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Home My WebLink AboutNCC213819_NOI Application_20210628Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 6/24/2021 11:42:49 AM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 6/25/2021 7:46:17 AM (Review- Construction NOI 57181) • The task was assigned to Broussard, Brooklyn C by round robin distribution 6/24/2021 11:44 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 28, 2021 5:00 PM 6/24/2021 11:44 AM Submit by Selkane, Aziza 6/28/2021 8:57:00 AM (Payment Verification for NCC213819) * Eleanor Mierzejewski • Selkane, Aziza assigned the task to Selkane, Aziza 6/28/2021 8:56 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 6, 2021 5:00 PM 6/25/2021 7:46 AM .• 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 56925 NOI No. Prior Reviewer Brooklyn Broussard Name 1a. Project Name * NC-UNION-2021-Yadkin Regional Water Supply Project, NOI 56925 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) 8048002 01144031B 651301372573 651304843349 652301260202 652301252509 652301354472 652301459117 652303443557 655301198504 655403309841 655404517011 656403101920 656403104819 656403104855 656403105862 656403107740 656403108663 656403109547 656301390866 656403207533 656403205614 QaQA n004 74 A n VJV4VJL II I+U 656403312508 656403214495 656403109929 656403117904 656403116377 656403117487 656403119526 656403119526 656403118368 656403119223 656403119188 656403210298 656403211397 656403210079 656403211158 08051007A 8048001 01237003 1234013 08048012F 1234004 1231003 1231009 01231010 01204014 01204014A 01204013 01204012B 01204012A 01204012E 01204012 01204011 01204010 01204009B 01204009D 01204009E 01201006E 01201005 01201005A 01201006D 01201015 01201015A 01174001A 01174002 01174004 01174009 01174009A 01174008B 01174008D 01174008 01174012 01174015D 01174015 01171003 01147003 01144001 01147001 1144029 01144031 01144025A 01144022 01144021 1117011 01144012A 01114001 01114009 01114002 01114003B 01114003D 01114003A 01114003 01111006A 01111006 01111016 01111015 01111009 01111006C 01111004 01111001 1084007 01081008 01081003 01081002 01081002E 01081010 559102891768 559204705209 559204708135 559102697688 559204614328 559204628027 559204629482 559204727398 559204729584 559204727605 559204833004 559204847369 559202955196 559202964793 650201056996 650201165933 650201073256 650201079456 650201184447 650201290208 650303202590 650201299993 650303209352 650303209516 650303311121 650303312310 650303313488 650303217499 650303312962 650303321403 650303323940 650303329699 650303420883 650303320711 650303420949 650303430334 650303338791 650303348176 650304540353 650304642746 650304647871 650304741720 650304741520 650302854129 650302775304 650302879446 650302976470 651301086353 651301075705 651301179851 651301284006 651301277852 651301264652 651301362166 651301377180 651301463938 651302551627 651302650627 651302650461 651302668580 651302657302 651302750363 651302752184 651302754247 651302754087 651302758170 651302854442 651302863428 651302962674 651302961996 652301062888 652301067902 652301170803 652301168920 652301166854 652301377333 652301457528 652302873961 652302755360 652302855469 653201190214 653303331121 653303248252 653303343199 653303430274 653303349540 653303441316 653303446437 653304528850 653304538857 653304647312 653302654344 653302852070 653302861357 653302769920 653302973767 653302977450 653302979450 654301073560 653302985442 654301078568 654301088241 654301175999 654301280384 654301387499 654301381908 654301486512 654301499086 654302574910 654302670588 654302681121 654302676984 654302781112 654302781523 654302689966 654302884696 655301096797 654302994787 2. County* Union 3. Highway or Street Cottonville Road Address* Street name only is acceptable if no address nunber assigned yet 4. City or Township* Norwood 5. State * NC 6. Zip Code* 28128 7. Latitude* Enter the latitude in decirral degrees 35.2279 8. Longitude * Enter the longitude in decinal degrees (K JST be negative) -80.1751 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* 06/28/2021 Estinated Construction Project Start Date 10. Date to End * 11 /22/2023 Estinated Construction Project End Cate 11. SIC (Primary) * Other (9999) Standard Industrial aassification for Development 12. Acres to be 180.97 disturbed* (including off -site borrow and waste areas) 13. Total site area 180.97 (acres) * 14. Post- 0.00 construction (Estirrated) impervious area (acres) * NCC Project NCC-UNION-2021 -NC-UNION-2021 -Yadkin Regional Water Supply Tracking ID Project, NOI 56925 Assigned automatically 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 Hardy Creek Waterbody* %rre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 13-17-42 Index No.