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HomeMy WebLinkAboutNCC203016_NOI Application_20200716 Action History (UTC-05:00)Eastern Time(US&Canada) Subrrit by Anonymous User 7/14/2020 8:03:08 PM(NCG01 NOI Submission) Approve by Clark, Paul 7/15/2020 1:02:27 PM(Review-Construction NOI 28269) • The task was assigned to Clark, Paul by round robin distribution 7/14/2020 8:04 PM • The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:July 16,2020 5:00 PM 7/14/2020 8:04 PM Submit by Selkane,Aziza 7/16/2020 8:30:54 AM(Payment Verification for NCC203016) * Lowder Recycling and Disposal • Selkane,Aziza assigned the task to Selkane,Aziza 7/16/2020 8:29 AM • The task was assigned to DEMLR NCG01 Payment Team.The due date is:August 26, 2020 5:00 PM 7/15/2020 1:02 PM �ThF1 1Construction Stormwater: Notice of Intent (NOI) National Pollutant Discharge Elimination System 'D application for•• - .•-under NorthCarolina's General Permit 1 1111:STORIMATER DISCHARGES associated with construction activities(or NORTH CAROLINA Enrlrnnmenfu�Qr�arlry A. Project Information Part A. Project Location and Waterbody Information Are you submitting f•No an NOI that was r Yes rejected before? 1a. Project Name* Lowder Property-760 South Peace Haven Road 1 b.Specific Lot This field rray be used to list specifc lot numbers. Numbers 2.County* Forsyth 3. Highway or Street 760 South Peace Haven Road Address* Street nacre only is acceptable if no address number assigned yet 4.City or Townsh i p* Clemmons 5.State* NC 6.Zip Code* 27012 7. Latitude* Enter the latitude in decimal degrees 36.0542 8. Longitude* Enter the longitude in decimal degrees(M.JST be negative) -80.3722 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* 07/27/2020 Estimated Construction Project Start Date 10. Date to End* 07/30/2021 Estimated Construction Project End Date 11.SIC(Primary)* Residential, Single Family Houses(SFE)(1521) Standard Industrial Classification for Development 12.Acres to be 5.65 disturbed* (including off-site borrow and waste areas) 13.Total site area 6.19 (acres)* 14. Post- 1.86 construction (Estirrated) impervious area (acres)* NCC Project NCC-FORSY-2020-Lowder Property-760 South Peace Haven Tracking ID Road 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 Muddy Creek Waterbody* Ibrre of w aterbody into w hich storrrw ater runoff w ill discharge 15b.Waterbody 12-94-(0.5) Index No.* NCWaterbody Index Number Stormwater rJ 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* Lowder Recycling&Disposal, LLC It pernittee is an individual(i.e.,organization does not apply),enter first and last narre in this field. 2. First Name* Gene If Corporation,enter Faegistered Agent First%rre 3. Last Name* Lowder It Corporation,enter F;bgistered Agent Last Iona 3b.Title Manager 4. Permitee E-mail glowder@lowderinc.com Address* 5. Permittee (336)403-4285 Telephone No.* 6. Permittee Mailing Street Address Address* 2840 Griffith Road Address Line 2 aty State/Rovince/F;bgion Winston-Salem NC Fbstal/Zip Code Country 27103-6420 us Check box if the V Yes street address the same as mailing address 7. Permittee Street Street Address Address* 2840 Griffith Road Address Line 2 city State/Frovince/Region Winston-Salem NC Fbstal/Zip Code Country 27103-6420 us 8.Type of Non-Government Ownership* C. Site Contact Information Part C. ^ Roject Site Contact Inforrration ....................................................................................................................................................................................................................................................................................................................................................................................... 1. Primary Site Gene Contact-First Name* 2. Primary Site Lowder Contact-Last Name* 3.Title Project Manager 4.Site Contact E- glowder@lowderinc.com mail Address* 5.Site Contact (336)403-4285 Telephone No.* 6.Organization Lowder Recycling and Disposal, LLC Name 7.Site Contact Street Address Mailing Address* 2840 Griffith Road Address Line 2 City State/Rovince/Region Winston-Salem NC Postal/Zip Code Country 27103-6420 us 8. Consultant Name (Optional) Steve Causey First and Last nacre 9. Consultant E-mail scausey@allied-engsurv.com This person will be copied on all correspondence. 10. Consultant (336)765-2377 Telephone No. D. E&SC Plan Part D. ^ Erosion&Sedirrent Control(E&SC)Ran Approval Inforrration ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 07/09/2020 Approved* 2. E&SC Plan Project 303988 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. 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 Review Completed-Lowder Property-760 South Approval letter or 166.67KB Peace Haven Road.pdf Grading Permit Mist be FDFforrrat 6.Site Location Map Helpful for linear project review (Optional) Mist be FDFfornat.Rease do not upload entire set of E&SCplans. 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-eNO1-Certification-Form-Lowder Property- Form 1.76MB 760 South Peace Haven Rd.pdf Mist be FDFformat This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.66(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 knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case underthis 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 guiltyofa Class 2 misdemeanor which mayinclude 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 Responsible Person named on this Notice of Intent f 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* Gene Lowder Title Owner Organization Legally Ibsponsible Entity Lowder recycling and disposal Date* 07/14/2020 F. Tracking and COC Info NOI Tracking No. 28269 NC Reference No. NCG01-2020-3016 Uses'count_nurrber'variable(increrrented by SP) Certificate of NCC203016 Coverage (COC) Uses'count_nurrber'variable(increrrented by SP) No.* Count Number 3016 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. NCC203016-2020 Invoice Due Date 8/14/2020 Initial Fee $ 100.00 Invoice Status OPEN