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HomeMy WebLinkAboutNCC230872_NOI Application_20230330Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 3/22/2023 8:58:00 AM (NCG01 NOI Submission) Approve by Kieu Tran 3/28/2023 10:49:41 AM (Review - NOI 133252 Suttles Road Station Site) • The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 27, 2023 5:00 PM. The priority is: High 3/22/2023 8:58:09 AM • The task was assigned to Paul.Clark by round robin distribution 3/22/2023 8:58:09 AM • Paul.Clark reassigned the task to Kieu Tran 3/27/2023 11:45:51 PM 0 sorry, reassigning late. this is for you. thx. Submit by Tev.Holloman 3/30/2023 11:20:21 AM (Payment Verification for NCC230872) 0 JOSHUA M BELL • The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 9, 2023 5:00 PM. The priority is: High 3/28/2023 10:50:08 AM • Tev.Holloman assigned the task to Tev.Holloman 3/30/2023 11:19:18 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 Previous Rejected NOI No. 132189 Prior Reviewer Name Kieu Tran 1a. Project Name* Suttles Road Station Site 1b. Specific Lot Numbers This field may be used to list specifc lot numbers. N/A 1c. Parcel ID Number(s) (PIN) List all PINS associated with this project. N/A 2. County* Chatham 3. Highway or Street Address* Suttles Road Street name only is acceptable if no address number assigned yet 4. City or Township* Pittsboro 5. State* NC 6. Zip Code* 27312 7. Latitude* Enter the latitude in decimal degrees 35.7500 8. Longitude* Enter the longitude in decimal degrees (MUST be negative) -79.1650 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* 10/31/2022 Estimated Construction Project Start Date 10. Date to End* 06/28/2024 Estimated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial Classification for Development 12. Acres to be 2.80 disturbed* (including off -site borrow and waste areas) 13. Total site area 2.80 (acres) * 14. Post -construction 0.10 impervious area (Estimated) (acres) * Project Tracking ID NCC-CHATH-2022-Suttles Road Station Site 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* Haw River Tributary Name of waterbody into which stormwater runoff will discharge 15b. Waterbody Index No.* 16-(36.7) 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 This question was added to the eNOI 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 Public Service Company of North Carolina, Incorporated 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* Andrew If Corporation, enter Registered Agent First Name 3. Last Name* Moore If Corporation, enter Registered Agent Last Name 3b. Title Director - Engineering and Construction 4. Permitee E-mail andrew.moore@dominionenergy.com Address * 5. Permittee 704.718.4114 Telephone No.* 6. Permittee Mailing Street Address Address * P.O. Box 1398 Address Line 2 City State / Province / Region Gastonia NC Postal / Zip Code Country 28053 United States Check box if the Yes street address the same as mailing address 7. Permittee Street Street Address Address * 800 Gaston Road Address Line 2 City State / Province / Region Gastonia NC Postal / Zip Code Country 28053 United States 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. Proiect Site Contact Information 1. Primary Site Robert Contact - First Name* 2. Primary Site Lepsic Contact - Last Name* 3. Title Environmental Specialist 4. Site Contact E-mail robert.lepsic@dominionenergy.com Address * 5. Site Contact 919.810.7883 Telephone No.* 6. Organization Name Dominion Energy Environmental Services 7. Site Contact Street Address Mailing Address* 2020 Energy Drive Address Line 2 City Apex Postal / Zip Code 27502 8. Consultant Name (Optional) Joshua Bell First and Last name 9. Consultant E-mail jmbell@smeinc.com This person will be copied on all correspondence. 10. Consultant 704.517.2618 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) andrew.moore@dominionenergy.com Default is legally responsible person e-mail 12. Billing Telephone (For Annual Fee correspondence) 704.718.4114 Default is legally responsible person telephone State / Province / Region NC Country us D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Plan Approval Information ...................................................................................................................................................................... 1. Date E&SC Plan 10/07/2022 Approved * 2. E&SC Plan Project CHATH-2023-002 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 CHATH-2023-002_20221007_LOA.pdf 259.24KB Approval letter or Must be PDF format Grading Permit 6. Signed FRO Financial Responsibility/Ownership Form SuttlesRd Station FRO 105322.pdf 491.3KB Must be PDF format 7. Site Location Map Must be PDF format (limit 20 MB) Suttles Site Location.pdf 4.41 MB Please do not upload entire set of E&SC plans. B. 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 SuttlesRd eNOI 134541.pdf 582.66KB 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 o' .y.—Imiri lwwte Type Name* Andrew Moore Title Director - Engineering & Construction Organization Legally Responsible Entity Public Service Company of North Carolina, Inc. Date * 03/22/2023 F. Tracking and COC Info NOI Tracking No. 133252 NC Reference No. NCG01-2023-0872 Indicates NCG01 or NCG25. Uses NOI number until approved, then uses NUMBER incremented by SP (passed from workflow if eNOI approved) Certificate of NCC230872 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. NCC230872-2023 Invoice Due Date 4/27/2023 Initial Fee $ 100.00 Invoice Status OPEN