NCC201165_NOI Application_20200330

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/20/2020 9:54:55 AM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 3/20/2020 2:27:25 PM (Review- Construction NOI 23320)
• The task was assigned to McCoy, Suzanne by round robin distribution 3/20/2020 9:55 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 24, 2020 5:00
PM 3/20/2020 9:55 AM
Submit by Garcia, Lauren V 3/30/2020 10:37:19 AM (Payment Verification for NCC201165)
* Alfred Benesch & Company
• Garcia, Lauren V assigned the task to Garcia, Lauren V 3/30/2020 10:36 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 1, 2020 5:00 PM
3/20/2020 2:27 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
la. Project Name * West Mecklenburg High School Gym Addition
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers
2. County* Mecklenburg
3. Highway or Street 7400 Tuckaseegee Road
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Charlotte
5. State * NC
6. Zip Code* 28214
7. Latitude* Enter the latitude in decimal degrees
35.2490
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-80.9520
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*
05/18/2020
Estimated Construction Project Start Date
10. Date to End *
08/27/2021
Estimated Construction Project End Cate
11. SIC (Primary) *
Other (0000)
Standard Industrial C]assification for Development
12. Acres to be
2.06
disturbed*
(including off -site borrow and waste areas)
13. Total site area 57.70
(acres)*
14. Post- 18.10
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-MECKL-2020-West Mecklenburg High School Gym Addition
Tracking ID Assigned automatically
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 Paw Creek
Wate rbody* f\brre of waterbody into which stormwater runoff will discharge
15b. Waterbody 11-124
Index No. * NCWaterbody Index I inber
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
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. ^
Fternittee Inforrration - Legally Fbsponsible 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 Charlotte Mecklenburg Board of Education
Name * If perrrittee is an individual (i.e., organization does not apply), enter first and last nave in this field.
2. First Name* Gary
IF Corporation, enter F;bgistered Agent First Barre
3. Last Name* Adams
If Corporation, enter Faegistered Agent Last Wre
3b. Title Director of Architecture
4. Permitee E-mail [e-mail]
Address *
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 3301 Stafford Drive
Address Line 2
city
Charlotte
Fostal / Zip Code
28208-3576
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
V Yes
Street Address
3301 Stafford Drive
Address Line 2
City
Charlotte
Fbstal / Zip Code
28208-3576
8. Type of Government - County
Ownership*
State / Ftovince / Faegion
NC
Country
us
State / Ffovince / Fbgion
NC
Country
us

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Chip
Contact - First
Name *
2. Primary Site
Lofton
Contact - Last
Name *
3. Title
Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
[phone]
Telephone No.
6. Organization
Charlotte Mecklenburg Schools
Name
7. Site Contact
Street Address
Mailing Address*
3301 Stafford Drive
Address Line 2
City
Charlotte
Fbstal / Zip Code
28208-3576
8. Consultant Name
(Optional)
Pam Johnson
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
[phone]
Telephone No.
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 12/19/2019
Approved *
2. E&SC Plan Project MECCKL-2020-043
Number/ID * Assigned by agency or local program
3. E&SC Plan r State DEQ Office
Approved by* r 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. For linear projects, please also upload a site map showing the overall extent of the project or
include the beginning point and end point coordinates in the "Notes" box below.
5. E&SC Plan DEQ Approval-jm-12182019.pdf 1.49MB
Approval letter or Mast beRDFformat
Grading Permit
Site Map (Optional) Helpful for linear project review
Mast be R7Fform3t
Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies for linear projects if necessary.
6. NOI Certification WMHS NOI signed.pdf 1.33MB
Form Mast be FDFfon-rat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E (i) provides that:
Any person who knowingly makes anyfalse 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 Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the
Commission implementing this Atcle shall be guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
17 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.
* 17 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
f 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
I. �Ju
Type Name * Gary S. Adams
Title Director of Architecture
Organization Charlotte Mecklenburg Schools
Date * 03/20/2020

F. Tracking and COC Info
NOI Tracking No. 23320
NC Reference No. NCG01-2020-1165
Uses 'count number' variable (incremrented by SP)
Certificate of NCC201165
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 1165
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)