NCC242528_ESC Approval Submitted_20240820

ROY COOPER 2
Governor
:),e_4..
ELIZABETH S.BISER �`,, �°„,,,,,,
Secretary Q""V1O�
WILLIAM E.TOBY VINSON,JR NORTH CAROLINA
Interim Director Environmental Quality
06-14-2024
LETTER OF APPROVAL
McDonald's USA LLC
101 N. Carpentar St
Click or tap here to enter text.
RE: Project Name: McDonald's
Permit Number: HOKE-2024-00154
Acres Approved: 1.3
County: Hoke
City: Raeford
Address: US Hwy 401
River Basin: Cape Fear
Stream Classification: C: Aquatic Life, Secondary Contact Recreation, Fresh water
Submitted By: Lori Britt
Plan Type: New Plan (Express)
Dear McDonald's USA LLC,
This office has reviewed the subject erosion and sedimentation control plan. We hereby issue this
Letter of Approval. Any modifications required for approval are listed in the body of the email that
accompanied this attached letter. The enclosed 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 not explicitly exempt are required to complete
and submit an electronic Notice of Intent (eNOI) form requesting a Certificate of Coverage (COC)
under the NCG010000 Construction General Permit. After the form is reviewed and found to be
complete, you will receive a link with payment instructions for the annual permit fee. After the fee
is processed,you will receive the COC. As the Financially Responsible Party shown on the FRO form
submitted for this project,you MUST obtain the COC prior to commencement of any land disturbing
activity. The eNOI form may be accessed at deq.nc.gov/NCG01.
-.A D E Q North Carolina Department of Environmental Quality I Division of Energy,Mineral and Land Resources
512 North Salisbury Street 1612 Mail Service Center I Raleigh,North Carolina 27699-1612
NORTH CAROLINA
rePamnem m emroom,�i war4
919.707.9200

Letter of Approval
McDonald's USA LLC
06-14-2024
Page 2 of 2
Please direct questions about the eNOI form to the Stormwater Program staff in the Raleigh central
office. If the owner/operator of this project changes in the future, the new responsible party must
obtain a new COC.
Title 15A NCAC 4B .0118(a) and the NCG01 permit require that the following documentation be
kept on file at the job site:
1. The approved E&SC plan as well as any approved deviation.
2. The NCG01 permit and the COC, 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 compliance with the approved plan.
North Carolina's Sedimentation Pollution Control Act is performance-oriented,requiring protection
of existing natural resources and adjoining properties. If, following the commencement of this
project, the erosion and sedimentation control plan is inadequate to meet the requirements of the
Sedimentation Pollution Control Act of 1973 (North Carolina General Statute 113A-51 through 66),
this office may require revisions to the plan and implementation of the revisions to ensure
compliance with the Act.
Acceptance and approval of this plan is conditioned upon your compliance with Federal and State
water quality laws, regulations, and rules. In addition, local city or county ordinances or rules may
also apply to this land-disturbing activity. This approval does not supersede any other permit or
approval.
Please note that this approval is based in part on the accuracy of the information provided in the
Financial Responsibility Form and on the plan, which you provided. You are requested to file an
amended form if there is any change in the information included on the form.
Your cooperation is appreciated.
Sincerely,
Land Quality Section

CERTIFICATE OF PLAN APPROVAL
,;; STATE
Y
%i,. MpY ID.177s `YO1,
/147 1
i J 'S'
110' o;
> h• ;
III,\<St Q�,�,A2n iz 1r� 444
``, '";QUAM VW
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).
McDonald's
US Hwy 401 Club Pond Road Raeford, NC 28376
6/14/2024 HOKE-2024-00154
Date of Plan Approval DEQ Clf,iProject 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: McDonald's
*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: Hoke City or Township: Raeford
Highway/Street: US Hwy 401 Latitude: 35.007000 Longitude:-79.173000
3. Approximate date land-disturbing activity will commence: 7/1/2024
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 1.30
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: Tammy Kahm E-mail Address: [e-mail]
Phone: [phone] Mobile: [phone]
9. Landowner(s)of Record:
Landowner(s) of Record
Name Email Business Phone Mobile Phone
Trina Riddle T 1/2 919-695-6271
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
4200 Morganton Fayetteville NC 28314 4200 Morganton Fayetteville NC 28314
Rd., Ste. 150 Rd., Ste. 150
Name Email Business Phone Mobile Phone
Joseph Riddle III Descendants Trust 1/2 919-685-6271
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
4200 Morganton Fayetteville NC 28314 4200 Morganton Fayetteville NC 28314
Rd., Ste. 150 Rd., Ste. 150

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
McDonald's USA LLC tammy.kahm©us.mcd.com 919-695-6271 9196956271
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
101 N. Carpentar Chicago IL 60607 101 N. Carpentar Chicago IL 60607
St St
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
Tammy Kahm [e-mail] 919-695-6271
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
103 Wyseferry Morrisville NC 27560 103 Wyseferry Morrisville NC 27560
Ct. Ct.
(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
Sambatek, LLC [e-mail] 919-848-6121
Physical Address Mailing Address
Street 1 _ City State Zip Street 1 City State Zip
8312 Creedmoor Raleigh NC 27613 8312 Creedmoor Raleigh NC 27613
Road Road

Additional Details
1. Stream Classification: C: Aquatic Life, Secondary Contact Recreation, Fresh water
2. Was Express Review Requested: Yes
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.