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HomeMy WebLinkAboutNCC192152_NOI Application_20191003Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 10/2/2019 8:17:17 AM (NCG01 NOI Submission) Approve by McCoy, Suzanne 10/2/2019 9:28:06 AM (Review- Construction NOI 16572) • The task was assigned to McCoy, Suzanne by round robin distribution 10/2/2019 8:17 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 4, 2019 5:00 PM 10/2/2019 8:17 AM Submit by EADS\smccoy2 10/3/2019 7:46:05 AM (Payment Verification for NCC192152) * Teramore Development. • EADS\smccoy2 assigned the task to EADS\smccoy2 10/3/2019 7:45 AM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 13, 2019 5:00 PM 10/2/2019 9:28 AM STME NORTH CAROLINA Ernvlronmentol qualily A. Project Information Part A. Project Location and Waterbody Inforrration 1. Project Name * Dollar General - Salisbury Store #2568 2. County* Rowan 3. Highway or Street 2277 Statesville Boulevard Address * Street name only is acceptable if no address nurrber assigned yet 4. City or Township* Salisbury 5. State * NC 117-8) TII�T 7i1) M F1Ii f_TiI a 10141 6. Zip Code* 28147 7. Latitude * Enter the latitude in decirral degrees 35.6954 8. Longitude * Enter the longitude in decirral degrees (MIST be negative) -80.5233 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 * 11 /29/2019 Estimated Construction Project Start Date 10. Date to End* 05/26/2020 Estimated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial aassification for Development 12. Acres to be 1.68 disturbed* (including off -site borrow and waste areas) 13. Total site area 1.52 (acres)* 14. Post- 37,788.00 construction (Estimated) impervious area (acres) * NCC Project NCC-ROWAN-2019-Dollar General - Salisbury Store #2568 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. 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 Draft Branch Waterbody* Narre of waterbody into which storrrwater runoff will discharge 15b. Waterbody 12-110-4 Index No. * NCWaterbody Index Pbnber Stormwater r No discharges will flow pr Yes to additional wate rs * 15c. Additional Grants Creek Receiving Waterbody narre Waterbody 15d. Waterbody 12-110 Index No. NCWaterbody Index Ninber 15e. Additional Waterbody narre Receiving Waterbody 15f. Waterbody NCWaterbody Index kbrrber Index No. 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. Perrrittee Information - Legally Responsible Entity and Individual ..................................................................................................................................................................... h 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 Teramore Construction Name * 2. First Name* Zach ff Corporation, enter Registered Agent First l\brre 3. Last Name * Crumley V Corporation, enter Registered Agent Last Barre 3b. Title Senior Vice President 4. Permitee E-mail tglass@teramore.net Address* 5. Permittee 229-516-4289 Telephone No.* 6. Permittee Mailing Street Address Address* PO Box6460 Address Line 2 City Thomasville Postal / Zip Code 31758 Check box if the street address the same as mailing address 7. Permittee Street Address* r Yes Street Address 165 Big Star Drive Address Line 2 City Thomasville Fbstal / Zip Code 31757 State / Province / Region GA Country USA State / Province / Region GA Country US C. Site Contact Information Part C. Roiect Site Contact Information 1. Type of Non -Government Ownership* 2. Primary Site Hub Contact - First Name * 3. Primary Site Honeycutt Contact - Last Name * 4. Title 5. Site Contact E- jennifer@brec.biz mail Address* 6. Site Contact 704-985-5268 Telephone No.* 7. Organization Name 8. Site Contact Street Address Mailing Address* PO Box6460 Address Line 2 city Thomasville Fbstal / Zip Code 31758 9. Consultant Name (optional) Jennifer Edwards First and Last name 10. Consultant E- jennifer@brec.biz mail This person will be copied on all correspondence. 11. Consultant Telephone No. State / Province / Region GA Country USA D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Ran ADDroval Information 1. Date E&SC Plan 09/04/2019 Approved * 2. E&SC Plan Project Dollar General Statesville Blvd Salisbury Number/ID* Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by r Local Program 4. Local Program* Rowan County 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 APPROVED _ESC_PERMIT.pdf 96.68KB Approval Mist be PCFfornat letter/documentation 6. NOI Certification SKM_C364e19100115171.pdf 388.79KB Form Mist be RDFfornat This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.6B (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. * V 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. * V 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. * I7 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 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* Zach Crumley Title Senior Vice President Organization Teramore Construction Date * 10/02/2019 F. Tracking and COC Info NOI Tracking No. 16572 NC Reference No. NCG01-2019-2152 Uses 'count number variable (incremrented by SP) Certificate of NCC192152 Coverage (COC) Uses'count_nunber'variable (incremrented by SF) No. * Count Number 2152 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.)