NCC205900_NOI Application_20210106

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/21/2020 1:38:49 PM (NCG01 NOI Submission)
Approve by Meloy, Michael 12/21/2020 2:42:29 PM (Review- Construction NOI 39576)
• The task was assigned to Meloy, Michael by round robin distribution 12/21/2020 1:40 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 23, 2020 5:00
PM 12/21/2020 1:40 PM
Submit by McCoy, Suzanne 1/6/2021 9:22:08 AM (Payment Verification for NCC205900)
* Moyock Development Group
• McCoy, Suzanne assigned the task to McCoy, Suzanne 1/6/2021 9:21 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 1, 2021 5:00 PM
12/21/2020 2:43 PM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was r Yes
rejected before?
Previous Rejected 39295
NOI No.
Prior Reviewer Lauren Garcia
Name
1a. Project Name * Tractor Supply - Moyock, NC
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
1 c. Parcel ID
List all Rim associated w ith this project.
Number(s) (PIN)
Parcel ID Number
0009000079A0000
Global PIN
8022-59-3321
2. County*
Currituck
3. Highway or Street 166 Caratoke Highway
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* Moyock
5. State * NC
6. Zip Code* 27958
7. Latitude* Enter the latitude in decimal degrees
36.5461
8. Longitude * Enter the longitude in decirral degrees (MJSTbe negative)
-76.1898
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* 02/01/2021
Estimated Construction Project Start Rate

10. Date to End * 09/30/2021
Estinated Construction Project End Cate
11. SIC (Primary)* Commercial (1542)
Standard Industrial aassification for Developrnent
12. Acres to be 3.60
disturbed* (including off -site borrow and waste areas)
13. Total site area 6.80
(acres) *
14. Post- 2.34
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-CURRI-2021-Tractor Supply - Moyock, NC
Tracking ID Assignedautorraticaly
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 Northwest River
Wate rbody* %rre of waterbody into which stornwater runoff will discharge
15b. Waterbody 3-1-2-2
Index No.* NCWaterbody Index Number
Stormwater rJ 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. ^
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 * Moyock Development Group, LLC
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * William
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Ronalter
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Member
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-695-3694
Telephone No.*
6. Permittee Mailing Street Address
Address* 155 West New York Avenue
Address Line 2
Suite 200
Cty
Southern Pines
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
Fbstal / Zip Code
28387-5446
F Yes
Street Address
155 West New York Avenue
Address Line 2
Suite 200
city
Southern Pines
Fbstal / Zip Code
28387-5446
State / Ffovince / Fbgion
NC
Country
us
State / Frovince / Region
NC
Country
us
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
Gavin
Contact - First
Name *
2. Primary Site
Melia
Contact - Last
Name *
3. Title
Member
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
910-724-6720
Telephone No.*
6. Organization
Moyock Development Group, LLC
Name
7. Site Contact
Street Address
Mailing Address*
155 West New York Avenue
Address Line 2
Suite 200
Oty
State / Rovince / Region
Southern Pines
NC
Fbstal / Zip Code
Country
28387-5446
us
8. Consultant Name
(Optional)
Cathleen M. Saunders
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
252-202-7112
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person a-rrail (older NOIs may not populate)
12. Billing
(For Annual Fee correspondence)
Telephone
910-695-3694
Default is legally responsible person telephone (older NOIs ray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 10/01/2020
Approved *
2. E&SC Plan Project CURRI-2021-006
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. 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 Curri-2021-006 Tractor Supply Co. - Moyock, NC -
Approval letter or 783.27KB
10012020.pdf
Grading Permit
Mist be RDFfon-rat
6. Site Location Map Mist be RDFforrret (lint 201VB)
5-P20034-topo.pdf 372.74KB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Provide any additional information that night help the reviewer better understand how uploaded docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification NCG01-w WCRsig 12.15.20.pdf 433.49KB
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:* IT The Legally Responsible Person named on this Notice of Intent
f 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* William C Ronalter
Title Member -Manager
Organization Legally Plesponsible Entity
Moyock Development Group, LLC
Date * 12/21 /2020

F. Tracking and COC Info
NOI Tracking No. 39576
NC Reference No.
NCG01-2020-5900
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205900
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5900
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. NCC205900-2020
Invoice Due Date 1/20/2021
Initial Fee $ 100.00
Invoice Status OPEN