Loading...
HomeMy WebLinkAboutNCC210640_NOI Application_20210203Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 1/29/2021 4:44:33 PM (NCG01 NOI Submission) Approve by Meloy, Michael 2/2/2021 8:34:57 AM (Review- Construction NOI 42434) • Garcia, Lauren V reassigned the task to Meloy, Michael 2/1/2021 1:47 PM • The task was assigned to Garcia, Lauren V by round robin distribution 1/29/2021 4:44 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: February 2, 2021 5:00 PM 1/29/2021 4:44 PM Submit by Selkane, Aziza 2/3/2021 9:38:41 AM (Payment Verification for NCC210640) * RuthAnn Scales • Selkane, Aziza assigned the task to Selkane, Aziza 2/3/2021 9:37 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 16, 2021 5:00 PM 2/2/2021 8:35 AM .• 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 41745 NOI No. Prior Reviewer Michael Meloy Name 1a. Project Name* Troutman Industrial Park 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) 4742218388, 4741381818, 4742306535, 4741395538, 4742311256, 4742313332, 4742314406 2. County* Iredell 3. Highway or Street 386 Murdock Rd Address* Street name only is acceptable if no address number assigned yet 4. Cityor Township* Troutman 5. State * NC 6. Zip Code* 28166 7. Latitude* Enter the latitude in decimal degrees 35.7180 8. Longitude * Enter the longitude in decimal degrees (UBTbe negative) -80.8770 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* 02/01/2021 Estimated Construction Project Start Date 10. Date to End* 12/31/2021 Estinated Construction Project End Cate 11. SIC (Primary)* Commercial (1542) Standard Industrial Classification for Development 12. Acres to be 3.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 158.33 (acres) * 14. Post- 55.00 construction (Estimated) impervious area (acres) * NCC Project NCC-IREDE-2021-Troutman Industrial Park 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 I-L Creek Waterbody* Narreof waterbody into which stormwater runoff will discharge 15b. Waterbody 12-108-20-4-4 Index No. * NCWaterbody Index Nanber Stormwater V 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. ^ 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 Legally Pesponsible Entity Name * Walmart Fulfillment Services, LLC 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 * Mark If Corporation, enter Faegistered Agent First Wre 3. Last Name* Goldsmith IF Corporation, enter F;bgistered Agent Last %rre 3b. Title Director EH&S Compliance 4. Permitee E-mail Mark.Goldsmith@walmart.com Address* 5. Permittee 479-360-4749 Telephone No.* 6. Permittee Mailing Street Address Address* 702 Southwest 8th Street Address Line 2 City Bentonville Fbstal / Zip Code 72716-0505 Check box if the street address the same as mailing address 7. Permittee Street Address* V Yes Street Address 702 Southwest 8th Street Address Line 2 city Bentonville Fbstal / Zip Code 72716-0505 State / Frovince / Fbgion AR Country us State / Frovince / Faegion AR Country us 8. Type of Ownership is only individual if an individual is naned in B.1. above. Ownership* Non -Government C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Mark Contact - First Name * 2. Primary Site Goldsmith Contact - Last Name * 3. Title Director EH&S Compliance 4. Site Contact E- Mark.Goldsmith@walmart.com mail Address* 5. Site Contact 479-360-4749 Telephone No. 6. Organization Walmart Fulfillment Service, LLC Name 7. Site Contact Street Address Mailing Address* 702 Southwest 8th Street Address Line 2 City Bentonville Fbstal / Zip Code 72716-0505 8. Consultant Name (Optional) Charlie Yowell First and Last nacre 9. Consultant E-mail cyovvell@bohlereng.com This person will be copied on all correspondence. 10. Consultant 919-578-9000 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) Mark.Goldsmith@walmart.com Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 479-360-4749 Default is legally responsible person telephone State / Rovince / Region AR Country us D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 01/07/2020 Approved * 2. E&SC Plan Project TRTMN-2018-085 Number/ID * Assigned by agency or local program 3. E&SC Plan Approved by* 4. Local Program* f State DEQ Office r Local Program Iredell County Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can include the beginning point and end point coordinates in the "Notes" box below). 5. E&SC Plan Troutman Approval Letter 1.7.2020.pdf 810.54KB Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map NUst be RDFforrrat (lint 20 NB) Troutman Industrial Park Location Map.pdf 1.53MB Rease do not upload entire set of E&SC plans. 7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded documents support the application. Include additional waterbodies if necessary. Phone conversation with Michael Meloy on 1/27/21. Revised to only include the 1/7/20 approval letter and disturbed area of 3 acres. 8. NOI Certification 03001-500 NCG01-eNO1-Certification-Form 2021- Form 778.88KB 01-29.pdf Mast be FDFfon-rat 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 If the Erosion and Sediment Control Plan approved by the delegated program is not compliant with Part II (Stormwater Pollution Prevention Plan) of the NCG010000 General Permit. I will nonetheless ensure that all conditions of Part II of the permit are met on the project at all times. * 17 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 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 Type Name* Mark S Goldsmith Title Director EH&S Compliance\ Organization Legally Ibsponsible Entity Walmart Fulfillment Services. LLC Date * 01 /29/2021 F. Tracking and COC Info NOI Tracking No. 42434 NC Reference No. NCG01-2021-0640 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC210640 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 640 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2021 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC210640-2021 Invoice Due Date 3/4/2021 Initial Fee $ 100.00 Invoice Status OPEN