* NCWaterbody Index Number Stormwater r No discharges will flow Pf Yes to additional wate rs * 15c. Additional South Ugly Creek Receiving Waterbody narre Waterbody 15d. Waterbody 13-17-42-2 Index No. NCWaterbody Index Nurrber 15e. Additional Long Creek Receiving Waterbody narre Waterbody 15f. Waterbody 13-17-31 Index No. NCWaterbody Index Nurrber 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 * Union County 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 * John If Corporation, enter Faegistered Agent First %rre 3. Last Name* Shutak It Corporation, enter Pbegistered Agent Last %rre 3b. Title Engineering Division Director 4. Permitee E-mail john.shutak@unioncountync.gov Address* 5. Permittee 7042833651 Telephone No.* 6. Permittee Mailing Street Address Address* 500 N. Main Street Address Line 2 Suite 600 aty Monroe Check box if the street address the same as mailing address 7. Permittee Street Address* Fbstal / Zip Code 28112 V Yes Street Address 500 N. Main Street Address Line 2 Suite 600 city Monroe Fbstal / Zip Code 28112 State / Ffovince / Fbgion NC Country USA State / Ftovince / Region NC Country USA 8. Type of Ownership is only individual if an individual is naned in B.1. above. Ownership* Government - County C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Kyle Contact - First Name * 2. Primary Site Anderson Contact - Last Name * 3. Title Project Manager 4. Site Contact E- kanderson@garney.com mail Address* 5. Site Contact 316-833-6632 Telephone No. 6. Organization Garney Companies, Inc. Name 7. Site Contact Street Address Mailing Address* 620 Allenton Street Address Line 2 City Norwood Postal / Zip Code 28128 8. Consultant Name (Optional) Jay Jackson First and Last nacre 9. Consultant E-mail jjackson@hazenandsawyer.com This person will be copied on all correspondence. 10. Consultant Telephone No. 11. Billing E-mail (For Annual Fee correspondence) john.shutak@unioncountync.gov Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 7042833651 Default is legally responsible person telephone State / Province / Region NC Country us D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 06/11/2021 Approved * 2. E&SC Plan Project UNION-2021-050 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 * Mooresville (MRO) 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 Yadkin Regional Water Supply Project (Miles5-30) Approval letter or 421.28KB (UNION-2-21-050) approval w mods (002).pdf Grading Permit Mist be FDFforrrat 6. Site Location Map Mist be RDFforrret (lint 201VB) Figure 1-Vicinity Map.pdf 1.2MB 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. The first 5 miles of this project was submitted for ESC review prior to miles 5-30. The eNO1 and ESC were approved Feb 2021. Certificate of Coverage No NCC210499. Additional Waterbodies: Stream Index: 13-17-31-6 Stream Name: Horse Branch Stream Index: 13-17-29 Stream Name: Gilberts Creek Stream Index: 13-17 Stream Name: Rocky River Stream Index: 13-17-36-14 Stream Name: Gold Branch Stream Index: 13-17-36-14-1 Stream Name: Brandon Branch Stream Index: 13-17-36-13 Stream Name: Watson Creek 8. NOI Certification 20210624_eNO1_CertificationForm_Union2021- Form 880.07KB 050_Executed.pdf Mast be FDFfornat 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 Article; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this 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 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 J)& 1l kw Type Name * John Shutak Title Engineering Division Director Organization Legally Responsible Entity Union County Date * 06/24/2021 F. Tracking and COC Info NOI Tracking No. 57181 NC Reference No. NCG01-2021-3819 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC213819 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 3819 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. NCC213819-2021 Invoice Due Date 7/25/2021 Initial Fee $ 100.00 Invoice Status OPEN