NCC241911_NOI Application_20240621

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 6/20/2024 2:32:38 PM (NCG01 NOI Submission)
Approve by Brooklyn.Broussard 6/21/2024 6:37:56 AM (Review-NOI 203172 NC 762 Pressure Zone Water
Transmission Main and Finished Water Pump Station)
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is:June 25,2024 5:00 PM.
The priority is: Medium 6/20/2024 2:32:49 PM
• The task was assigned to Brooklyn.Broussard by round robin distribution 6/20/2024 2:32:49 PM
Submit by Tev.Holloman 6/21/2024 11:23:19 AM (Payment Verification for NCC241911)
•Union County
• The task was assigned to DEMLR NCG01 Payment Team.The due date is:August 2,2024 5:00 PM.The
priority is: Medium 6/21/2024 6:38:11 AM
• Tev.Holloman assigned the task to Tev.Holloman 6/21/2024 11:22:59 AM

applicationConstruction Stormwater: Notice of Intent (NOI)
National Pollutant Discharge Elimination System(NPDES)
General Permit 1 OOOO:STORMWATER DISCHARGES associated with construction activities
NORTH CAROUNA
Environmental Quality
A. Project Information
Part A.
Project Location and Waterbody Information
...................................................................................................................................................................................................................................................................................................................................................................................................
Are you submitting an NOI that was rejected before?
No
Yes
1a. Project Name*
NC 762 Pressure Zone Water Transmission Main and Finished Water Pump Station
1b.Specific Lot Numbers
This field may be used to list specifc lot numbers.
See Parcel ID Numbers listed under Ale.
1c.Parcel ID Number(s)(PIN)
List all PINS associated with this project.
08-051-003A
08-051-012A
08-051-012
08-051-014
08-051-033
08-051-034
08-051-041
08-051-042
08-051-002E
08-051-002M
08-051-002A
08-05-1002L
08-05-4008
02-230-018
02-230-017
02-230-013
02-230-015
02-230-016
02-230-023
02-230-012
02-230-039
02-230-028
02-230-014A
02-230-008C
02-230-008
02-230-008A
02-199-063
02-199-064
02-199-065
02-199-066
02-199-067

OL-IIJy-OVO
02-199-069
02-199-070
02-199-006M
02-199-006L
02-199-006K
02-199-006
02-199-018
02-199-027
02-199-026
02-199-006G
02-199-006J
02-199-006E
02-199-015
02-202-004
02-202-003B
02-202-007
02-202-008B
02-205-006A
02-205-006L
02-205-006
02-205-006B
02-205-006C
02-205-006D
02-205-006E
02-205-001
02-205-001C
02-208-002A
02-205-004
02-208-005
02-208-005A
02-208-010C
02-208-016
02-208-007
02-208-007B01
02-208-007F
02-208-007G
02-208-007H
2.County*
Union
3. Highway or Street Address*
New Salem Road
Street name only is acceptable if no address number assigned yet
4.City or Township*
Monroe
5.State* NC
6.Zip Code* 28110
7. Latitude* Enter the latitude in decimal degrees
35.0656
8. Longitude* Enter the longitude in decimal degrees(MUST be negative)
-80.4401
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* 07/08/2024
Estimated Construction Project Start Date
10. Date to End* 08/17/2026
Estimated Construction Project End Date
11.SIC(Primary)*
Other(9999)
Standard Industrial Classification for Development
12.Acres to be 23.00
disturbed* (including off-site borrow and waste areas)
13.Total site area 23.00
(acres)*
14. Post-construction 0.49
impervious area (Estimated)
(acres)*
Project Tracking ID NCC-UNION-2024-NC 762 Pressure Zone Water Transmission Main
and Finished Water Pump Station
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 Waterbody*
Richardson Creek
Name of waterbody into which stormwater runoff will discharge
15b.Waterbody Index No.*
13-17-36-(5)
NC Waterbody Index Number
Stormwater discharges will flow to additional waters*
No
Yes
15c.Additional Receiving Waterbody
Bull Branch
Waterbody name
15d.Waterbody Index No.
13-17-36-12
NC Waterbody Index Number
15e.Additional Receiving Waterbody
Jacks Branch
Waterbody name
15f.Waterbody Index No.
13-17-36-15-4
NC Waterbody Index Number
16a.Is this project subject to the NC Sediment Pollution Control Act?*
Yes
No, not subject to NC SPCA

17. Is this project funded with ARPA(American Rescue Plan Act)grant funds?
No
Yes
This question was added to the eNOI on 1/26/2023 and will not be answered in applications submitted prior to that date.
18.ARPA Project Number
Project number assigned by Division of Water Infrastructure(e.g.,SRP-D-ARP-0090)
SRP-D-ARP-0161
CONFIRMED ARPA Project Number
REVIEWER:Confirm DWI Assigned ARPA Project No.(Revise if necessary)
SRP-D-ARP-0161
19. Letter of Intent to Fund(LOIF)ARPA Project
Please upload the Letter of Intent to Fund provided by the N.C.Division of Water Infrastructure(DWI)for this project that references the assigned ARPA
Project number.
U nion_D-ARP-0161_LOI F-Revised_230621.pdf 804.43KB
Must be PDF format

