NCC191556_Modification Review_20200110

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/10/2020 11:14:07 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 1/10/2020 12:50:48 PM (Construction COC ADD TO FILE Review- NCC191556)
The task was assigned to Georgoulias, Bethany. The due date is: January 15, 2020 5:00 PM
1/10/2020 11:14 AM

Y. ,
NORTH CAPCLINA
Emlremmentel Quality
Certificate of NCC191556
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
Cottage Green Subdivision
Address
1801 slippery Rock Lane, City of Monroe, NC
County
Union
Latitude
34.9670
Longitude
-80.5060
Permittee Listed
WR, dba Ryan Homes
Legally Responsible
Jonathan Hess
Individual
NC Reference No.
NCG01-2019-1556
E&SC Plan ID
18-00201981
Original NOI
15194
Tracking No.*
Date COC Issued*
08/26/2019
Prior Rescission
This field will populate only ff OOChas already been rescinded.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 We inforrration if necessary
Explanation Lot # 27 .14ac
Lot # 29 .15ac
Lot # 31 .15ac
Lot # 46 .16ac
Lot # 47 .14ac
Lot # 54 .16ac
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 DDcurnentation (Pevised E&SCApproval, rose -Out Doc, etc.)
Documentation Cottage Green ENOI Lots 46-47-29-54-27-31.pdf 2.69MB
Mist be FDFforrrat
North Carolina General Statute 143-215.6113 (i) 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).
fJ 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*
Jonathan Hess
Title *
Vice President
Organization*
Ryan Homes
Date *
01 /10/2020
Email Address*
[e-mail]
Btail for Oonfirrration
Telephone Number*
704.815.3500
Contact Nunber if we need to reach you
Date Formatted
20200110