NCC201089_NOI Application_20200324

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/17/2020 2:20:39 PM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 3/18/2020 3:40:38 PM (Review- Construction NOI 23178)
• The task was assigned to McCoy, Suzanne by round robin distribution 3/17/2020 2:21 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 19, 2020 5:00 PM.
The priority is: High 3/17/2020 2:21 PM
Submit by McCoy, Suzanne 3/24/2020 7:45:55 AM (Payment Verification for NCC201089)
* Robert A Mooty
• McCoy, Suzanne assigned the task to McCoy, Suzanne 3/24/2020 7:45 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 29, 2020 5:00 PM. The
priority is: High 3/18/2020 3:40 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
la. Project Name * North River Farms
1 b. Specific Lot This field may be used to list specifc lot numbers.
Numbers
2. County* Camden
3. Highway or Street SR 1115
Address* Street name only is acceptable if no address number assigned yet
4. Cityor Township* Shiloh Township
5. State * NC
6. Zip Code* 27921
7. Latitude* Enter the latitude in decimal degrees
36.3051
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-76.0267
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*
03/23/2020
Estimated Construction Project Start Date
10. Date to End *
06/23/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial Classification for Development
12. Acres to be
5.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 328.00
(acres)*

14. Post- 1.00
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-CAMDE-2020-North River Farms
Tracking ID Assigned autorraticaly
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 Crooked Creek
Wate rbody* %rre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 30-2-4
Index No.* NCWaterbody Index Nunber
Stormwater rJ No
discharges will flow r- Yes
to additional
wate rs *
16a. Is this project
subject to the NC
Sediment Pollution
Control Act?*
16b. Is this project
subject to the US
Clean Water Act?
r Yes
r No, not subject to NC SPCA
r Yes
f No, not subject to US CWA
This project will be issued a Certificate of Coverage under NCG250000 rather than NCG010000. The Erosion and
Sediment Control Plan shall be reviewed and approved by the appropriate DEMLR Regional Office, and then this Notice
of Intent form shall be completed and submitted.

B. Permittee Information
Part B. ^
F2rnittee 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 North River Farm LLC
Name * If perrrittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name* Tood
It Corporation, enter Fbgistered Agent First Barre
3. Last Name* Coyle
If Corporation, enter FZegistered Agent Last Wre
3b. Title Owner
4. Permitee E-mail [e-mail]
Address *
5. Permittee 252-455-0534
Telephone No.*
6. Permittee Mailing Street Address
Address* 4601 North Croatan Highway
Address Line 2
Po Box 1094
Qty
State / F rovince / Faegion
Kitty Hawk
NC
F ostal / Zip Code
Country
27949-6084
us
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
4601 North Croatan Highway
Address Line 2
Po Box 1094
C7ty
State / Ffovince / Fbgion
Kitty Hawk
NC
Flostal / Zip Code
Country
27949-6084
us
8. Type of
Individual
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Todd
Contact - First
Name *
2. Primary Site
Coyle
Contact - Last
Name *
3. Title
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
252-455-0534
Telephone No.
6. Organization
North River Farms LLC
Name
7. Site Contact
Street Address
Mailing Address*
4601 North Croatan Highway
Address Line 2
Po Box 1094
city
Kitty Hawk
Postal / Zip Code
27949-6084
8. Consultant Name
(Optional)
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
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 03/05/2020
Approved *
2. E&SC Plan Project CAMDE-2020-004
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 * Washington (WaRO)
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 NRF Approval Letter.pdf
Approval letter or NRF Plan Approval.pdf
Grading Permit
Mist be FDFforrrat
Site Map (Optional) Helpful for linear project review
1.92MB
858.61 KB
NRF Map.pdf 458.73KB
Mist be RDFfornat
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.
6. NOI Certification NRF Notice of Intent.pdf 698.12KB
Form Mist be RDFfornat
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
Type Name * Todd Coyle
Title Owner
Organization North River Farms
Date * 03/17/2020

F. Tracking and COC Info
NOI Tracking No. 23178
NC Reference No. NCG25-2020-1089
Uses 'count number' variable (incremrented by SP)
Certificate of NCC201089
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 1089
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.)