Loading...
HomeMy WebLinkAboutNCC191012_NOI Application_20190718 Action History (UTC-05:00) Eastern Time(US&Canada) Submit by Anonymous User 7/18/2019 11:06:17 AM(NCG01 NOI Submission) Approve by Lucas,Annette 7/18/2019 5:50:37 PM(Review-Construction NOI 13620) • The task was assigned to Lucas,Annette by round robin distribution 7/18/2019 11:06 AM • The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:July 22,2019 5:00 PM 7/18/2019 11:06 AM Submit by Lucas,Annette 7/18/2019 5:51:59 PM(Payment Verification-NCG01-2019-1012) • The task was assigned to Lucas,Annette.The due date is: July 19,2019 5:00 PM 7/18/2019 5:50 PM 1 sees �' � ••. -• i •• i i• i IY sell NORTH CAROLINA Ernvlronmental QUII A. Project Information Part A. Project Location and Waterbody Information 1. Project Name* Jefferson Apparel 2. County* Ashe 3. Highway or Street Jefferson Apparel Road Address* Street narra only is acceptable if no address nurrber assigned yet 4. City or Township* Crumpler 5. State* NC 6.Zip Code* 28617 7. Latitude* Enter the latitude in decirral degrees 36.4440 8. Longitude* Enter the longitude in decirral degrees(MJSTbe negative) -81.4028 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* 07/17/2019 Estimated Construction Project Start Date 10. Date to End* 07/17/2020 Estimated Construction Project End Date 11. SIC(Primary)* Commercial(1542) Standard Industrial gassification for Developrrant 12.Acres to be 0.68 disturbed* (including off-site borrow and waste areas) 13.Total site area 12.80 (acres)* 14. Post- 0.00 construction (Estimated) impervious area (acres)* NCC Project NCC-ASHE-2019-Jefferson Apparel Tracking ID Assigned autorratically 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. You may enter up to 3 waterbodies. 15a. Receiving Dog Creek Waterbody* Nacre of waterbody into which stormuater runoff will discharge 15b.Waterbody 10-1-33 Index No.* NCWaterbody Index Nanber Stormwater r No discharges will flow rj Yes to additional wate rs* 15c.Additional New River Receiving Waterbody narre Waterbody 15d.Waterbody 10-1-(31.5) Index No. NCWaterbody Index Ninber 15e.Additional Waterbody nave Receiving Waterbody 15f.Waterbody NCWaterbody Index Narrber Index No. 16a.Is this project r Yes subject to the NC f No, not subject to NC SPCA Sediment Pollution Control Act?* B. Permittee Information Part B. Perrrittee 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 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 Vannoy Property Management III LLC Name* 2. First Name* Mark ff Corporation,enter Registered Agent First l\b e 3. Last Name* Vannoy Y Corporation,enter Registered Agent Last Barre 3b.Title President 4. Permitee E-mail mark.vannoy@jrvannoy.com Address* 5. Permittee 336-846-7191 Telephone No.* 6. Permittee Mailing Street Address Address* PO Box635 Address Line 2 City State/Province/Region Jefferson NC Postal/Zip Code Country 28640 US Check box if the r Yes street address the same as mailing address 7. Permittee Street Street Address Address* 1608 U.S. Hwy 221 N Address Line 2 City State/Province/Region Jefferson NC Postal/Zip Code Country 28640 US C. Site Contact Information Part C. Project Site Contact Information .................................................................................................................... 1.Type of Non-Government Ownership* 2. Primary Site Mark Contact-First Name* 3.Primary Site Vannoy Contact-Last Name* 4.Title President 5.Site Contact E- mark.vannoy@jrvannoy.com mail Address* 6.Site Contact 336-846-7191 Telephone No.* 7.Organization Vannoy Property Management III LLC Name 8.Site Contact Street Address Mailing Address* PO Box635 Address Line 2 City State/Province/Region Jefferson NC Fbstal/Zip Code Country 28640 USA D. E&SC Plan Part D. Erosion&Sediment Control(E&SC)Ran Approval Information ....................................................................................................................................................................................................................................... ............................................................................................. 1. Date E&SC Plan 07/15/2019 Approved* 2. E&SC Plan Project Ashe-2019-004 Number/ID* Assigned by agency or local program 3. E&SC Plan f•State DEQ Office Approved by r Local Program 4.State DEQ Office* Winston-Salem(WSRO) Documentation of E&SC Plan approval and the signed Notice of Intent(NOI)Certification Form is required for a complete application. 5. E&SC Plan ESC_APPROVAL.pdf 3.77MB Approval Mast be FDFfornat letter/documentation 6. NOI Certification Signed NOI.pdf 331.82KB Form Mist be RDFfornat This is an Express f•No Review Project* r Yes E. Certification North Carolina General Statute 143-215.613(1)provides that: Anyperson who knowinglymakes any false statement,representation,or certification in anyapplication,record,report,plan,or other documentfiled or required to be maintained under this Article or a rule implementing this Article;or who knowinglymakes 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 deice or method required to be operated or maintained under this Article or rules of the Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand dollars($10,000). Under penalty of law, I certify that: rJ 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. * I7 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:* r The Responsible Person named on this Notice of Intent r Authorized Responsible Person* Important:The person who signs this Certification above and signs the NOI Certification Form should be the same person(or authorized responsible person within the same organization)as listed in Section B(Permittee Information) of this form. *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 f��rt (14'vy'r2�1 Type Name* Mark Vannoy Title President Organization Vannoy Property Management III Date* 07/18/2019 F. Tracking and COC Info NOI Tracking No. 13620 NC Reference No. NCG01-2019-1012 Uses'count number variable(incremented by SP) Certificate of NCC191012 Coverage (COC) Uses'count_nunber'variable(increrrented bySP) No.* Count Number 1012 Sequential nunber for subrrittal that is incremented by Stored Procedure COC Year 2019 Year of date reviewed(used to assign YY digits after"NGC'in OOCno.)