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. 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 NOI Cert Form - Randolph Mall - Signed.pdf 94.77KB Form Mist be RDFfornat 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 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 * James M Hull Title Member Manager Organization Legally Responsible Entity Asheboro Mall, LLC Date * 08/05/2020 F. Tracking and COC Info NOI Tracking No. 29523 NC Reference No. NCG01-2020-3374 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC203374 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 3374 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2020 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC203374-2020 Invoice Due Date 9/5/2020 Initial Fee $ 100.00 Invoice Status OPEN