NCC193046_Modification Review_20200409

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/8/2020 7:42:19 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 4/9/2020 7:46:27 AM (Construction COC ADD TO FILE Review- NCC193046)
• The task was assigned to Georgoulias, Bethany. The due date is: April 13, 2020 5:00 PM
4/8/2020 7:42 PM

Y. ,
NORTH CAPCLINA
Emlremmentel Quality
Certificate of NCC193046
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
Elmwood
Address
Howard Circle, Charlotte, NC
County
Mecklenburg
Latitude
35.2686
Longitude
-80.9368
Permittee Listed
D.R. Horton, Inc
Legally Responsible
Bart Carroll
Individual
NC Reference No.
NCG01-2019-3046
E&SC Plan ID
LDGP-2018-00251
Original NOI
19114
Tracking No.*
Date COC Issued*
12/06/2019
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This field will populate only ff OOChas already been rescinded.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 ivbre information if necessary
Explanation Purchase of lots 1-16, 31-33, 53-54, 56, 60-69 and basin conversion.
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 E&SCApproval, (lose -Out Doc, etc.)
Documentation Letter of Approval modified April 2019 - Elmwood
Lots 1-16 31-33 53-54 56 60-69 basin 27.23KB
conversion.pdf
Mast be FDFforrrat
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 * 04/08/2020
Email Address* [e-mail]
Email for Confirrration
Telephone Number* 704-620-7373
Contact Narrber if we need to reach you
Review Date 04/09/2020
Request Date 20200408
Formatted
Review Date 20200409
Formatted