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HomeMy WebLinkAboutNCC205469_NOI Application_20201201Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 11/24/2020 4:38:06 PM (NCG01 NOI Submission) Approve by Clark, Paul 11/25/2020 12:47:50 PM (Review- Construction NOI 37273) • The task was assigned to Clark, Paul by round robin distribution 11/24/2020 4:38 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 26, 2020 5:00 PM 11/24/2020 4:38 PM Submit by Selkane, Aziza 12/1/2020 1:23:57 PM (Payment Verification for NCC205469) * Daniel L Saltsman • Selkane, Aziza assigned the task to Selkane, Aziza 12/1/2020 1:23 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 6, 2021 5:00 PM 11 /25/2020 12:47 PM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting IT No an NOI that was r Yes rejected before? 1a. Project Name * FB - Military Working Dog Facility, PN72426 1 b. Specific Lot This field rray be used to list specifc lot nunbers. Numbers 2. County* Cumberland 3. Highway or Street Lamont Road Address* Street narre only is acceptable if no address number assigned yet 4. City or Township* Fort Bragg 5. State * NC 6. Zip Code * 28310 7. Latitude* Enter the latitude in decirral degrees 35.1570 8. Longitude* Enter the longitude in decir al degrees (M.JST be negative) -79.0739 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* 12/07/2020 Estimated Construction Project Start Date 10. Date to End* 12/31/2021 Estimated Construction Project End Date 11. SIC (Primary) * Other (9999) Standard Industrial aassification for Developrrent 12. Acres to be 6.20 disturbed* (including off -site borrow and waste areas) 13. Total site area 6.20 (acres) * 14. Post- 1.02 construction (Estirrated) impervious area (acres) * NCC Project NCC-CUMBE-2020-FB - Military Working Dog Facility, PN72426 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 Cypress Creek Waterbody* Nsrre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 18-23-23 Index No.* NCWaterbody Index Nurrber Stormwater V 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. ^ Fbrnittee 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 * Fort Bragg Directorate of Public Works 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 * Monica If Corporation, enter Faegistered Agent First %rre 3. Last Name* Stephenson It Corporation, enter Pbegistered Agent Last %rre 3b. Title Director 4. Permitee E-mail monica.a.stephenson.civ@mail.mil Address* 5. Permittee 910-396-4009 Telephone No.* 6. Permittee Mailing Street Address Address* 2175 Reilly Road Stop A Address Line 2 City Fort Bragg Fbstal / Zip Code 28310-5000 Check box if the F Yes street address the same as mailing address 7. Permittee Street Street Address Address* 4300 Butner Road Address Line 2 State / Frovince / Fbgion NC Country us city State / Frovince / Region Fort Bragg NC Fbstal / Zip Code Country 28310 us 8. Type of Government - Federal Ownership * C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Lee Contact - First Name * 2. Primary Site Ward Contact - Last Name * 3. Title Chief, Water Management Branch 4. Site Contact E- lee.p.\&ard.civ@mail.mil mail Address* 5. Site Contact 910-908-5286 Telephone No. 6. Organization Fort Bragg Directorate of Public Works Name 7. Site Contact Street Address Mailing Address* 2175 Reilly Road Stop A Address Line 2 City Fort Bragg Postal / Zip Code 28310-5000 8. Consultant Name (Optional) Dan Saltsman, PE First and Last nacre 9. Consultant E-mail dan.saltsman@stantec.com This person will be copied on all correspondence. 10. Consultant 919-532-2331 Telephone No. State / Rovince / Region NC Country us D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 11/23/2020 Approved * 2. E&SC Plan Project CUMBE-2021-051 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 * Fayetteville (FRO) 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 cumbe-2021-051ap.pdf Approval letter or Mist be RDF format Grading Permit 6. Site Location Map Mist be RDFformat (lint 20 NB) 742.95KB PN 72426 Vicinity Map.pdf 942.4KB 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 docurrents support the application. Include additional waterbodies for linear projects if necessary. 8. NOI Certification PN72426 Signed NOI Certification Form.pdf 458.43KB Form Must be RDF formal 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 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 * Lee Ward Title Chief, Water Management Branch Organization Legally Plesponsible Entity Fort Bragg Directorate of Public Works Date * 11/24/2020 F. Tracking and COC Info NOI Tracking No. 37273 NC Reference No. NCG01-2020-5469 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC205469 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 5469 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. NCC205469-2020 Invoice Due Date 12/25/2020 Initial Fee $ 100.00 Invoice Status OPEN