B. Permittee Information
Part B.
Permittee 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 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 Responsible Entity
Union County Water
If permittee is an individual,enter first and last name in this field.Otherwise,enter organization/business name.
Note: If the permittee is a business,the business must be registered with the INC Secretary of State.You can verify the
registration here. Permittee must be the same entity that is responsible for the land-disturbing activity as listed on the NC
SPCA Financial Responsibility/Ownership(FRO)Form.
2. First Name* Thomas
If Corporation,enter Registered Agent First Name
3. Last Name* Mann
If Corporation,enter Registered Agent Last Name
3b.Title CIP Program Manager
4. Permitee E-mail Address*
[e-mail]
5. Permittee Telephone No.*
704-292-2560
6. Permittee Mailing Address*
Street Address
500 North Main Street
Address Line 2
Suite 400
City State/Province/Region
Monroe INC
Postal/Zip Code Country
28112 United States
Check box if the street address the same as mailing address
Yes

7.Permittee Street Address
Street Address
500 North Main Street
Address Line 2
Suite 400
City State/Province/Region
Monroe NC
Postal/Zip Code Country
28112 United States
8.Type of Ownership*
Ownership is only individual if an individual is named in B.1.above.
Government-County

C. Site Contact Information
Part C.
Project Site Contact Information
................................................................................................................................................................................................................................................................................................................................................................................................
1. Primary Site Contact-First Name*
Justin
2. Primary Site Contact-Last Name*
Collins
3.Title
Project Manager
4.Site Contact E-mail Address*
[e-mail]
5.Site Contact Telephone No.*
704-261-1146
6.Organization Name
State Utility Contractors
7.Site Contact Mailing Address*
Street Address
PO Box 5019
Address Line 2
City State/Province/Region
Monroe NC
Postal/Zip Code Country
28111 United States
8.Consultant Name
(Optional)
Brown and Caldwell
First and Last name
9.Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10.Consultant Telephone No.
9545266853
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-mail
12. Billing Telephone
(For Annual Fee correspondence)
704-292-2560
Default is legally responsible person telephone

D. E&SC Plan
Part D.
Erosion&Sediment Control(E&SC)Plan Approval Information
......................................................................................................................................................................
1. Date E&SC Plan 03/24/2023
Approved*
2. E&SC Plan Project UNION-2023-048
Number/ID* Assigned by agency or local program
3. E&SC Plan State DEQ Office
Approved by* 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 2023 03 24
Approval letter or 762Transmission Mai n_NCDEQErosionApproval_U... 1.91 MB
Grading Permit
2023-048.pdf
Must be PDF format
6.Signed FRO Financial Responsibility/Ownership Form
2022 12 01
1.14M6
762ZoneWaterMain_NCDEQ_ESC_FinancialResp...
Must be PDF format
7.Site Location Map Must be PDF format(limit 20 MB)
D7.Site Location Map.pdf 270.82KB
Please do not upload entire set of E&SC plans.
8. Notes(Optional) Provide any additional information that might help the reviewer better understand how uploaded documents
support the application.Include additional waterbodies if necessary.
Additional Receiving Waterbody:Austin Branch
Waterbody Index No.: 13-17-36-15-1
9. NOI Certification 20240620
Form 584.09K6
762Transmission Mai n_NCDEQStormwaterN01.pdf
Must be PDF format
This is an Express No
Review Project* Yes

E. Certification
North Carolina General Statute 143-215.613(1)provides that:
Any person who knowingly makes any false 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 Article;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 Article shall
be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars($10,000).
Under penalty of law, I certify that:
* 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.
* 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.
* I will abide by all conditions of the NCG010000 General Permit and the approved
Erosion and Sediment Control Plan.
* 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:* The Legally Responsible Person named on this Notice of Intent
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* Thomas Mann
Title CIP Program Manager
Organization Legally Responsible Entity
Union County Water
Date* 06/20/2024

F. Tracking and COC Info
NOI Tracking No. 203172
NC Reference No. NCG01-2024-1911
Indicates NCG01 or NCG25.Uses NOI number until approved,then uses NUMBER incremented by SIP(passed
from workflow if eNOI approved)
Certificate of NCC241911
Coverage(COC) No.* Uses NOI number until approved,then uses NUMBER incremented by SIP(formatted and passed from workflow if
eNOI approved)
Initial Invoice No. NCC241911-2024
Invoice Due Date 7/21/2024
Initial Fee $ 120.00
Fee increased to$120,effective October 3,2023
Invoice Status OPEN