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HomeMy WebLinkAboutNCC212760_NOI Application_20210511Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 5/5/2021 12:04:40 PM (NCG01 NOI Submission) Approve by Clark, Paul B 5/6/2021 9:14:07 AM (Review- Construction NOI 52183) • The task was assigned to Clark, Paul B by round robin distribution 5/5/2021 12:05 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 7, 2021 5:00 PM. The priority is: High 5/5/2021 12:05 PM Submit by Selkane, Aziza 5/11/2021 10:47:45 AM (Payment Verification for NCC212760) * AndrewJ Smith • Selkane, Aziza assigned the task to Selkane, Aziza 5/11/2021 10:46 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: June 17, 2021 5:00 PM. The priority is: High 5/6/2021 9:14 AM .• 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 * C-12 Hangar Replacement (P728) - EXPRESS 1 b. Specific Lot This field may be used to list specifc lot numbers. Numbers N/A- Federal property 1 c. Parcel ID List all Rios associated w ith this project. Number(s) (PIN) 436000377695 2. County* Onslow 3. Highway or Street Gooden St Address* Street name only is acceptable if no address number assigned yet 4. City or Township* Camp Lejeune 5. State * NC 6. Zip Code* 28547 7. Latitude* Enter the latitude in decimal degrees 34.7111 8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative) -77.4344 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* 04/30/2021 Estimated Construction Project Start Rate 10. Date to End * 04/28/2023 Estimated Construction Project End Date 11. SIC (Primary) * Other (9999) Standard Industrial aassification for Development 12. Acres to be 17.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 17.00 (acres) * 14. Post- 7.81 construction (Estirreted) impervious area (acres) * NCC Project NCC-ONSLO-2021-C-12 Hangar Replacement (P728) - EXPRESS 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 Southwest Creek Waterbody* Narreof waterbody into which storrrwater runoff will discharge 15b. Waterbody 19-17-(6.5) Index No. * NCWaterbody Index Nurrber Stormwater V 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 Responsible Entity Name * MCB Camp Lejeune 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 * Neal If Corporation, enter Registered Agent First %rre 3. Last Name* Paul It Corporation, enter F;bgistered Agent Last %rre 3b. Title Deputy Public Works Officer 4. Permitee E-mail talia.barraco@usmc.mil Address* 5. Permittee (910) 451-3238 X3242 Telephone No.* 6. Permittee Mailing Street Address Address* 1005 Michael Road Address Line 2 City State / Ffovince / Fbgion Camp Lejeune NC Fbstal / Zip Code Country 28547 United States Check box if the V Yes street address the same as mailing address 7. Permittee Street Street Address Address* 1005 Michael Road Address Line 2 City State / Frovince / Region Camp Lejeune NC Fbstal / Zip Code Country 28547 United States 8. Type of Ownership is only individual if an individual is naned in B.1. above. Ownership* Government- Federal C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Tom Contact - First Name * 2. Primary Site Phelps Contact - Last Name * 3. Title Project Superintendent 4. Site Contact E- tphelps@walshgroup.com mail Address* 5. Site Contact 845-264-7441 Telephone No. 6. Organization Archer Western Name 7. Site Contact Street Address Mailing Address* AS4100CA White St Address Line 2 Archer Western New River AS city Jacksonville Postal / Zip Code 28540 8. Consultant Name (Optional) Andrew Vaskov First and Last narre 9. Consultant E-mail andrew.vaskov@mbakerintl.com This person will be copied on all correspondence. 10. Consultant 412-269-6114 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) tphelps@walshgroup.com Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 845-264-7441 Default is legally responsible person telephone 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 04/08/2021 Approved * 2. E&SC Plan Project ONSLO-2021-067 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 * Wilmington (WiRO) 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 Camp LeJeune 4 15 2021.pdf 266.14KB Approval letter or Mist beRDFformat Grading Permit 6. Site Location Map Mist be RDFforrret (lint 201VB) 180807 P728 - Overall Site-CS101.pdf 841.77KB 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 if necessary. 8. NOI Certification P728_C12Hanger_NOICertForm_05.05.21.pdf 392.54KB Form Wst be RDFforrret This is an Express f 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:* r The Legally Responsible Person named on this Notice of Intent r 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* Talia Prendergast Title PWD Civil Engineer Organization Legally Responsible Entity MCB Camp Lejeune Date * 05/05/2021 F. Tracking and COC Info NOI Tracking No. 52183 NC Reference No. NCG01-2021-2760 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC212760 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 2760 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. NCC212760-2021 Invoice Due Date 6/5/2021 Initial Fee $ 100.00 Invoice Status OPEN