NCC201094_NOI Application_20200330

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/18/2020 11:23:58 AM (NCG01 NOI Submission)
Approve by Garcia, Lauren V 3/19/2020 8:28:13 AM (Review- Construction NOI 23224)
• The task was assigned to Garcia, Lauren V by round robin distribution 3/18/2020 11:24 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 20, 2020 5:00
PM 3/18/2020 11:24 AM
Submit by Garcia, Lauren V 3/30/2020 10:43:54 AM (Payment Verification for NCC201094)
* Shirdi Sai Temple of Charlotte
• Garcia, Lauren V assigned the task to Garcia, Lauren V 3/30/2020 10:42 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 30, 2020 5:00 PM
3/19/2020 8:28 AM

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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
la. Project Name * Shirdi Sai Temple
1 b. Specific Lot This field rray be used to list specffc lot numbers.
Numbers 08282019D
2. County* Union
3. Highway or Street 2006 State Hwy 218
Address* Street name only is acceptable if no address nunber assigned yet
4. City or Township* Indian Trail
5. State * NC
6. Zip Code* 28079
7. Latitude* Enter the latitude in decinal degrees
35.1629
8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative)
-80.5737
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*
04/01/2020
Estinated Construction Project Start Date
10. Date to End *
09/30/2020
Estinated Construction Project End Date
11. SIC (Primary) *
Other (0000)
Standard Industrial Classification for Development
12. Acres to be
3.32
disturbed*
(including off -site borrow and waste areas)
13. Total site area 35.11
(acres)*
14. Post- 0.82
construction (Estirrated)
impervious area
(acres) *

NCC Project NCC-UNION-2020-Shirdi Sai Temple
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 Duck Creek
Wate rbody* Nave of waterbody into which storrrwater runoff will discharge
15b. Waterbody 13-17-18-3
Index No. * NCWaterbody Index Narrber
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. ^
F2rnittee 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 Shirdi Sai Temple
Name * If perrrittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
2. First Name* Veera
If Corporation, enter ilegistered Agent First Barre
3. Last Name* Thota
If Corporation, enter Faegistered Agent Last Wre
3b. Title Director
4. Permitee E-mail [e-mail]
Address *
5. Permittee 314-757-2295
Telephone No.*
6. Permittee Mailing Street Address
Address* 7013 South Creek Road
Address Line 2
city State / Ftovince / Faegion
Charlotte NC
Fostal / Zip Code Country
28277-4321 us
Check box if the rJ Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
7013 South Creek Road
Address Line 2
City
State / Ffovince / Fbgion
Charlotte
NC
Fbstal / Zip Code
Country
28277-4321
us
8. Type of
Non -Government
Ownership*

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Sonia
Contact - First
Name *
2. Primary Site
Bhave
Contact - Last
Name *
3. Title
Superindendent
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
7043097353
Telephone No.
6. Organization
SRB Designbuild
Name
7. Site Contact
Street Address
Mailing Address*
10550 Independence Pointe Pkwy
Address Line 2
Suite 300
city
Matthews
Fbstal / Zip Code
28105
8. Consultant Name
(Optional)
Jason Banks
First and Last nacre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
7047491432
Telephone No.
State / Rovince / Region
NC
Country
us

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
............................................................................................................................................................................................................................................................................................................................__
1. Date E&SC Plan 03/02/2020
Approved *
2. E&SC Plan Project union-2018-086
Number/ID * Assigned by agency or local program
3. E&SC Plan r State DEQ Office
Approved by* r Local Program
4. State DEQ Office * Mooresville (MRO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. For linear projects, please also upload a site map showing the overall extent of the project or
include the beginning point and end point coordinates in the "Notes" box below.
5. E&SC Plan
Approval letter or
Grading Permit
Site Map (Optional)
20200310121906. pdf
Mast be FDFfornat
Helpful for linear project review
Mast be FDFform3t
339.17KB
Notes (Optional) Ffovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional waterbodies for linear projects if necessary.
We received three approval letters in quick succession. They are
all attached. I spoke with the reviewer and he noted the difference
were the result of internal policies on addressing changes in areas
in revisions to approved plans. Our original plan had 7.7 denuded
acres, our current plan has 3.32 denuded acres.
6. NOI Certification noi-signed.pdf 8.46MB
Form Mast be FDFformat
This is an Express F No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.6E (i) 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 Atide 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 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 * Veera Thota
Title Director
Organization Shirdi Sai Temple
Date * 03/18/2020

F. Tracking and COC Info
NOI Tracking No. 23224
NC Reference No. NCG01-2020-1094
Uses 'count number' variable (incremrented by SP)
Certificate of NCC201094
Coverage (COC) Uses 'count number' variable (incremented by SP)
No.*
Count Number 1094
Sequential number for submittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)