NCC242263_ESC Approval Submitted_20240725

Jennifer Edw ads<[e-mail]>
NC DEM LR - FRO FApplication Approval w th M odifications Needed CRM 0170123
1 message
SVC_DoNotReply-DEQ Ft'rm its<DoNotReply-DEQ Fbrm [e-mail]> T ue,Jul 23,2024 at 2:21 PM
To: "BREC, PA"<[e-mail]>, "Teram ore Developm eit, LLC"<jstrickland@teram cre.net>
Cc:"Hairston,Jalen A"<[e-mail]>
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North Carolina Department of Environmental Quality
Division of Energy, Mineral & Land Resources
Land Quality Section
Roy Cooper
G cvernor
Elizabeth S. Biser
Secretary
William Vinson Jr.(Acting)
Director
07-23-2024
Teram ore Developm ent, LLC
214 Klum ec Road
Salisbury, NC 28144
RE: Project Name Dollar G eneral-M ocksville Store#30457
Acres Approved: 1.99
Application ID: PA-006133
Perm i Number: DAVIE-2025-0118
Address: US Hwy 64 W
City: M ccksville
County: Davie
River Basin:Yadkin-Pee Dee
Stream Classification:WS-III:Water Supply III
Plan Type: Revised Plan
Dear Teramore Developm ent, LLC,
This office has reviewed the subject erosion and sedim citation control plan. We find the plan to be acceptable with m odifications and
hereby issue this Letter of Approval with Modifications. The Modifications Required for Approval are listed on the attached page.The
Certificate of Approval must be posted at the job site. This plan approval shall expire three(3)years following the date of approval, if no
land-disturbing activity has been undertaken,as is required by Title 15A NCAC 4B .0129.
As of April 1, 2019, all new construction activities are required to complete and subm it an electronic Notice of Intent (eNO) form requesting
a Certificate
of Coverage(CO C) under the NCG010000 Construction General Perm it.After the form is reviewed and found to be com plete,you will receive

a link with payment instructions for the$120 annual permit fee.After the fee is processed,you will receive the CO C
via email.As the Financially Responsible Party shown on the FRO form submitted for this project,you MUST obtain the CO C prior to
cammeicement of any land disturbing activity.The eNO lform may be accessed atdeq.nc.gov/NCG01. Please
direct questions about the eNO[form to the Storm water
Program staff in the Raleigh central office. If the owner/operator of this project changes in the future,the new responsible partym ust
obtain a new CO C
Title 15A NCAC 4B.0118(a)and the NCG01 perm it require that the following documentation be kept on file at the job site:
1.The approved E&S plan as well as any approved deviation.
2.The NCG01 perm it and the CO C once it is received.
3. Records of inspections made during the previous 12 months.
Also,this letter gives the notice required by G S. 113A-61.1(a)of our right of periodic inspection to ensure corn Fliance with the approved
plan.
North Carolina's Sedim citation Pollution Control Act is perform aice-oriented, requiring protection of existing natural resources and adjoining
properties. If,following the com m eicem ent of this project,the erosion and sedim citation control plan is inadequate to meet the
requirem ants of the Sedim entation Pollution Control Act of 1973(North Carolina G eieral Statute 113A-51 through 66),this office m aj require
revisions to the plan and im fiem entation of the revisions to insure corn Fiiance with the Act.
Acceptance and approval of this plan is conditioned upon your corn fiiance with Federal and State water quality laws, regulations, and rules.
In addition, local city or county ordinances or rules m ay also apply to this land-disturbing activity. This approval does not supersede any
other perm t or approval.
Please note that this approval is based in part on the accuracy of the inform ation provided in the Financial Responsibility/0 wiership Form,
which you provided. You are requested to file an am ended form if there is any change in the inform ation included on the form. This perm it
allows for a land-disturbance,as called for on the application and plan, not to exceed the approved acres. Exceeding the acreage can be a
violation of this perm it and may require a revised plan and additional application fee.In addition, it would be helpful if you notify this office of
the proposed starting date for this project.
M odifications Required for Approval:
1. Please print this em al as your Letter of Approval for your NCG010000 Certificate of Coverage application.
2.Please notify this office prior to your pre-construction conference for this project by calling [phone] and asking to
speak with the Land Q uality inspector for your county. Perm ission m ust be obtained and granted from NC DEQ DEMLR prior to
the rem oval of any ESC m easures.All additional perm its should be obtained, as necessary, prior to beginning construction. [GS
113A-51, 15A NCAC 4B .0120]
3.Any off-site borrow and waste required for this project must com efrom a site with an approved erosion control plan, a site
regulated under the Mining Act of 1971, or a landfill regulated by the Division of Solid Waste Management. Trash/debris from
dem dition activities or generated by any activities on site m ust be disposed of at a facility regulated by the Division of Solid
Waste Management or per Division of Solid Waste Management or Division of Water Resources rules and regulations. [15A
NCAC 4B .0110]
4.Additional measures m ay be required -The applicant is responsible for the control of sediment on-site. If the approved
erosion and sedim entation control measures prove insufficient,the applicant m ust take those additional steps necessary to stop
sedim ant from leaving this site. [15A NCAC 4B .0115]
5.The NCG01 has a $120 yearly fee and our office often receives closure inspection requests days prior to yearly NCGO1 fee
payment due dates. Be advised the project requires a closure inspection report by DEM LR prior to filing the Notice of
Term ination (NOT)to terminate NCG01 coverage. The closure inspection should not be requested until after the site has
achieved full vegetative stabilization and measures have been rem wed. The rem oval of temporary ESC measures, including
basins, requires prior approval.0 ten, a full growing season is necessary between initial seeding/m ulching and removal of
m easures. Please plan your construction accordingly to avoid contacting our office prematurely for a closure inspection. Also
be advised you may be asked for representative site pictures prior to a closure inspection. [General Corn melt]
6. Please revise sediment basin outlet. PVC pipe at that length is prone to clogging and malfunctioning. Recom m end having a
longer rip rap/dissipation pad.
Your cooperation is appreciated.

