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HomeMy WebLinkAboutNCC190490_Modification Review_20191028Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 10/25/2019 1:35:05 PM (ADD TO FILE Submittal) Approve by Georgoulias, Bethany 10/28/2019 8:50:37 AM (Construction COC ADD TO FILE Review- NCC190490) The task was assigned to Georgoulias, Bethany. The due date is: October 30, 2019 5:00 PM 10/25/2019 1:35 PM �mw+� NORTH CAROUNA e'vorwMienfal Quanty Certificate of NCC190490 Coverage (COC) Enter the Certificate of Coverage Minter (Use capital letters) No. * Information associated with this permit Project Name Westchester County Day School Address 2045 N. Old Greensboro Road, Hlgh Point, NC County Davidson Latitude 35.9735 Longitude -80.0898 Permittee Listed Westchester County Day School Legally Responsible Cobb Atkinson Individual NC Reference No. NCG01-2019-0490 E&SC Plan ID DAVID-2019-022 Original NOI 11766 Tracking No.* Date COC Issued* 06/05/2019 Prior Rescission This field will populate only if COChas already been rescinded. Date Modification Information: Reason for r Closed -Out Lots/Outparcels in E&SC Plan Modification* f Additional Lots/Outparcels Approved - E&SC Revised r Other Revision(s) to E&SC Plan f Multiple Reasons (List) Ad d io n al Ivbre information if necessary Explanation Revisions including removal of tennis courts, addition of phase lines, demolition and rebuild of the Cats Den building and adjustment of fill slope away from creek. You must upload supporting documentation below. Do not upload E&SC Plans unless specific plan sheets are the only documentation with approval for revised acres of disturbance, etc. (only upload applicable sheets). Supporting Upload Supporting Documentation (Revised E&SCApproval, dose -Out Doc, etc.) Documentation Westchester Grading Permit_2019-10-15.pdf 11.28MB Mist be F13F forrrat North Carolina General Statute 143-215.613 (1) provides that: Any person who knowingly makes any false statement, representation, or certification in anyapplication, record, report, plan, or other documentfiled or required to be maintained underthis 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 device 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). I7 I, as an authorized representative, hereby request modification to coverage under the NPDES Stormwater Permit for the subject project site. I am familiar with the information contained in this request and to the best of my knowledge and belief such information is true, complete and accurate. "This form must be signed by a responsible corporate officer that 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 bu,Omsk Type Name* Cobb Atkinson Title * Headmaster Organization * Westchester County Day School Date * 10/25/2019 Email Address* cobbatkinson@vuestchestercds.com Email for Confirmation Telephone Number* 3368696685 Contact Namber if we need to reach you Date Formatted 20191025