NCC192380_NOI Application_20191018

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/16/2019 12:04:43 PM (NCG01 NOI Submission)
Approve by Clark, Paul 10/16/2019 12:13:25 PM (Review- Construction NOI 17266)
• The task was assigned to Clark, Paul by round robin distribution 10/16/2019 12:05 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 18, 2019 5:00
PM 10/16/2019 12:05 PM
Submit by Lucas, Annette 10/18/2019 8:34:14 AM (Payment Verification for NCC192380)
• Lucas, Annette assigned the task to Lucas, Annette 10/18/2019 8:33 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 27, 2019 5:00
PM 10/16/2019 12:13 PM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Information
1. Project Name * Randolph County Jail Addition & Renovation
2. County* Randolph
3. Highway or Street 790 New Century Drive
Address * Street name only is acceptable if no address number assigned yet
4. City or Township* Asheboro
5. State * NC
1r-i)iTiT7i)ilf1Iif_T1IIa10141
6. Zip Code* 27205
7. Latitude * Enter the latitude in decimal degrees
35.6680
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-79.8320
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*
10/01/2019
Estimated Construction Project Start Date
10. Date to End*
03/15/2021
Estimated Construction Project End Date
11. SIC (Primary)*
Other (0000)
Standard Industrial aassification for Development
12. Acres to be
4.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area
7.00
(acres)*
14. Post-
2.00
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-RANDO-2019-Randolph County Jail Addition & Renovation
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 Little River
Wate rbody* Barre of waterbody into which stormuater runoff will discharge
15b. Waterbody 13-25-1
Index No.* NC Waterbody Index Nanber
Stormwater W No
discharges will flow F Yes
to additional
wate rs *
16a. Is this project F 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 Bordeaux Construction Company
Name *
2. First Name* Cliff
ff Corporation, enter Registered Agent First l\brre
3. Last Name * Merrill
ff Corporation, enter Registered Agent Last Barre
3b. Title Project Manager
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-418-3728
Telephone No.*
6. Permittee Mailing Street Address
Address* 135 East Martin Street, Suite 101
Address Line 2
City State / Province / Region
Raleigh NC
Postal / Zip Code Country
27601 us
Check box if the V Yes
street address the
same as mailing
address
7. Permittee Street Street Address
Address* 135 East Martin Street, Suite 101
Address Line 2
City
State / Province / Region
Raleigh
NC
Pastal / Zip Code
Country
27601
us

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Government - County
Ownership*
2. Primary Site Bobby
Contact - First
Name *
3. Primary Site Clark
Contact - Last
Name *
4. Title Project Superintendent
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 252-469-1218
Telephone No.*
7. Organization Bordeaux Construction Company
Name
8. Site Contact Street Address
Mailing Address* 135 East Martin Street, Suite 101
Address Line 2
City
Raleigh
Rbstal / Zip Code
27601
9. Consultant Name (optional)
First and Last nave
10. Consultant E- This person will be copied on all correspondence.
mail
11. Consultant
Telephone No.
State / Rovince / Region
North Carolina
Country
United States

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 04/12/2018
Approved *
2. E&SC Plan Project Rando-2018-025
Number/ID* Assigned by agency or local program
3. E&SC Plan f• State DEQ Office
Approved by r Local Program
4. State DEQ Office * Raleigh (RRO)
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 Jail NPDES Permit Approval Letter.pdf 602.46KB
Approval Mist be FDFfornat
letter/documentation
6. NOI Certification Randolph eNO1 Certification Form.pdf 898.81KB
Form Mist be RJFformat
This is an Express f• No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.613 (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.
* 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.
* I7 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
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 * Cliff Merrill
Title Project Manager
Organization Bordeaux Construction Company
Date * 10/16/2019

F. Tracking and COC Info
NOI Tracking No. 17266
NC Reference No. NCG01-2019-2380
Uses 'count number variable (incremrented by SP)
Certificate of NCC192380
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 2380
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.)