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HomeMy WebLinkAboutNCC230586_NOI Application_20230324Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 2/27/2023 2:01:16 PM (NCG01 NOI Submission) Approve by Kieu Tran 3/3/2023 8:48:03 AM (Review - NOI 128707 Clarke Creek Force Main) • The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 2, 2023 5:00 PM 2/27/2023 2:01:24 PM • The task was assigned to Brooklyn. Broussard by round robin distribution 2/27/2023 2:01:24 PM • bethany.georgoulias reassigned the task to Kieu Tran 3/1/2023 10:35:37 AM Submit by Tev.Holloman 3/24/2023 8:33:41 AM (Payment Verification for NCC230586) 0 Robert Rella The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 14, 2023 5:00 PM 3/3/2023 8:48:20 AM • Tev.Holloman assigned the task to Tev.Holloman 3/24/2023 8:32:01 AM R �o NORTH CAROUNA Environmental Quality A. Project Information Part A. Project Location and Waterbody Information Are you submitting an NOI that was rejected before? No Yes 1a. Project Name* Clarke Creek Force Main 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. 02107112, 02106104, 02121114, 02121113, 02104105, 02104103, 01921223, 01921228, 01922502, 01922423, 01922424, 01919101, 01938125, 01919102, 01919121, 01918135, 01934108, 01910102, 01934118, 01934105, 01934104,01934103,01911107,01930105,01742112,01936199,01736102,01742107,01742110,01720403, 01720102.01720103 2. County* Mecklenburg 3. Highway or Street Address* Various starting from Huntersville-Concord Road Street name only is acceptable if no address number assigned yet 4. City or Township* Huntersville 5. State* NC 6. Zip Code* 28078 7. Latitude* Enter the latitude in decimal degrees 35.4120 8. Longitude* Enter the longitude in decimal degrees (MUST be negative) -80.7870 U 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* 03/01/2023 Estimated Construction Project Start Date 10. Date to End* 09/30/2024 Estimated Construction Project End Date 11. SIC (Primary)* Other (9999) Standard Industrial Classification for Development 12. Acres to be 40.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 40.00 (acres) * 14. Post -construction 0.00 impervious area (Estimated) (acres) * Project Tracking ID NCC-MECKL-2023-Clarke Creek Force Main 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* Clarke Creek Name of waterbody into which stormwater runoff will discharge 15b. Waterbody Index No. 13-17-4 NC Waterbody Index Number Stormwater discharges will flow to additional waters* No Yes 15c. Additional Receiving Waterbody Cane Creek Waterbody name 15d. Waterbody Index No. 13-17-4-2-1 NC Waterbody Index Number 15e. Additional Receiving Waterbody South Prong Clarke Creek Waterbody name 15f. Waterbody Index No. 13-17-4-2 NC Waterbody Index Number 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 This question was added to the eNOl on 1/26/2023 and will not be answered in applications submitted prior to that date. Reviewer may update if status is known. 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 City of Charlotte 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* Joseph If Corporation, enter Registered Agent First Name 3. Last Name* Wilson If Corporation, enter Registered Agent Last Name 3b. Title Chief Engineer 4. Permitee E-mail Carl.Wilson@charlottenc.gov Address * 5. Permittee 704-336-1083 Telephone No.* 6. Permittee Mailing Street Address Address* 5100 Brookshire Boulevard Address Line 2 City State / Province / Region Charlotte NC Postal / Zip Code Country 28216-3371 US Check box if the Yes street address the same as mailing address 7. Permittee Street Street Address Address* 5100 Brookshire Boulevard Address Line 2 City State / Province / Region Charlotte North Carolina Postal / Zip Code Country 28202 United States 8. Type of Ownership is only individual if an individual is named in B.1. above. Ownership* Government - Municipal C. Site Contact Information Part C. Proiect Site Contact Information 1. Primary Site Andrew Contact - First Name* 2. Primary Site Merritt Contact - Last Name* 3. Title Project Manager 4. Site Contact E-mail amerritt@sucontractors.com Address * 5. Site Contact 704-261-1154 Telephone No.* 6. Organization Name State Utility Contractors 7. Site Contact Street Address Mailing Address* P.O. Box 5019 Address Line 2 City Monroe Postal / Zip Code 28111 8. Consultant Name (Optional) Kevin Quattlebaum First and Last name 9. Consultant E-mail kevin.quattlebaum@hdrinc.com This person will be copied on all correspondence. 10. Consultant 704-338-6729 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) Carl.Wilson@charlottenc.gov Default is legally responsible person e-mail 12. Billing Telephone (For Annual Fee correspondence) 704-336-1083 Default is legally responsible person telephone State / Province / Region NC Country USA D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Plan Approval Information ...................................................................................................................................................................... 1. Date E&SC Plan 02/01/2023 Approved * 2. E&SC Plan Project MECKL-2023-027 Number/ID * Assigned by agency or local program 3. E&SC Plan State DEQ Office Approved by* 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 NCDEQ Clarke Creek FM Linear MECK-2023-027 Approval letter or Cond Approval.pdf 99.38KB Grading Permit Must be PDF format 6. Signed FRO Financial Responsibility/Ownership Form Clarke Creek - FRO signed - app only.pdf 102.98KB Must be PDF format 7. Site Location Map Must be PDF format (limit 20 MB) Project area 2022-09-12.pdf 176.78KB 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 cwilson_2-22-2023_11-03-01.pdf 827.04KB Form Must be PDF format This is an Express No Review Project* Yes E. Certification North Carolina General Statute 143-215.613 (1) 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 ,TosePh 441-7014 Type Name* Joseph Wilson Title Chief Engineer Organization Legally Responsible Entity City of Charlotte Date * 02/27/2023 F. Tracking and COC Info NOI Tracking No. 128707 NC Reference No. NCG01-2023-0586 Indicates NCG01 or NCG25. Uses NOI number until approved, then uses NUMBER incremented by SP (passed from workflow if eNOI approved) Certificate of NCC230586 Coverage (COC) No.* Uses NOI number until approved, then uses NUMBER incremented by SP (formatted and passed from workflow if eNOI approved) Initial Invoice No. NCC230586-2023 Invoice Due Date 4/2/2023 Initial Fee $ 100.00 Invoice Status OPEN