NCC205559_NOI Application_20201203

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/30/2020 9:38:53 AM (NCG01 NOI Submission)
Approve by Meloy, Michael 12/2/2020 7:37:43 AM (Review - Construction NOI 37441)
• Garcia, Lauren V reassigned the task to Meloy, Michael 12/1/2020 3:29 PM
• The task was assigned to Garcia, Lauren V by round robin distribution 11/30/2020 9:39 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 2, 2020 5:00
PM 11 /30/2020 9:39 AM
Submit by Selkane, Aziza 12/3/2020 11:49:35 AM (Payment Verification for NCC205559)
* Jennifer Yu
• Selkane, Aziza assigned the task to Selkane, Aziza 12/3/2020 11:49 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 13, 2021 5:00 PM
12/2/2020 7:37 AM

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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 37394
NOI No.
Prior Reviewer Michael Meloy
Name
1a. Project Name * NELSON PARK
1 b. Specific Lot This field rray be used to list specifc lot numbers.
Numbers
2. County* Mecklenburg
3. Highway or Street 7424 NELSON ROAD
Address * Street narre only is acceptable if no address number assigned yet
4. City or Township* CHARLOTTE
5. State * NC
6. Zip Code * 28227
7. Latitude * Enter the latitude in decimal degrees
35.1814
8. Longitude* Enter the longitude in decimal degrees (M. ST be negative)
-80.6575
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* 12/18/2020
Estimated Construction Project Start Date
10. Date to End* 09/24/2021
Estimated Construction Project End Cute
11. SIC (Primary)* Residential, Single Family Houses (SFE) (1521)
Standard Industrial aassification for Developrrent

12. Acres to be 5.00
disturbed* (including off -site borrow and waste areas)
13. Total site area 5.18
(acres) *
14. Post- 2.10
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-MECKL-2020-NELSON PARK
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 IRVINS CREEK
Waterbody* fume of waterbody into which story water runoff will discharge
15b. Waterbody 11-137-9-2
Index No.* NCWaterbody Index Nbrrber
Stormwater V No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project F 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 Legally Pesponsible Entity
Name * SJ PROVIDENCE LLC
It 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 * SHEAH
If Corporation, enter Faegistered Agent First %rre
3. Last Name* ZHU
It Corporation, enter Pbegistered Agent Last %rre
3b. Title MANAGING MEMBER
4. Permitee E-mail [e-mail]
Address*
5. Permittee 704-497-6908
Telephone No.*
6. Permittee Mailing Street Address
Address* 600 White Tail Terrace
Address Line 2
City State / Frovince / Fbgion
Waxhtaw NC
Fbstal / Zip Code Country
28173-7220 US
Check box if the F Yes
street address the
same as mailing
address
7. Permittee Street
Street Address
Address*
600 White Tail Terrace
Address Line 2
City
State / Frovince / Region
Waxhaw
NC
Fbstal / Zip Code
Country
28173-7220
US
8. Type of
Individual
Ownership

C. Site Contact Information
Part C.
Roject Site Contact Inforrration
.......................................................................................................................................................................................................
1. Primary Site
Shawn
Contact - First
Name *
2. Primary Site
Santee
Contact - Last
Name *
3. Title
PROJECT MANAGER
4. Site Contact E-
[e-mail]
mail Address*
5. Site Contact
7044004282
Telephone No.
6. Organization
Santee Land Group
Name
7. Site Contact
Street Address
Mailing Address*
11535 Carmel Commons Blvd, Suite 101
Address Line 2
City
Charlotte
Fbstal / Zip Code
28269
8. Consultant Name
(Optional)
SANTEE LAND GROUP, INC.
First and Last narre
9. Consultant E-mail
[e-mail]
This person will be copied on all correspondence.
10. Consultant
7044004282
Telephone No.
State / Rovince / Region
North Carolina
Country
UNITED STATES

D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 11/14/2019
Approved *
2. E&SC Plan Project 397879
Number/ID * Assigned by agency or local program
3. E&SC Plan f State DEQ Office
Approved by* r Local Program
4. Local Program* Mecklenburg County
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 Erosion control permit dated 11-14-2019.pdf 67.54KB
Approval letter or Mast beRDFformat
Grading Permit
6. Site Location Map Mist be RDFformat (lint 20 NB)
Nelson Park Townhomes Location Map.pdf 1.54MB
Rease do not upload entire set of E&SC plans.
7. Notes (Optional) Rovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional waterbodies for linear projects if necessary.
8. NOI Certification NCG01-eNO1-Certification-Form-20190919-DEMLR-
Form 374.01 KB
SW Owner Signed.pdf
Mast be FDFfon-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 Responsible Person named on this Notice of Intent
f 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* SHEAH ZHU
Title Managing Member
Organization Legally Ibsponsible Entity
SJ Providence, LLC
Date * 11 /30/2020

F. Tracking and COC Info
NOI Tracking No. 37441
NC Reference No.
NCG01-2020-5559
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC205559
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 5559
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2020
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC205559-2020
Invoice Due Date 1/1/2021
Initial Fee $ 100.00
Invoice Status OPEN