NCC192324_NOI Application_20191015

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/11/2019 3:59:32 PM (NCG01 NOI Submission)
Approve by McCoy, Suzanne 10/14/2019 8:36:51 AM (Review- Construction NOI 17109)
• The task was assigned to McCoy, Suzanne by round robin distribution 10/11/2019 4:00 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 15, 2019 5:00
PM 10/11/2019 4:00 PM
Submit by McCoy, Suzanne 10/15/2019 7:45:20 AM (Payment Verification for NCC192324)
* Richard Baker.
• McCoy, Suzanne assigned the task to McCoy, Suzanne 10/15/2019 7:44 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 25, 2019 5:00
PM 10/14/2019 8:37 AM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Hertford Solar
2. County* Hertford
3. Highway or Street Early Station Road
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Ahoskie
5. State * NC
1r-i)iTld7G)MF11i(-_ToIa1010
6. Zip Code* 27910
7. Latitude * Enter the latitude in decirral degrees
36.2720
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-77.0268
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*
11/01/2019
Estimated Construction Project Start Date
10. Date to End*
11 /06/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Other (0000)
Standard Industrial aassification for Development
12. Acres to be
70.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area
70.00
(acres)*
14. Post-
2.61
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-HERTF-2019-Hertford Solar
Tracking ID
Assigned autorratically

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 Ahoskie Creek
Waterbody* Narre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 25-14-1
Index No. * NCWaterbody Index Nunber
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.
Perrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
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 Kruger Energy Hertford, LLC
Name *
2. First Name* Felicia
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Bellows
Y Corporation, enter Registered Agent Last Barre
3b. Title Managing Director, Development
4. Permitee E-mail Felicia. [e-mail]
Address*
5. Permittee [phone]
Telephone No.*
6. Permittee Mailing Street Address
Address* 3285 Chemin Bedford
Address Line 2
City
Montreal
Postal / Zip Code
H3S 1 G5
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
fJ Yes
Street Address
3285 Chemin Bedford
Address Line 2
City
Montreal
Fbstal / Zip Code
H3S 1 G5
State / Province / Region
QC
Country
CA
State / Province / Region
QC
Country
CA

C. Site Contact Information
Part C.
Proiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Felicia
Contact - First
Name *
3. Primary Site Bellows
Contact - Last
Name *
4. Title Managing Director, Development
5. Site Contact E- Felicia. [e-mail]
mail Address*
6. Site Contact [phone]
Telephone No.*
7. Organization
Kruger Energy Hertford, LLC
Name
8. Site Contact
Street Address
Mailing Address*
3285 Chemin Bedford
Address Line 2
city
Montreal
Fbstal / Zip Code
H3S 1 G5
9. Consultant Name (optional)
Timmons Group - Sol Moore
First and Last narre
10. Consultant E- [e-mail]
mail This person will be copied on all correspondence.
11. Consultant [phone]
Telephone No.
State / Province / Region
QC
Country
CA

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 10/11/2019
Approved *
2. E&SC Plan Project Flertf-2020-004
Number/ID* Assigned by agency or local program
3. E&SC Plan f• 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.
5. E&SC Plan 2019-10-10 NCDEQ Erosion Control Letter of
Approval 795.24KB
Approval.pdf
letter/documentation
Mist be RDF format
6. NOI Certification NCG01 Certification Form_Signed.pdf 719.08KB
Form Mist be RDFfornet
This is an Express f• No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.613 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
rJ 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.
* I7 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
r 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
Type Name *
Felicia Bellows
Title
Managing Director, Development
Organization
Kruger Energy Hertford, LLC
Date *
10/11 /2019

F. Tracking and COC Info
NOI Tracking No. 17109
NC Reference No. NCG01-2019-2324
Uses 'count number variable (incremrented by SP)
Certificate of NCC192324
Coverage (COC) Uses'count_nunber'variable (incremrented by SF)
No. *
Count Number 2324
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)