NCC202078_NOI Application_20200519

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/15/2020 2:20:42 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 5/18/2020 12:59:00 PM (Review- Construction NOI 25698)
• The task was assigned to Morman, Alaina by round robin distribution 5/15/2020 2:21 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: May 19, 2020 5:00 PM
5/15/2020 2:21 PM
Submit by Garcia, Lauren V 5/19/2020 2:51:49 PM (Payment Verification for NCC202078)
* Bootsmead Developer LLC
• Garcia, Lauren V assigned the task to Garcia, Lauren V 5/19/2020 2:51 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: June 29, 2020 5:00 PM
5/18/2020 12:59 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting IT No
an NOI that was r Yes
rejected before?
1a. Project Name * The Grounds at Concord Roadway Infrastructure
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
2. County* Cabarrus
3. Highway or Street George Liles Parkway
Address* Street narre only is acceptable if no address number assigned yet
4.CityorTownship* Concord
5. State * NC
6. Zip Code * 28027
7. Latitude* Enter the latitude in decimal degrees
35.3746
8. Longitude* Enter the longitude in decimal degrees (M.JST be negative)
-80.6382
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*
11/30/2020
Estinated Construction Project End Date
11. SIC (Primary)*
Industrial (1541)
Standard Industrial Classification for Developrrent
12. Acres to be
17.71
disturbed*
(including off -site borrow and waste areas)
13. Total site area 1,502.72
(acres) *

14. Post- 2.62
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-CABAR-2020-The Grounds at Concord Roadway
Tracking ID Infrastructure
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 Coddle Creek
Wate rbody* %rre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 13-17-6-(5.5)
Index No.* NCWaterbody Index Number
Stormwater rJ 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. ^
Fbrnittee 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 Legally Pesponsible Entity
Name * D.H. Griffin Infrastructure, LLC
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name * Chris
IF Corporation, enter Faegistered Agent First %rre
3. Last Name* Carter
It Corporation, enter F;bgistered Agent Last %ne
3b. Title Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 336-389-5388
Telephone No.*
6. Permittee Mailing Street Address
Address* 1005 North Church Street
Address Line 2
Suite 550
City
State / Frovince / Fbgion
Charlotte
NC
Fbstal / Zip Code
Country
28206-3222
us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
1005 North Church Street
Address Line 2
Suite 550
City
State / Ftovince / Region
Charlotte
NC
Fbstal / Zip Code
Country
28206-3222
us
8. Type of
Non -Government
Ownership

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Jimmy
Contact - First
Name *
2. Primary Site
Barnett
Contact - Last
Name *
3. Title
Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
980-279-7669
Telephone No.
6. Organization
D.H. Griffin Infrastructure, LLC
Name
7. Site Contact
Street Address
Mailing Address*
1005 North Church Street
Address Line 2
City
Charlotte
Fbstal / Zip Code
28206-3222
8. Consultant Name
(Optional)
Rob Keidel
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
704-333-0325
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 05/01/2020
Approved *
2. E&SC Plan Project CABAR-2020-070
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 Approved NCDEQ Erosion Control Permit.pdf 186.5KB
Approval letter or Mist beRDFfornat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) Site Location Map.pdf 684.66KB
Mast be RDFfornat. Rease do not upload entire set of E&SCplans.
7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies for linear projects if necessary.
8. NOI Certification NOI Certification. pdf 616.84KB
Form Wst be RDF format
This is an Express r 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 Article; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Artcle; 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 Artcle 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
yjv(�W-__
Type Name * Christopher M. Carter
Title Manager
Organization Legally Plesponsible Entity
D.H. Griffin Infrastructure, LLC
Date * 05/15/2020

F. Tracking and COC Info
NOI Tracking No. 25698
NC Reference No. NCG01-2020-2078
Uses 'count number' variable (incremrented by SP)
Certificate of NCC202078
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 2078
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.)