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HomeMy WebLinkAboutNCC204105_NOI Application_20200922Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 9/15/2020 12:53:40 PM (NCG01 NOI Submission) Approve by Morman, Alaina 9/18/2020 2:14:32 PM (Review- Construction NOI 31457) • Clark, Paul reassigned the task to Morman, Alaina 9/15/2020 3:26 PM * thx • The task was assigned to Clark, Paul by round robin distribution 9/15/2020 12:54 PM • The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 17, 2020 5:00 PM 9/15/2020 12:54 PM Subnut by Selkane, Aziza 9/22/2020 8:43:18 AM (Payment Verification for NCC204105) * Shawntrelle D Kast • Selkane, Aziza assigned the task to Selkane, Aziza 9/22/2020 8:42 AM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 30, 2020 5:00 PM 9/18/2020 2:15 PM .• 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 30921 NOI No. Prior Reviewer Alaina Morman Name 1a. Project Name * Repair Roads and Pavement at Access, Range, MCX 1 b. Specific Lot This field rray be used to list specifc lot numbers. Numbers 2. County* Craven 3. Highway or Street Jackson Drive Address * Street narre only is acceptable if no address number assigned yet 4. City or Township* Cherry Point 5. State * NC 6. Zip Code * 28533-0006 7. Latitude * Enter the latitude in decimal degrees 34.9219 8. Longitude* Enter the longitude in decimal degrees (MJSTbe negative) -76.8783 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* 10/01/2020 Estimated Construction Project Start Date 10. Date to End* 10/04/2021 Estimated Construction Project End Cute 11. SIC (Primary)* Industrial (1541) Standard Industrial aassification for Developrrent 12. Acres to be 34.50 disturbed* (including off -site borrow and waste areas) 13. Total site area 34.50 (acres) * 14. Post- 18.20 construction (Estimated) impervious area (acres) * NCC Project NCC-CRAVE-2020-Repair Roads and Pavement at Access, Range, Tracking ID MCX 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 Slocum Creek Waterbody* N larre of waterbody into which stormwater runoff will discharge 15b. Waterbody 27-112 Index No.* NCWaterbody Index Number Stormwater r No discharges will flow pr Yes to additional wate rs * 15c. Additional Hancock Creek Receiving Waterbody narre Waterbody 15d. Waterbody 27-115 Index No. NCWaterbody Index Number 15e. Additional Waterbody narre Receiving Waterbody 15f. Waterbody NCWaterbody Index Number Index No. 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. ^ Fternittee 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 * WAS Cherry Point It 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 * Anthony If Corporation, enter Faegistered Agent First %rre 3. Last Name* Ference It Corporation, enter Pbegistered Agent Last %rre 3b. Title Deputy Facilities Director By direction of the Commanding Officer 4. Permitee E-mail anthony.ference@usmc.mil Address* 5. Permittee 2524663148 Telephone No.* 6. Permittee Mailing Street Address Address* P.O box8006 Address Line 2 Cherry Point Fbstal / Zip Code 28533-0006 Check box if the F Yes street address the same as mailing address 7. Permittee Street Street Address Address* Building 1 C street Address Line 2 State / Frovince / Plegion NC Country United States city State / Frovince / Region Cherry Point NC Fbstal / Zip Code Country 28533-0006 United States 8. Type of Government - Federal Ownership * C. Site Contact Information Part C. Roject Site Contact Inforrration ........................................................................................................................................................................................................... 1. Primary Site Nathan Contact - First Name * 2. Primary Site Arnett Contact - Last Name * 3. Title Environmental Engineer 4. Site Contact E- nathan.arnett@usmc.mil mail Address* 5. Site Contact 2524665271 Telephone No. 6. Organization WAS Cherry Point Environmental Affairs Name Department 7. Site Contact Street Address Mailing Address* Building 4223 Address Line 2 city Cherry Point Fbstal / Zip Code 28533-0006 8. Consultant Name (Optional) First and Last nacre 9. Consultant E-mail This person will be copied on all correspondence. 10. Consultant Telephone No. State / Rovince / Region NC Country United States D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 07/28/2020 Approved * 2. E&SC Plan Project Crave-2020-040 Number/ID * Assigned by agency or local program 3. E&SC Plan r State DEQ Office Approved by* r Local Program 4. State DEQ Office * Washington (WaRO) 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 ESC Repair Roads and Pavement at Access, Approval letter or 201.74KB Range, MCXpdf Grading Permit Mast be RDFfon-rat 6. Site Location Map Helpful for linear project review (Optional) Site Map repair roads at Access, Range, and 5.09MB MCXpdf Site Map 2 repair raods at Access, Range and 1.87MB MCXpdf Mast be RDF format. Rease do not upload entire set of E&SC plans. 7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support the application. Include additional w aterbodies for linear projects if necessary. 8. NOI Certification NCG01- Repair Roads and Pavement at Form 74.43KB Access, Range, MCX SIGNED.pdf Wst be FDFfornat This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.6E (i) 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 Atide; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the Commission implementing this Atcle 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 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 * Anthony A Ference Title Deputy Facilities Director By direction of the Commanding Officer Organization Legally Plesponsible Entity MCAS Cherry Point Date * 09/15/2020 F. Tracking and COC Info NOI Tracking No. 31457 NC Reference No. NCG01-2020-4105 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC204105 Coverage (COC) Uses 'count number' variable (increrrented by SP) No.* Count Number 4105 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. NCC204105-2020 Invoice Due Date 10/17/2020 Initial Fee $ 100.00 Invoice Status OPEN