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HomeMy WebLinkAboutNCC213994_NOI Application_20210708Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 7/7/2021 9:38:51 AM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 7/7/2021 9:59:18 AM (Review- Construction NOI 58457) • The task was assigned to Broussard, Brooklyn C by round robin distribution 7/7/2021 9:39 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: July 9, 2021 5:00 PM 7/7/2021 9:39 AM Submit by Selkane, Aziza 7/8/2021 8:57:00 AM (Payment Verification for NCC213994) * Richard Vanore • Selkane, Aziza assigned the task to Selkane, Aziza 7/8/2021 8:56 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 18, 2021 5:00 PM 7/7/2021 9:59 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 58206 NOI No. Prior Reviewer Brooklyn Broussard Name 1a. Project Name* Interstate Industrial Park 1 b. Specific Lot This field rray be used to list specifc lot numbers. Numbers 1 c. Parcel ID List all R% associated w ith this project. Number(s) (PIN) 7863822753,7863725118 2. County* Guilford 3. Highway or Street 215 E JJ Drive Address* Street name only is acceptable if no address number assigned yet 4. CityorTownship* Greensboro 5. State * NC 6. Zip Code* 27406 7. Latitude* Enter the latitude in decimal degrees 36.0357 8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative) -79.7839 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* 07/01/2021 Estimated Construction Project Start Date 10. Date to End * 04/30/2022 Estimated Construction Project End Date 11. SIC (Primary)* Industrial (1541) Standard Industrial aasslfication for Development 12. Acres to be 16.09 disturbed* (including off -site borrow and waste areas) 13. Total site area 21.09 (acres) * 14. Post- 8.50 construction (Estimated) impervious area (acres) * NCC Project NCC-GUILF-2021-Interstate Industrial Park Tracking ID 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 South Buffalo Creek Waterbody* %rreof waterbody into which stormwater runoff will discharge 15b. Waterbody 16-11-14-2 Index No. * NCWaterbody Index Nunber 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 Pesponsible Entity Name * Koury Corporation 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 * Richard If Corporation, enter Faegistered Agent First %rre 3. Last Name* Vanore It Corporation, enter Pbegistered Agent Last %rre 3b. Title President 4. Permitee E-mail rvanore@kourycorp.com Address* 5. Permittee 336-299-9200 Telephone No.* 6. Permittee Mailing Street Address Address* 2275 Vanstory Street Address Line 2 Suite 200 aty Greensboro Check box if the street address the same as mailing address 7. Permittee Street Address* Fbstal / Zip Code 27403-3623 F Yes Street Address 2275 Vanstory Street Address Line 2 Suite 200 city Greensboro Fbstal / Zip Code 27403-3623 State / Ffovince / Pegion NC Country us State / Ftovince / Region NC Country us 8. Type of Ownership is only individual if an individual is naned in B.1. above. Ownership* Non -Government C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Anthony Contact - First Name * 2. Primary Site Lester Contact - Last Name * 3. Title Engineer 4. Site Contact E- adl@evans-eng.com mail Address* 5. Site Contact 336-279-7450 Telephone No. 6. Organization Evans Engineering, Inc Name 7. Site Contact Street Address Mailing Address* 4609 Dundas Drive Address Line 2 city Greensboro Fbstal / Zip Code 27407-1613 8. Consultant Name (Optional) Anthony Lester First and Last nacre 9. Consultant E-mail adl@evans-eng.com This person will be copied on all correspondence. 10. Consultant 336-382-4416 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) bjones@kourycorp.com Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 336-299-9200 Default is legally responsible person telephone 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 06/29/2021 Approved * 2. E&SC Plan Project 3046 Number/ID * Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* City of Greensboro 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 Approval Letter.pdf Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Mast be RDFforrret (lint 20 NB) 215 E J J Dr - Google Maps.pdf Rease do not upload entire set of E&SC plans. 372.63KB 269.09KB 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 NCG01 Construction Stormwater General Permit Form 208.41 KB Certification Form.pdf Mast be FDFfon-rat 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 Amide 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 If the Erosion and Sediment Control Plan approved by the delegated program is not compliant with Part II (Stormwater Pollution Prevention Plan) of the NCG010000 General Permit. I will nonetheless ensure that all conditions of Part II of the permit are met on the project at all times. * 17 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 IT 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 P�*Jvw Type Name* Blake Jones Title Vice President -Construction Division Organization Legally Ibsponsible Entity Koury Corporation Date * 07/07/2021 F. Tracking and COC Info NOI Tracking No. 58457 NC Reference No. NCG01-2021-3994 Uses 'count_nurber' variable (increrrented by SP) Certificate of NCC213994 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 3994 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. NCC213994-2021 Invoice Due Date 8/6/2021 Initial Fee $ 100.00 Invoice Status OPEN