NCC214668_NOI Application_20210817

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/16/2021 9:54:51 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 8/16/2021 10:41:49 AM (Review- Construction NOI 62195)
. The task was assigned to Broussard, Brooklyn C by round robin distribution 8/16/2021 9:56 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 18, 2021 5:00
PM 8/16/2021 9:56 AM
Submit by Selkane, Aziza 8/17/2021 1:31:21 PM (Payment Verification for NCC214668)
* Magnolia Huntersville Development Co., LLC
• Selkane, Aziza assigned the task to Selkane, Aziza 8/17/2021 1:30 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 27, 2021 5:00
PM 8/16/2021 10:42 AM

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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 62065
NOI No.
Prior Reviewer Brooklyn Broussard
Name
1a. Project Name * NORTH CREEK VILLAGE - COMMERCIAL (Huntersville East)
1 b. Specific Lot This field may be used to list specffc lot numbers.
Numbers
1 c. Parcel ID List all R% associated w ith this project.
Number(s) (PIN) 011-07-318, 011-07-322, 011-07-320, 011-07-319, 011-07-336, 011-07-317, 011-
07-337,011-07-315,011-26-140
2. County* Mecklenburg
3. Highway or Street Sam Furr Road
Address* Street name only is acceptable if no address number assigned yet
4. City or Township* TOWN OF HUNTERSVILLE
5. State * NC
6. Zip Code * 28078
7. Latitude* Enter the latitude in decimal degrees
35.4512
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-80.8023
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* 08/01/2021
Estimated Construction Project Start Date
10. Date to End* 03/31/2023
Estimated Construction Project End Cate

11. SIC (Primary)* Commercial (1542)
Standard Industrial Classification for Development
12. Acres to be 37.20
disturbed* (including off -site borrow and waste areas)
13. Total site area 59.20
(acres) *
14. Post- 11.30
construction (Estimated)
impervious area
(acres) *
Project Tracking ID NCC-MECKL-2021-NORTH CREEK VILLAGE -COMMERCIAL
(Huntersville East)
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 Ramah Creek
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 13-17-4-4
Index No. * NCWaterbody Index Nurrber
Stormwater V 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. ^
Fbrnittee 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 * Magnolia Huntersville Development Co, 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 * Stephen
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Vinson
It Corporation, enter F;bgistered Agent Last %rre
3b. Title Managing Partner
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-371-6238
Telephone No.*
6. Permittee Mailing Street Address
Address* 9525 Birkdale Crossing Drive
Address Line 2
Suite 200
aty
Huntersville
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
Fbstal / Zip Code
28078-8458
F Yes
Street Address
9525 Birkdale Crossing Drive
Address Line 2
Suite 200
city
Huntersville
Fbstal / Zip Code
28078
State / Ffovince / Fbgion
NC
Country
Mecklenburg
State / Ftovince / 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
Ken
Contact - First
Name *
2. Primary Site
Shufelt
Contact - Last
Name *
3. Title
Construction Manager
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
704-897-1406
Telephone No.*
6. Organization
Magnolia Huntersville Development Co., LLC
Name
7. Site Contact
Street Address
Mailing Address*
9525 Birkdale Crossing Drive
Address Line 2
Suite 200
City
State / Rovince / Region
Huntersville
NC
Postal / Zip Code
Country
28078-8458
us
8. Consultant Name
(Optional)
Michael Theberge
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
9802723400
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
[e-mail]
Default is legally responsible person e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
919-371-6238
Default is legally responsible person telephone

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 08/12/2021
Approved *
2. E&SC Plan Project EPW425427
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Town of Huntersville
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 EC Permit Only Approval Ltr #425427.pdf 102.34KB
Approval letter or Mist beRDFforml
Grading Permit
6. Site Location Map Mist be RDFfornat (lint 201VB)
North Creek Village - Cover Sheet oath Location
955.5KB
Map.pdf
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies if necessary.
8. NOI Certification NCG01 Notice of Intent signed.pdf 558.75KB
Form Mast be FDFfon-rat
This is an Express F 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 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 Amide 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 If the Erosion and Sediment Control Plan approved by the delegated program is
not compliant with Part II (Stormwater Pollution Prevention Plan) of the
NCG010000 General Permit. I will nonetheless ensure that all conditions of Part
II of the permit are met on the project at all times.
* 17 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 Legally Responsible Person named on this Notice of Intent
IT 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* Ken Shufelt
Title Construction Manager
Organization Legally Ibsponsible Entity
Magnolia Huntersville Development Co., LLC
Date * 08/16/2021

F. Tracking and COC Info
NOI Tracking No. 62195
NC Reference No.
NCG01-2021-4668
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC214668
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 4668
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC214668-2021
Invoice Due Date 9/15/2021
Initial Fee $ 100.00
Invoice Status OPEN