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HomeMy WebLinkAboutNCC191878_NOI Application_20190913Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 9/12/2019 2:05:54 PM (NCG01 NOI Submission) Approve by McCoy, Suzanne 9/13/2019 11:22:25 AM (Review- Construction NOI 15857) • The task was assigned to McCoy, Suzanne by round robin distribution 9/12/2019 2:06 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 16, 2019 5:00 PM 9/12/2019 2:06 PM Submit by McCoy, Suzanne 9/13/2019 11:26:29 AM (Payment Verification for NCC191878) * J. Westmoreland Inc • McCoy, Suzanne assigned the task to McCoy, Suzanne 9/13/2019 11:25 AM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 25, 2019 5:00 PM 9/13/2019 11:22 AM STME NORTH CAROLINA Ernvlronmentol qualily A. Project Information Part A. Project Location and Waterbody Inforrration 1. Project Name * J Westmoreland, Inc - LCID Landfill 2. County* Forsyth 3. Highway or Street 6250 Walnut Cove Road Address * Street name only is acceptable if no address nurrber assigned yet 4. City or Township* Walkertown 5. State * NC 117-8) sT.:2,G) M 1-11 (-_TiI a 1010 6. Zip Code* 27051 7. Latitude * Enter the latitude in decirral degrees 36.1964 8. Longitude * Enter the longitude in decirral degrees (MIST be negative) -80.1646 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* 09/16/2019 Estimated Construction Project Start Date 10. Date to End* 09/28/2020 Estimated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial aassification for Development 12. Acres to be 14.20 disturbed* (including off -site borrow and waste areas) 13. Total site area 38.73 (acres)* 14. Post- 3.20 construction (Estimated) impervious area (acres) * NCC Project NCC-FORSY-2019-J Westmoreland, Inc - LCID Landfill 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. You may enter up to 3 waterbodies. 15a. Receiving Old Field Creek Waterbody * Narre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 22-25-11 Index No. * NCWaterbody Index N nber Stormwater r No discharges will flow rj Yes to additional wate rs * 15c. Additional Waterbody narre Receiving Waterbody 15d. Waterbody NC Waterbody Index N nber Index No. 15e. Additional Waterbody narre Receiving Waterbody 15f. Waterbody NC Waterbody Index N rater Index No. 16a. Is this project r Yes subject to the NC f No, not subject to NC SPCA Sediment Pollution Control Act?* B. Permittee Information Part B. Perrrittee Information - Legally Responsible Entity and Individual ..................................................................................................................................................................... h 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 J Westmoreland, Inc Name * 2. First Name* Thomas If Corporation, enter Registered Agent First l\b e 3. Last Name * Westmoreland ff Corporation, enter Registered Agent Last Barre 3b. Title President 4. Permitee E-mail jwinc@triad.rr.com Address* 5. Permittee 336-529-4472 Telephone No.* 6. Permittee Mailing Street Address Address* 6851 Old Still Trail Address Line 2 City Kernersville Postal / Zip Code 27284 Check box if the street address the same as mailing address 7. Permittee Street Address* fJ Yes Street Address 6851 Old Still Trail Address Line 2 City Kernersville R bstal / Zip Code 27284 State / Province / Region NC Country us State / Province / Region NC Country us C. Site Contact Information Part C. Roiect Site Contact Information 1. Type of Non -Government Ownership* 2. Primary Site Thomas Contact - First Name * 3. Primary Site Westmoreland Contact - Last Name * 4. Title President 5. Site Contact E- jwinc@triad.rr.com mail Address* 6. Site Contact 336.529.4472 Telephone No.* 7. Organization J Westmoreland, Inc Name 8. Site Contact Street Address Mailing Address* 6851 Old Still Trail Address Line 2 aty Kernersville Fbstal / Zip Code 27284 9. Consultant Name (optional) Alex Carter First and Last narre 10. Consultant E- acarter@beesonengineering.com mail This person will be copied on all correspondence. 11. Consultant 336.748.0071 Telephone No. State / Province / Region NC Country us D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Ran Approval Information ....................................................................................................................................................................................................................................... 1. Date E&SC Plan 09/10/2019 Approved * 2. E&SC Plan Project 43495 Number/ID* Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by r Local Program 4. Local Program* Winston-Salem/Forsyth County Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a complete application. 5. E&SC Plan AP 43495 Approval Letter.pdf 182.92KB Approval Mist be PCFfornat letter/documentation 6. NOI Certification eNO1 Form Signed.pdf 1.84MB Form Mist be RDFfornet This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.6B (1) provides that: Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand dollars ($10,000). Under penalty of law, I certify that: rJ 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. * V 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. * I7 I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control Plan. * V 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. * I7 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 r Authorized Responsible Person* Important: The person who signs this Certification above and signs the NOI Certification Form should be the same person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information) of this form. *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* Thomas Westmoreland Title President Organization J Westmoreland, Inc Date * 09/12/2019 F. Tracking and COC Info NOI Tracking No. 15857 NC Reference No. NCG01-2019-1878 Uses 'count number variable (incremrented by SP) Certificate of NCC191878 Coverage (COC) Uses 'count _nunber'variable (increrrented bySP) No. * Count Number 1878 Sequential nunber for subrrittal that is incremented by Stored Procedure COC Year 2019 Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)