NCC203671_NOI Application_20200828

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/23/2020 11:50:01 AM (NCG01 NOI Submission)
Approve by Clark, Paul 8/24/2020 1:52:05 PM (Review- Construction NOI 30271)
• The task was assigned to Clark, Paul by round robin distribution 8/23/2020 11:51 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 26, 2020 5:00
PM 8/23/2020 11:51 AM
Submit by Selkane, Aziza 8/28/2020 12:54:30 PM (Payment Verification for NCC203671)
* Kimberly R Smith
• Selkane, Aziza assigned the task to Selkane, Aziza 8/28/2020 12:53 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 5, 2020 5:00 PM
8/24/2020 1:52 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 * Magellan Selma Tank Expansion; Project ID: JOHNS-2020-026
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
2. County* Johnston
3. Highway or Street 4414 Buffalo Road
Address* Street narre only is acceptable if no address number assigned yet
4.CityorTownship* Selma
5. State * NC
6. Zip Code * 27576
7. Latitude* Enter the latitude in decimal degrees
35.5555
8. Longitude* Enter the longitude in decimal degrees (KUST be negative)
-78.2967
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*
01/01/2021
Estimated Construction Project Start Date
10. Date to End *
06/30/2022
Estinated Construction Project End Date
11. SIC (Primary) *
Other (9999)
Standard Industrial Cassification for Leveloprrent
12. Acres to be
5.25
disturbed*
(including off -site borrow and waste areas)
13. Total site area 27.00
(acres) *

14. Post- 0.93
construction (Estirrated)
impervious area
(acres) *
NCC Project NCC-JOHNS-2021-Magellan Selma Tank Expansion; Project ID:
Tracking ID JOHNS-2020-026
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 Unnamed tributary (UT) to Mill Creek Stream
Waterbody* Segment 27-40
%rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 27-40
Index No.* NCWaterbody Index Nunber
Stormwater r No
discharges will flow pr Yes
to additional
wate rs *
15c. Additional Neuse River
Receiving Waterbody name
Waterbody
15d. Waterbody 27-(39.7)
Index No. NCWaterbody Index Nurrber
15e. Additional Waterbody narre
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Nunber
Index No.
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. ^
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 Legally Pesponsible Entity
Name * Magellan Terminals Holdings, L.P.
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name * Kyle
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Krshka
It Corporation, enter F;bgistered Agent Last %ne
3b. Title Director of Operations
4. Permitee E-mail [e-mail]
Address*
5. Permittee 918-574-7560
Telephone No.*
6. Permittee Mailing Street Address
Address* One Williams Center OTC-8
Address Line 2
City State / Rovince / F;bgion
Tulsa OK
Fbstal / Zip Code Country
74172 USA
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
4414 Buffalo Rd
Address Line 2
City
State / Ftovince / Region
Selma
NC
Fbstal / Zip Code
Country
27576
US
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
.........................................................................................................................................................................................................
1. Primary Site
Jimmie
Contact - First
Name *
2. Primary Site
Williamson
Contact - Last
Name *
3. Title
Operator III
4. Site Contact E-
jmmie.\[e-mail]
mail Address*
5. Site Contact
919-965-5217
Telephone No.
6. Organization
Magellan Terminals Holdings, L.P. Selma
Name
7. Site Contact
Street Address
Mailing Address*
4414 Buffalo Road
Address Line 2
city
Selma
Fbstal / Zip Code
27576-5601
8. Consultant Name
(Optional)
First and Last nacre
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 08/18/2020
Approved *
2. E&SC Plan Project JOHNS-2020-026
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 * Raleigh (RRO)
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 20200818 Selma ESC Permit Approval.pdf 326.74KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Helpful for linear project review
(Optional) Mast be FCFfornat. 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 Signed NOI Form.pdf 264.68KB
Form Mist be RDFfornat
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 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
r� �v�,6 -�-'
Type Name * Kyle T Krshka
Title Director, Operations
Organization Legally Plesponsible Entity
Magellan Terminal Holdings, L.P.
Date * 08/23/2020

F. Tracking and COC Info
NOI Tracking No. 30271
NC Reference No. NCG01-2020-3671
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of NCC203671
Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 3671
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC203671-2020
Invoice Due Date 9/23/2020
Initial Fee $ 100.00
Invoice Status OPEN