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HomeMy WebLinkAboutNCC191946_NOI Application_20190930 Action History (UTC-05:00) Eastern Time(US&Canada) Submit by Anonymous User 9/17/2019 7:24:03 AM(NCG01 NOI Submission) Approve by Morman,Alaina 9/18/2019 8:52:38 AM(Review-Construction NOI 15967) • The task was assigned to Morman,Alaina by round robin distribution 9/17/2019 7:24 AM • The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: September 19,2019 5:00 PM 9/17/2019 7:24 AM Submit by McCoy,Suzanne 9/30/2019 1:02:56 PM(Payment Verification for NCC191946) * Marshallberg Vol Fire Dept Inc. • McCoy, Suzanne assigned the task to McCoy,Suzanne 9/30/2019 1:02 PM • The task was assigned to DEMLR NCG01 Payment Team.The due date is:October 30,2019 5:00 PM 9/18/2019 8:52 AM E, • 1 • • 1 III • 1 1 sees �' � ••. -• i •• i i• i IY sell NORTH CAROLINA Ernvlronmental QUII A. Project Information Part A. Project Location and Waterbody Information 1. Project Name* Marshallberg Voluntary Fire Department 2. County* Carteret 3. Highway or Street 1138 Straits Road Address* Street narra only is acceptable if no address nurrber assigned yet 4. City or Township* Smyrna 5. State* NC 6.Zip Code* 28579 7. Latitude* Enter the latitude in decirral degrees 34.7470 8. Longitude* Enter the longitude in decirral degrees(MJSTbe negative) -76.5211 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* 09/30/2019 Estimated Construction Project Start Date 10. Date to End* 09/30/2020 Estimated Construction Project End Date 11. SIC(Primary)* Commercial(1542) Standard Industrial gassification for Developrrant 12.Acres to be 3.90 disturbed* (including off-site borrow and waste areas) 13.Total site area 8.01 (acres)* 14. Post- 0.96 construction (Estimated) impervious area (acres)* NCC Project NCC-CARTE-201 9-Marshall berg Voluntary Fire Department 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. 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 Tush Creek Wate rbody* Nacre of waterbody into which stormuater runoff will discharge 15b.Waterbody 21-35-7-25 Index No.* NC Waterbody Index PJunber Stormwater W No discharges will flow F 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. Perrrittee Information-Legally Responsible 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 Marshallberg Voluntary Fire Department, Inc. Name* 2. First Name* John ff Corporation,enter Registered Agent First l\brre 3. Last Name* Day Y Corporation,enter Registered Agent Last Barre 3b.Title President 4. Permitee E-mail johnday.nc@gmail.com Address* 5. Permittee 252-729-5111 Telephone No.* 6. Permittee Mailing Street Address Address* P.O. Box Address Line 2 City State/Province/Region Marshallberg NC Postal/Zip Code Country 28553 us Check box if the r Yes street address the same as mailing address 7. Permittee Street Street Address Address* 1138 Straits Road Address Line 2 City State/Province/Region Smyrna NC Rastal/Zip Code Country 28579-9541 US C. Site Contact Information Part C. Project Site Contact Information .................................................................................................................... 1.Type of Non-Government Ownership* 2. Primary Site Bryan Contact-First Name* 3.Primary Site Blake Contact-Last Name* 4.Title Chief 5.Site Contact E- jbryanblake@gmail.com mail Address* 6.Site Contact (252)729-2641 Telephone No.* 7.Organization Name 8.Site Contact Street Address Mailing Address* P.O. Box Address Line 2 City State/Province/Region Marshallberg NC Fbstal/Zip Code Country 28553 us 9.Consultant Name (Optional) Ginger Y.Turner First and Last narre 10.Consultant E- ginger@tcgpa.com mail This person will be copied on all correspondence. 11. Consultant 252-499-2166 Telephone No. D. E&SC Plan Part D. Erosion&Sediment Control(E&SC)Ran Approval Information ....................................................................................................................................................................................................................................... .............................................................................................. 1. Date E&SC Plan 08/12/2019 Approved* 2. E&SC Plan Project CARTE-2020-005 Number/ID* Assigned by agency or local program 3. E&SC Plan f•State DEQ Office Approved by r Local Program 4.State DEQ Office* Wilmington(WiRO) 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 Marshallberg VFD Letter of Approval with Mod.pdf 229.08KB Approval Mist be RDFforrrat letter/documentation 6. NOI Certification NCG01 NOI MVFD.pdf 946.92KB Form Mist be RJFforrrat This is an Express f•No Review Project* r Yes E. Certification North Carolina General Statute 143-215.613(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. * 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. * I7 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 r 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* John Day Title President Organization Marshallberg Voluntary Fire Department, Inc. Date* 09/17/2019 F. Tracking and COC Info NOI Tracking No. 15967 NC Reference No. NCG01-2019-1946 Uses'count number variable(incremented by SP) Certificate of NCC191946 Coverage (COC) Uses'count_nunber'variable(increrrented bySP) No.* Count Number 1946 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.)