NCC192719_Modification Review_20191219

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/16/2019 10:23:44 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 12/19/2019 9:53:30 AM (Construction COC ADD TO FILE Review- NCC192719)
* Verified through Jess Meyer from Bart Carroll that this modification is for an additional 1.4 acres (the
original approval was also for 1.4 acres).
• The task was assigned to Georgoulias, Bethany. The due date is: December 19, 2019 5:00 PM
12/16/2019 10:23 AM

Y. ,
NORTH CAPCLINA
Emlremmentel Quality
Certificate of NCC192719
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
Lakewalk Lots 84, 112-117
Address
Bluefield Road, Mooresville, NC
County
Iredell
Latitude
35.6150
Longitude
-80.8600
Permittee Listed
D.R. Horton, Inc
Legally Responsible
Bart Carroll
Individual
NC Reference No.
NCG01-2019-2719
E&SC Plan ID
MVLLE-2017-018
Original NOI
18245
Tracking No.*
Date COC Issued*
12/03/2019
Prior Rescission
This field will populate only ff ODChas already been rescinded.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
r Multiple Reasons (List)
Addional ivbre infornation if necessary
Explanation Additional Lot permitting of 83,85-88,109,109
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 (%vised ERSC Approval, (lose -Out Doc, etc.)
Documentation Lakewalk Permit Lots 83,85-88,108,109.pdf 447.76KB
Mast be FDFfon-rat
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes anyfalse 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 underthis Article; orwho 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 notto exceed ten thousand
dollars ($10,000).
17 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
Type Name*
Bart Carroll
Title *
NPDES Manager
Organization*
D.R. Horton, Inc.
Date *
12/16/2019
Email Address*
[e-mail]
Email for Confirrration
Telephone Number*
704-620-7373
Contact Nbrrber if we need to reach you
Date Formatted
20191216