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HomeMy WebLinkAboutNCC230196_NOI Application_20230124Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 1/23/2023 6:56:40 AM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 1/23/2023 7:22:32 AM (Review - NOI 123582 Tidal Wave Auto Spa - Tarboro, NC) • The task was assigned to Broussard, Brooklyn C by round robin distribution 1/23/2023 6:56 AM • The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 26, 2023 5:00 PM 1/23/2023 6:56 AM by Workflow 1/23/2023 7:22:41 AM (Workflow Start Event) Submit by Holloman, Tevye L 1/24/2023 9:19:31 AM (Payment Verification for NCC230196) * Martie Murphy • Holloman, Tevye L assigned the task to Holloman, Tevye L 1/24/2023 9:18 AM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 6, 2023 5:00 PM 1/23/2023 7:22 AM �a NORTH CAROLINA, Enri--tn! C2-1;ly A. Project Information Part A. Project Location and Waterbody Information Are you submitting an NOI that was rejected before? No + Yes Previous Rejected NOI No. 123284 Prior Reviewer Name Brooklyn Broussard la. Project Name* Tidal Wave Auto Spa - Tarboro, NC 1b. Specific Lot Numbers This field may be used to list specifc lot numbers. 1c. Parcel ID Number(s) (PIN) List all PINs associated with this project. 472799752600 2. County* Edgecombe 3. Highway or Street Address US HWY 258 & River Oaks Drive Street name only is acceptable if no address number assigned yet 4. City or Township* Town of Tarboro 5. State* NC 6. Zip Code* 27886 7. Latitude* Enter the latitude in decimal degrees 35.8836 8. Longitude* Enter the longitude in decimal degrees (MUST be negative) -77.5493 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* 01/23/2023 Estimated Construction Project Start Date 10. Date to End* 10/16/2023 Estimated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial Classification for Development 12. Acres to be 1.96 disturbed* (including off -site borrow and waste areas) 13. Total site area 1.39 (acres)* 14. Post -construction 1.09 impervious area (Estimated) (acres) * Project Tracking ID NCC-EDGEC-2023-Tidal Wave Auto Spa - Tarboro, NC Assigned automatically (not used) 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 Waterbody* Unnamed tributary of Holly Creek Name of waterbody into which stormwater runoff will discharge 15b. Waterbody Index No.* 28-81-1 NC Waterbody Index Number Stormwater discharges will flow to additional waters No Yes 16a. Is this project subject to the NC Sediment Pollution Control Act?* Yes No, not subject to NC SPCA 17. Is this project funded with ARPA (American Rescue Plan Act) grant funds?* No Yes Reviewer: Revise if necessary until this question is included on the eNOl. B. Permittee Information Part B. Permittee Information - Legally Responsible Entity and Individual ........................................................................................................................................................................ Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application form must 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item (6) of that permit. 1. Permittee* Legally Responsible Entity TWAS Properties LLC If permittee is an individual, enter first and last name in this field. Otherwise, enter organization/business name. Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the registration here. Permittee must be the same entity that is responsible for the land -disturbing activity as listed on the NC SPCA Financial Responsibility/Ownership (FRO) Form. 2. First Name* Martie If Corporation, enter Registered Agent First Name 3. Last Name* Murphy If Corporation, enter Registered Agent Last Name 3b. Title Director of Entitlement 4. Permitee E-mail martie@shjconstructiongroup.com Address* 5. Permittee 706-647-0414 Telephone No.* 6. Permittee Mailing Street Address Address* 124 East Thompson Street Address Line 2 City State / Province / Region Thomaston GA Postal / Zip Code Country 30286-3664 US Check box if the Yes street address the same as mailing address 7. Permittee Street Street Address Address * 124 East Thompson Street Address Line 2 City State / Province / Region Thomaston GA Postal / Zip Code Country 30286-3664 US 8. Type of Ownership is only individual if an individual is named in B.1. above. Ownership* Non -Government C. Site Contact Information Part C. Project Site Contact Information ................................................................................................................................................................................................................................................................................................................................................................................................. 1. Primary Site John Contact - First Name* 2. Primary Site Wells Contact - Last Name* 3. Title Construction Manager 4. Site Contact E-mail john@shjconstructiongroup.com Address* 5. Site Contact Telephone No.* 6. Organization Name 7. Site Contact Mailing Address* 706-647-0474 Street Address 124 East Thompson Street Address Line 2 City Thomaston Postal / Zip Code 30286-3664 8. Consultant Name (optional) Josh Russell First and Last name 9. Consultant E-mail jrussell@paulsonmitchell.com This person will be copied on all correspondence. 10. Consultant 770-650-7685 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) martie@shjconstructiongroup.com Default is legally responsible person e-mail 12. Billing Telephone (For Annual Fee correspondence) 706-647-0414 Default is legally responsible person telephone State / Province / Region GA Country us D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Plan Approval Information 1. Date E&SC Plan 10/28/2022 Approved * 2. E&SC Plan Project EDGEC-2023-003 Number/ID* Assigned by agency or local program 3. E&SC Plan State DEQ Office Approved by* Local Program 4. State DEQ Office* Raleigh (RRO) 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 EDGEC-2023-003_20221028_LOA.pdf 128.16KB Approval letter or Must be PDF format Grading Permit 6. Signed FRO Financial Responsibility/Ownership Form Tarboro, NC FRO form.pdf 1.21 MB Must be PDF format 7. Site Location Map Must be PDF format (limit 20 MB) Tarboro NC Site Location Map.pdf 2.55MB Please do not upload entire set of E&SC plans. 8. Notes (Optional) Provide any additional information that might help the reviewer better understand how uploaded documents support the application. Include additional waterbodies if necessary. 9. NOI Certification Tarboro NOI-cert form.pdf 476.98KB Form Must be PDF format This is an Express • No Review Project* Yes E. Certification North Carolina General Statute 143-215.613 (i) provides that: Any person who knowingly makes any false 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 Article; 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 Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). Under penalty of law, I certify that: * 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. * 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. * I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control Plan. * 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:* The Legally Responsible Person named on this Notice of Intent 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* Martie Murphy Title Director of Entitlement Organization Legally Responsible Entity TWAS Properties LLC Date * 01 /23/2023 F. Tracking and COC Info NOI Tracking No. 123582 NC Reference No. NCG01-2023-0196 Indicates NCG01 or NCG25. Uses NOI number until approved, then uses NUMBER incremented by SP (passed from workflow if eNOI approved) Certificate of NCC230196 Coverage (COC) No.* Uses NOI number until approved, then uses NUMBER incremented by SIP (formatted and passed from workflow if eNOI approved) Initial Invoice No. NCC230196-2023 Invoice Due Date 2/22/2023 Initial Fee $ 100.00 Invoice Status OPEN