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HomeMy WebLinkAboutNCC205842_NOI Application_20201218Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 12/15/2020 7:12:39 AM (NCG01 NOI Submission) Approve by Morman, Alaina 12/16/2020 4:16:42 PM (Review- Construction NOI 39158) • Garcia, Lauren V reassigned the task to Morman, Alaina 12/15/2020 4:21 PM • The task was assigned to Garcia, Lauren V by round robin distribution 12/15/2020 7:13 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 17, 2020 5:00 PM 12/15/2020 7:13 AM Submit by Selkane, Aziza 12/18/2020 11:10:35 AM (Payment Verification for NCC205842) * Preston S Johnson • Selkane, Aziza assigned the task to Selkane, Aziza 12/18/2020 11:09 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 27, 2021 5:00 PM 12/16/2020 4:17 PM .• SThF� '; 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 38750 NOI No. Prior Reviewer Alaina Morman Name 1a. Project Name * Davidson Water Transmission Main Phase III - Extension to NC115 1 b. Specific Lot This field may be used to list specffc lot numbers. Numbers 1 c. Parcel ID List all R% associated w ith this project. Number(s) (PIN) 00325317, 00325316, 00325315, 00325318, 00325319, 4654060685.000, 4654184695.000, 4654168300.000 2. County* Mecklenburg 3. Highway or Street South Main Street Address* Street name only is acceptable if no address number assigned yet 4. City or Township* Davidson 5. State * NC 6. Zip Code* 28036 7. Latitude* Enter the latitude in decimal degrees 35.4974 8. Longitude * Enter the longitude in decimal degrees (UBTbe negative) -80.8506 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* 12/21/2020 Estimated Construction Project Start Date 10. Date to End* 06/01/2022 Estinated Construction Project End Cate 11. SIC (Primary)* Other (9999) Standard Industrial aassification for Development 12. Acres to be 5.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 5.00 (acres) * 14. Post- 0.00 construction (Estimated) impervious area (acres) * NCC Project NCC-MECKL-2020-Davidson Water Transmission Main Phase III Tracking ID Extension to NC115 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 South Prong West Branch Rocky River Waterbody* Narreof waterbody into which stormwater runoff will discharge 15b. Waterbody 13-17-3-1 Index No. * NCWaterbody Index Nurrber Stormwater F No discharges will flow 17 Yes to additional wate rs * 15c. Additional CATAWBA RIVER (Lake Norman below Receiving elevation 760) Waterbody Waterbodynarre 15d. Waterbody 11-(75) Index No. NCWaterbody Index N nber 15e. Additional Waterbody name Receiving Waterbody 15f. Waterbody NCWaterbody Index Narrber Index No. 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. ^ 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 Responsible Entity Name * City of Charlotte IF pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. Note: The organization name must match the business entity name registered with the NC Secretary of State. You can verify the registration here. 2. First Name * Joseph If Corporation, enter Registered Agent First %rre 3. Last Name* Wilson IF Corporation, enter F;bgistered Agent Last %rre 3b. Title Chief Engineer 4. Permitee E-mail cWlson@ci.charlotte.nc.us Address* 5. Permittee 704-336-1083 Telephone No.* 6. Permittee Mailing Street Address Address* 5100 Brookshire Blvd Address Line 2 City Charlotte Fbstal / Zip Code 28216 Check box if the street address the same as mailing address 7. Permittee Street Address* V Yes Street Address 5100 Brookshire Blvd Address Line 2 city Charlotte Fbstal / Zip Code 28216 State / Ffovince / Fbgion NC Country us State / Frovince / Region NC Country us 8. Type of Ownership is only individual if an individual is naned in B.1. above. Ownership* Government- Municipal C. Site Contact Information Part C. Project Site Contact Inforrration ........................................................................................................................................................................................................................................................................... 1. Primary Site Stephen Contact - First Name * 2. Primary Site Scott Contact - Last Name * 3. Title Engineering Project Manager 4. Site Contact E- stephen.scott@ci.charlotte.nc.us mail Address* 5. Site Contact 980-219-9488 Telephone No.* 6. Organization Charlotte Water Name 7. Site Contact Street Address Mailing Address* 5100 Brookshire Blvd. Address Line 2 City State / Province / Region Charlotte NC Postal / Zip Code Country 28216 us 8. Consultant Name (Optional) Preston Johnson First and Last narre 9. Consultant E-mail preston.johnson@aecom.com This person will be copied on all correspondence. 10. Consultant 8654144952 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) Default is legally responsible person e-n-ail (older NOts rray not populate) 12. Billing (For Annual Fee correspondence) Telephone Default is legally responsible person telephone (older NOls rray not populate) D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 06/18/2020 Approved * 2. E&SC Plan Project MECKL-2020-090 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 MECKL-2020-090-07212020.pdf 2.58MB Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Mist be RDFforrret (lint 20 NB) Site Map.pdf 1.25MB Rease do not upload entire set of E&SC plans. 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 Certification Form.pdf 81.48KB Form Wst be RDF format This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.66 (1) 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:* IT The Legally Responsible Person named on this Notice of Intent f Authorized Responsible Person* (signing on behalf of Legally Responsible Person named in Part B) 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 psepl if sa Type Name* Joseph Wilson Title Chief Engineer Organization Legally Responsible Entity City of Charlotte Date * 12/15/2020 F. Tracking and COC Info NOI Tracking No. 39158 NC Reference No. NCG01-2020-5842 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC205842 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 5842 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. NCC205842-2020 Invoice Due Date 1/15/2021 Initial Fee $ 100.00 Invoice Status OPEN