NCC190030_Modification Review ADDL LOTS_20200128

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/28/2020 5:45:21 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 1/30/2020 11:18:41 AM (Construction COC ADD TO FILE Review- NCC190030)
* Reviewer requested copy of the approval letter from Durham County, and it was provided via email on
113012020.
• The task was assigned to Georgoulias, Bethany. The due date is: January 31, 2020 5:00 PM
1/28/2020 5:45 PM

Y. ,
NORTH CAPCLINA
Emlremmentel Quality
Certificate of NCC190030
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
Croasdaile Farm North SD
Address
Meadowcreek, Arbonn/ood & Lauralwood Drives, Durham, NC
County
Durham
Latitude
36.0557
Longitude
-78.9403
Permittee Listed
Homes by Dickerson, Inc.
Legally Responsible
Brant Chesson
Individual
NC Reference No.
NCG01-2019-0030
E&SC Plan ID
5224-02
Original NOI
10021
Tracking No.*
Date COC Issued*
04/11/2019
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This field will populate only ff ODChas already been rescinded.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 i/bre infornation if necessary
Explanation Adding lots 371-377, 385-387, 412, townhomes 13-16
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).

Upload Supporting Documentation (%vised EBSC Approval, (lose -Out Doc, etc.)
Supporting
Documentation
Land Disturbing Permit.pdf
Mast be FDFfon-rat
North Carolina General Statute 143-215.66 (1) provides that:
4.38MB
Anyperson who knowinglymakes any false 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 knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis 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).
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
['�oie�a�r�ar �,�acmravli2rt
Type Name* Jonathan M Showalter
Title * VP/ COO
Organization* Homes by Dickerson
Date * 01 /28/2020
Email Address* [e-mail]
email for Confirmation
Telephone Number* 9198474447
Contact Nurrber if we need to reach you
Date Formatted 20200128