NCC193219_Modification Review_20200428

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/27/2020 11:26:09 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 4/28/2020 9:13:28 AM (Construction COC ADD TO FILE Review- NCC193219)
• The task was assigned to Georgoulias, Bethany. The due date is: April 30, 2020 5:00 PM
4/27/2020 11:26 AM

Y. ,
NORTH CAPCLINA
Emlremmentel Quality
Certificate of
NCC193219
Coverage (COC)
Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated
with this permit:
Project Name
Poplin Grove
Address
1699 W. Unionville -Indian Trail Road, Monroe, NC
County
Union
Latitude
35.0791
Longitude
-80.5749
Permittee Listed
M/I Homes, Inc.
Legally Responsible
Scottie Hopper
Individual
NC Reference No.
NCG01-2019-3219
E&SC Plan ID
18-00201555
Original NOI
19614
Tracking No.*
Date COC Issued*
12/17/2019
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This field will populate only ff OOChas already been rescinded.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 Nbre information if necessary
Explanation 110 additional lots (total of 125 Lots)
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 ESCApproval, (lose -Cut Doc, etc.)
Documentation ESC Approval Letter 04 24 20.pdf 264.03KB
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 knowinglyrenders
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* Scottie Hopper
Title * Construction Area Manager
Organization* M/I Homes, Inc.
Date * 04/27/2020
Email Address* [e-mail]
57ail for Confirmation
Telephone Number* 704-288-4222
Contact Nurrber if we need to reach you
Review Date 04/28/2020
Request Date 20200427
Formatted
Review Date 20200428
Formatted