NCC190101_Modification Review_20201201

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/1/2020 2:20:21 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 12/1/2020 2:28:28 PM (Construction COC ADD TO FILE Review- NCC190101)
• The task was assigned to Georgoulias, Bethany. The due date is: December 4, 2020 5:00 PM
12/1/2020 2:20 PM

Y . Ta4M1
NORTH CAPOLINA
EnYlrenmemf& Qnalay
Certificate of NCC190101
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
River East
Address
Norris Landing Rd., Pelitier, NC
County
Carteret
Latitude
34.4300
Longitude
-77.0440
Permittee Listed
D.R. Horton, Inc.
Legally Responsible
Elizabeth Shelton
Individual
NC Reference No.
NCG01-2019-0101
E&SC Plan ID
CARTE-2019-028
Original NOI
10384
Tracking No.*
Date COC Issued*
04/24/2019
Prior Rescission
This field will populate only if COChas already been rescinded.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 Legally Responsible Individual Has Changed
f Multiple Reasons (List)
Addional IVbre information if necessary
Explanation
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). For changes to the legally responsible individual, you must upload this form.

Supporting Upload Supporting Documentation (%vised I&SC Approval, (lose -Cut Doc, etc.)
Documentation River East CARTE-2019-028 Approval Revised 10-
294.66KB
20-2020.pdf
Wst be FDFfornat
North Carolina General Statute 143-215.6113 (i) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Artide 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 Artide 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).
� I 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.
Specify if you are:* r The Legally Responsible Individual
r Authorized Responsible Person*
*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* Donald Aiken
Title * Assistant Secretary
Organization* D.R. Horton, Inc.
Date * 12/01 /2020
Email Address* [e-mail]
En -ail for confin-ration
Telephone Number* 910-508-0017
Contact nunber if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email Additional errail for conf irrration
(Optional)
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 12/01/2020
Rescinded Since
Submitted?

Request Date 20201201
Formatted
Review Date 20201201
Formatted