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HomeMy WebLinkAboutNCC210152_NOI Application_20210127Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 1/7/2021 10:52:28 AM (NCG01 NOI Submission) Approve by Gamble, Aana C 1/9/2021 2:38:55 PM (Review- Construction NO140651) • The task was assigned to Gamble, Aana C by round robin distribution 1/7/2021 10:52 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 11, 2021 5:00 PM 1/7/2021 10:52 AM Submit by McCoy, Suzanne 1/27/2021 1:59:34 PM (Payment Verification for NCC210152) * Asheboro City Schools • McCoy, Suzanne assigned the task to McCoy, Suzanne 1/27/2021 1:58 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 22, 2021 5:00 PM 1/9/2021 2:39 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 * Asheboro High School 1 b. Specific Lot This field may be used to list specffc lot numbers. Numbers 1 c. Parcel ID List all Rios associated w ith this project. Number(s) (PIN) 7750 67 7039, 7750 66 7639, 7750 66 7443, 7750 77 3143, 7750 76 0681, 7750 76 2768, 7750 76 2572 2. County* Randolph 3. Highway or Street 1221 S. Park Street Address* Street name only is acceptable if no address number assigned yet 4. City or Township* Asheboro 5. State * NC 6. Zip Code * 27203 7. Latitude * Enter the latitude in decimal degrees 35.6898 8. Longitude * Enter the longitude in decinal degrees (K JST be negative) -79.8186 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* 01/29/2021 Estimated Construction Project Start Date 10. Date to End * 06/03/2022 Estimated Construction Project End Date 11. SIC (Primary)* Other (9999) Standard Industrial C]assification for Development 12. Acres to be 4.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 20.15 (acres) * 14. Post- 0.00 construction (Estirrated) impervious area (acres)* NCC Project NCC-RANDO-2021-Asheboro High School 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 Little River Wate rbody* Narre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 13-25-(1) Index No. * NCWaterbody Index Nurrber Stormwater W 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. ^ Fl rnittee 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 * Asheboro City Schools IF 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 * Sandra If Corporation, enter Faegistered Agent First Wre 3. Last Name* Spivey IF Corporation, enter F;bgistered Agent Last %rre 3b. Title Finance Officer 4. Permitee E-mail sspivey@asheboro.k12.nc.us Address* 5. Permittee 336-625-5104 Telephone No.* 6. Permittee Mailing Street Address Address* 1126 South Park Street Address Line 2 Cty Asheboro Fbstal / Zip Code 27203-6720 Check box if the street address the same as mailing address 7. Permittee Street Address* V Yes Street Address 1126 South Park Street Address Line 2 city Asheboro Fbstal / Zip Code 27203-6720 State / Ffovince / Fbgion NC Country us State / Frovince / Region NC Country us 8. Type of Ownership is only individual if an individual is naned in B.1. above. Ownership* Government- Municipal C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................. 1. Primary Site Edward Contact - First Name * 2. Primary Site Keller Contact - Last Name * 3. Title Director for Facilities and Maintenance 4. Site Contact E- eakeller@asheboro.k12.nc.us mail Address* 5. Site Contact 336-625-5104 Telephone No.* 6. Organization Asheboro City Schools Name 7. Site Contact Street Address Mailing Address* 1126 South Park Street Address Line 2 city State / Rovince / Region Asheboro NC Fbstal / Zip Code Country 27203-6720 us 8. Consultant Name (Optional) Keith Downing First and Last narre 9. Consultant E-mail kdowning@clhdesignpa.com This person will be copied on all correspondence. 10. Consultant 919-319-6716 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) sspivey@asheboro.kl2.nc.us Default is legally responsible person a-rrail (older NOIs rray not populate) 12. Billing (For Annual Fee correspondence) Telephone 336-625-5104 Default is legally responsible person telephone (older NOLs rray not populate) D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 12/29/2020 Approved * 2. E&SC Plan Project RANDO-2021-007 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 * Winston-Salem (WSRO) Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can include the beginning point and end point coordinates in the "Notes" box below). 5. E&SC Plan NCDEQ Plan Approval 12.29.20.pdf 329.3KB Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Mist be RDFformat (lint 20 NB) C000 COVER.pdf 765.32KB Rease do not upload entire set of E&SC plans. 7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies if necessary. 8. NOI Certification Asheboro High School - Scanned - NCG01-eNOI- Form 41.03KB Certification-Form-20201222-DEMLR-SW. pdf Mast be RDFformat This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.66 (1) 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:* IT The Legally Responsible Person named on this Notice of Intent f Authorized Responsible Person* (signing on behalf of Legally Responsible Person named in Part B) 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* Sandra Spivey Title Finance Officer Organization Legally Responsible Entity Asheboro City Schools Date * 01 /07/2021 F. Tracking and COC Info NOI Tracking No. 40651 NC Reference No. NCG01-2021-0152 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC210152 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 152 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2021 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC210152-2021 Invoice Due Date 2/8/2021 Initial Fee $ 100.00 Invoice Status OPEN