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HomeMy WebLinkAboutNCC192157_NOI Application_20191003Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 10/1/2019 12:18:26 PM (NCG01 NOI Submission) Approve by Lucas, Annette 10/2/2019 10:41:49 AM (Review- Construction NOI 16510) • The task was assigned to Lucas, Annette by round robin distribution 10/1/2019 12:18 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 3, 2019 5:00 PM 10/1/2019 12:18 PM Submit by EADS\smccoy2 10/3/2019 7:51:36 AM (Payment Verification for NCC192157) * Shannon Judd. • EADS\smccoy2 assigned the task to EADS\smccoy2 10/3/2019 7:51 AM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 13, 2019 5:00 PM 10/2/2019 10:41 AM STME NORTH CAROLINA Ernvlronmentol qualily A. Project Information Part A. Project Location and Waterbody Inforrration 1. Project Name * Garden Street Apartments ( Sitework Improvements) 2. County* Lee 3. Highway or Street Battle Street and Clark Circle Address * Street name only is acceptable if no address nurrber assigned yet 4. City or Township * Jonesboro and East Sanford Township 5. State * NC 1re) frIT7i)Mfi1i(-_ToIa1010 6. Zip Code* 27331 7. Latitude * Enter the latitude in decirral degrees 35.4611 8. Longitude * Enter the longitude in decirral degrees (MIST be negative) -79.1758 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)* Residential, Other than SFE (1522) Standard Industrial Gassification for Development 12. Acres to be 3.58 disturbed* (including off -site borrow and waste areas) 13. Total site area 12.20 (acres)* 14. Post- 2.00 construction (Estimated) impervious area (acres) * NCC Project NCC-LEE-2019-Garden Street Apartments ( Sitework Tracking ID Improvements) 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 Gastors Creek Wate rbody* Narre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 18-20-5 Index No. * NC Waterbody Index Ninber Stormwater PF 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. 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 Sanford Housing Authority Name * 2. First Name* Shannon ff Corporation, enter Registered Agent First l\b e 3. Last Name * Judd ff Corporation, enter Registered Agent Last Barre 3b. Title CEO 4. Permitee E-mail sjudd@sha-nc.org Address* 5. Permittee 919-897-2306 Telephone No.* 6. Permittee Mailing Street Address Address* P.O. Box636 Address Line 2 P.O. Box 143 City Sanford Postal / Zip Code 27331 Check box if the street address the same as mailing address 7. Permittee Street Address* r Yes Street Address 1000 Carthage Street Address Line 2 City Sanford Postal / Zip Code 27330-4115 State / Province / Region N.C. Country us State / Province / Region NC Country us C. Site Contact Information Part C. Proiect Site Contact Information 1. Type of Non -Government Ownership* 2. Primary Site Robbie Contact - First Name * 3. Primary Site Parker Contact - Last Name * 4. Title Project Manager 5. Site Contact E- Robbie.parker@mutualbuildersinc.com mail Address* 6. Site Contact 919-369-3527 Telephone No.* 7. Organization Mutual Builders, Inc. Name 8. Site Contact Street Address Mailing Address* P.O. Box270 Address Line 2 city Smithfield Pbstal / Zip Code 27577 9. Consultant Name (optional) Johnny Glenn Tew First and Last narre 10. Consultant E- JohnnyT@eclsglobalinc.com mail This person will be copied on all correspondence. 11. Consultant 910-897-3257 Ext. 3005 Telephone No. State / Province / Region N.C. Country us D. E&SC Plan Part D. Erosion & Sediment Control (MSC) Ran Approval Information ....................................................................................................................................................................................................................................... 1. Date E&SC Plan 09/30/2019 Approved * 2. E&SC Plan Project LEE-2020-010 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 * Raleigh (RRO) 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 18-332 Garden Street Apartments - erosion Approval 176.83KB approval.pdf letter/documentation Mist be R7F forrret 6. NOI Certification Notice of Intent Certification Form Garden Street.pdf 497.49KB Form Mist be RDFfornet 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 * Shannon Judd Title CEO Organization Sanford Housing Authority Date * 10/01 /2019 F. Tracking and COC Info NOI Tracking No. 16510 NC Reference No. NCG01-2019-2157 Uses 'count number variable (incremrented by SP) Certificate of NCC192157 Coverage (COC) Uses'count_nunber'variable (incremrented by SF) No. * Count Number 2157 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.)