NCC215459_NOI Application_20211001

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/29/2021 11:37:51 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 9/30/2021 7:10:18 AM (Review- Construction NOI 66866)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 9/29/2021 11:38 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 1, 2021 5:00
PM 9/29/2021 11:38 AM
Submit by Evans, Shaundra M 10/1/2021 9:46:22 AM (Payment Verification for NCC215459)
* James Maloney Vannoy
• Evans, Shaundra M assigned the task to Evans, Shaundra M 10/1/2021 9:45 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 11, 2021 5:00
PM 9/30/2021 7:10 AM

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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 * Cabarrus County EMS Headquarters
1 b. Specific Lot This field Tray be used to list specifc lot numbers.
Numbers N/A
1 c. Parcel ID List all Rios associated w ith this project.
Number(s) (PIN) 5620-02-2757; 5620-02-4830; 5620-02-4526; 5620-02-5371; 5620-02-9414
2. County* Cabarrus
3. Highway or Street 793 Cabarrus Ave West
Address* Street name 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
35.3950
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-80.6090
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*
10/11/2021
Estirrated Construction Project Start Rate
10. Date to End *
12/30/2022
Estinated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial C]assification for Development
12. Acres to be
7.48
disturbed*
(including off -site borrow and waste areas)

13. Total site area 10.08
(acres) *
14. Post- 3.26
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-CABAR-2021-Cabarrus County EMS Headquarters
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 Irish Buffalo Creek
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b. Waterbody 13-17-9-(2)
Index No. * NCWaterbody Index Number
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 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 NCG010000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
1. Permittee * Legally Pesponsible Entity
Vannoy Construction
IF pernittee is an individual, enter first and last narre in this field. Otherwise, enter organization/business narre.
Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the
registration here.
2. First Name * James
If Corporation, enter Faegistered Agent First Wre
3. Last Name* Maloney
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title General Counsel
4. Permitee E-mail [e-mail]
Address*
5. Permittee 336 846 4265
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box635
Address Line 2
City
Jefferson
Fbstal / Zip Code
28640
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
1608 US Hwy 221, North
Address Line 2
City
Jefferson
Fbstal / Zip Code
28640
State / Frovince / Pegion
NC
Country
Ashe
State / Frovince / Faegion
NC
Country
Ashe
8. Type of Ownership is only individual if an individual is naned in B.1. above.
Ownership* Non -Government

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Rob
Contact - First
Name *
2. Primary Site
Cook
Contact - Last
Name *
3. Title
Project Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
704 912 1337
Telephone No.
6. Organization
Vannoy Construction
Name
7. Site Contact
Street Address
Mailing Address*
4024 Barringer Dr
Address Line 2
city
Charlotte
Fbstal / Zip Code
28208
8. Consultant Name
(Optional)
Wesley Sherrill
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
1 704 975 0472
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
704 912 1337
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
United States

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 07/26/2021
Approved *
2. E&SC Plan Project CABAR-2021-073
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. 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 CCEMS_ NCDEQ_ erosion control permit.pdf 46.61 KB
Approval letter or Mast beRDFformat
Grading Permit
6. Signed FRO Financial Pesponsibility/Ownership Form
CCEMS Financial -Responsibility -Form -signed
924.91 KB
5.14.21.pdf
Mist be RDFfornat
7. Site Location Map Wst be RDFforrret (lint 201VB)
CCEMS_VICINITY MAP.pdf 297.93KB
Rease do not upload entire set of E&SC plans.
8. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
9. NOI Certification CCEMS-NCG01-eNOI-Certification Form Signed. pdf 529.35KB
Form Mist be RDFforrret
This is an Express r No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.66 (1) 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 Legally Responsible Person named on this Notice of Intent
r 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
Type Name * Rob Cook
Title Project Manager
Organization Legally Plesponsible Entity
Vannoy Construction
Date * 09/29/2021

F. Tracking and COC Info
NOI Tracking No. 66866
NC Reference No.
NCG01-2021-5459
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC215459
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5459
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC215459-2021
Invoice Due Date 10/30/2021
Initial Fee $ 100.00
Invoice Status OPEN