NCC210305_NOI Application_20210119

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/14/2021 9:28:42 PM (NCG01 NOI Submission)
Approve by Clark, Paul 1/18/2021 12:12:41 PM (Review- Construction NOI 41142)
• Georgoulias, Bethany reassigned the task to Clark, Paul 1/15/2021 2:24 PM
• The task was assigned to Garcia, Lauren V by round robin distribution 1/14/2021 9:29 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 18, 2021 5:00
PM 1/14/2021 9:29 PM
Submit by Selkane, Aziza 1/19/2021 7:55:49 AM (Payment Verification for NCC210305)
* SSSM Raleigh Durham
• Selkane, Aziza assigned the task to Selkane, Aziza 1/19/2021 7:54 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 1, 2021 5:00 PM
1/18/2021 12:13 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 40719
NOI No.
Prior Reviewer Not Sure or Not Listed
Name
1a. Project Name * 910 Church Street
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) 0746740048
2. County* Wake
3. Highway or Street 910 Church Street
Address* Street name only is acceptable if no address number assigned yet
4. CityorTownship* Morrisville
5. State * NC
6. Zip Code* 27560
7. Latitude* Enter the latitude in decimal degrees
35.8488
8. Longitude * Enter the longitude in decimal degrees (MJSTbe negative)
-78.8417
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
Estirrated Construction Project Start Date
10. Date to End* 01/31/2022
Estinated Construction Project End Date

11. SIC (Primary)* Other (9999)
Standard Industrial aassification for Development
12. Acres to be 2.77
disturbed* (including off -site borrow and waste areas)
13. Total site area 3.05
(acres) *
14. Post- 0.91
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-WAKE-2021-910 Church Street
Tracking ID Assigned automatically
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 Stirrup Iron Creek
Waterbody* Name of waterbody into which stormwater runoff will discharge
15b. Waterbody 27-33-4-2
Index No. * NCWaterbody Index Nurrber
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional Kit Creek
Receiving Waterbody narre
Waterbody
15d. Waterbody 16-41-1-17-2-(0.3)
Index No. NCWaterbody Index Number
15e. Additional Waterbody name
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Nurrber
Index No.
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 * ISSV Realty Holdings of NC, LLC
IF 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 * Vipulkumar
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Patel
IF Corporation, enter F;bgistered Agent Last %rre
3b. Title Managing Member
4. Permitee E-mail [e-mail]
Address*
5. Permittee 919-939-1792
Telephone No.*
6. Permittee Mailing Street Address
Address* 424 Balmoral Street
Address Line 2
Cty
Clayton
Fbstal / Zip Code
27520
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
F Yes
Street Address
910 Church Street
Address Line 2
city
Morrisville
Fbstal / Zip Code
27560
State / Frovince / Fbgion
NC
Country
Johnston
State / Ftovince / Faegion
NC
Country
Wake
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
Vipulkumar
Contact - First
Name *
2. Primary Site
Patel
Contact - Last
Name *
3. Title
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
919-939-1792
Telephone No.
6. Organization
Name
7. Site Contact
Street Address
Mailing Address*
424 Balmoral Street
Address Line 2
Oty
State / Rovince / Region
Clayton
NC
Fbstal / Zip Code
Country
27520
Johnston
8. Consultant Name
(Optional)
First and Last narre
9. Consultant E-mail
This person will be copied on all correspondence.
10. Consultant
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 [phone]
Default is legally responsible person telephone (older NOIs rray not populate)

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 01/07/2021
Approved *
2. E&SC Plan Project SEC-049904-2020
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Wake County
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 Approval- S&EConstructionPlanReviewChecklist-
Approval letter or 272.67KB
1 _7_21 _ac. pdf
Grading Permit
Mist be FDFfon-rat
6. Site Location Map Wst be RDFforrret (lint 201VB)
910 Church St. map.pdf 645.31KB
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 docurrents support
the application. Include additional waterbodies if necessary.
8. NOI Certification NCG01-eNO1-Certification -Form-20201222-DEMLR-
Form 2.04MB
SW-signed.pdf
Mast be FCFfon-rat
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 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
upulkr mom' Z Polel
Type Name* Vipulkumar Patel
ale Managing Member
Organization Legally Pesponsible Entity
ISSV Realty Holdings of NC, LLC.
01 /14/2021

F. Tracking and COC Info
NOI Tracking No. 41142
NC Reference No.
NCG01-2021-0305
Uses 'count_nunber' variable (increrrented by SP)
Certificate of
NCC210305
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 305
Sequential nunber for subnittal 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. NCC210305-2021
Invoice Due Date 2/17/2021
Initial Fee $ 100.00
Invoice Status OPEN