Sincerely,
Jack Lawry-Popelka, EIT
336-776-9659
North Carolina Departm ant of Environm aital Q uality
Division of Energy, M heral&Land Resources
Land Q uality Section
Enclosures: Certificate of Approval
M odifications Required for Approval
D_E Q 1 North Carolina Departm cent of Environm ental Q way I Division of Energy,Mineral and Land Resources
) Winston-Salem Regional 0 fice 1450 West Hanes M it Road,Suite 300 I Winston-Salem NC,27105
-.._- :.\ `' 336-776-9800
Em al correspondence to and from this address may be subject to the North Carolina Public Records Law and m ay be disclosed to third parties by an authorized state official.
2 attachments
DAVIE-2025-0118_Dollar G eieral-M ocksville Store#30457.pdf
120K
Application Report-Tuesday,July 23,2024 214 PM pdf
1-1 93K

CERTIFICATE OF PLAN APPROVAL
STATE
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The posting of this certificate certifies that an erosion and sedimentation control plan has been
approved for this project by the North Carolina Department of Environmental Quality in
accordance with North Carolina General Statute 113A — 57 (4) and 113A — 54 (d) (4) and North
Carolina Administrative Code, Title 15A, Chapter 4B.0107 (c). This certificate must be posted
at the primary entrance of the job site before construction begins and until establishment of
permanent groundcover as required by North Carolina Administrative Code, Title 15A,
Chapter 4B.0127 (b).
Dollar General - Mocksville Store #30457
US Hwy 64 W Mocksville, NC 27028
7/23/2024 DAVIE-2025-0118
Date of Plan Approval DEQ Project Identifier
Certificate of Coverage Number: _ __

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act, including any
activity under a common plan of development of this size as covered by the NCGO1 permit, before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name: Dollar General - Mocksville Store#30457
*If this project involves American Rescue Plan Act(ARPA)funds, list the Project Name below under which
you applied for funding through the Division of Water Infrastructure (DWI).
Is Project ARPA Funded ARPA Project Name ARPA Project#
No
2. Location of land-disturbing activity: County: Davie City or Township: Mocksville
Highway/Street: US Hwy 64 W Latitude: 35.904400 Longitude:-80.690000
3. Approximate date land-disturbing activity will commence: 5/6/2024
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 1.99
6. The application fee of $100.00 per acre (rounded up to the next acre) is assessed without a ceiling
amount (Example: 8.10-acre application fee is $900).
7. Has an erosion and sediment control plan been filed? Yes-Will be Mailed or Hand-Delivered
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name: Joe Strickland E-mail Address:[e-mail]
Phone: [phone] Mobile:
9. Landowner(s)of Record:
Landowner(s) of Record
Name Email Business Phone Mobile Phone
Teramore Development, LLC [e-mail] 2295164289
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
165 Big Star Dr Thomasville GA 31757 PO Box 6460 Thomasville GA 31757

Part B.
1. Company(ies) who are financially responsible for the land-disturbing activity (Provide a comprehensive list of all
responsible parties on accompanied page.)If the company is a sole proprietorship or if the landowner(s)is an individual(s), the
name(s) of the owner(s)may be listed as the financially responsible party(ies).
Primary Financially Responsible Party
Company Name Email Business Phone Mobile Phone
Teramore Development, LLC [e-mail] 7042247364
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
214 Klumac Road Salisbury NC 28144 214 Klumac Road Salisbury NC 28144
Additional Financially Responsible Parties
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form the
landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation control
plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Registered Agent Information
Name Email Business Phone Mobile Phone
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina agent who is registered on the NC Secretary of State business registry:
North Carolina Agent Information
Name Email Business Phone Mobile Phone
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
Engineering/Consulting Firm Information
Name Email Business Phone Mobile Phone
BREC, PA [e-mail] 3368444088
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
1520 Meadowview Wilkesboro NC 28697 1520 Meadowview Wilkesboro NC 28697
Drive Drive

Additional Details
1. Stream Classification: WS-III: Water Supply Ill
2. Was Express Review Requested: No
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
or his attorney-in-fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.