NCC190582_Modification Review_20200106

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/2/2020 11:51:51 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 1/6/2020 9:26:37 AM (Construction COC ADD TO FILE Review- NCC190582)
p Applicant inadvertently omitted approval letter from E&SC Program for Lot 10 but provided it by email
on 11612020. It will be included with the modification records for this permit.
• The task was assigned to Georgoulias, Bethany. The due date is: January 7, 2020 5:00 PM
1 /2/2020 11:51 AM

Y. ,
NORTH CAPCLINA
Emlremmentel Quality
Certificate of NCC190582
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
Seaforth Landing - Cotton Custom Homes
Address
203 Seaforth Landing Drive, Pittsboro, NC
County
Chatham
Latitude
35.7137
Longitude
-79.0666
Permittee Listed
cotton custom homes
Legally Responsible
Bill Cotton
Individual
NC Reference No.
NCG01-2019-0582
E&SC Plan ID
2019-04816
Original NOI
11959
Tracking No.*
Date COC Issued*
06/11/2019
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This field will populate only ff ODChas already been rescinded.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 information if necessary
Explanation lot 10 Seaforth Landing is being added - see attached
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 Land Disturbing Permit.pdf 183.34KB
Mast be FDFfon-rat
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 Article; or who knowingly makes 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 may include a fine not to 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*
Anita Becker
Title *
Office Manager
Organization *
COTTON CUSTOM HOMES
Date *
01 /02/2020
Email Address*
[e-mail]
Email for Confirrration
Telephone Number*
9193678615
Contact Nbrrber if we need to reach you
Date Formatted
20200102