NCC190118_Modification Review CONTACT CHANGES_20201205

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/23/2020 2:00:06 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 12/5/2020 10:25:04 AM (Construction COC ADD TO FILE Review- NCC190118)
• The task was assigned to Georgoulias, Bethany. The due date is: November 26, 2020 5:00 PM
11 /23/2020 2:00 PM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC190118
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit:
Project Name RiverLights Conventional Phase V &VI -clearing and grading
Address 4410 River Road, Wilmington, NC
County New Hanover
Latitude 34.0000
Longitude-78.0000
Permittee Listed NNP IV -Cape Fear River, LLC
Legally Responsible Donald J. Henry
Individual
NC Reference No. NCG01-2019-0118
E&SC Plan ID
Original NOI
Tracking No.
GP8-19, 19-00060
10458
Date COC Issued* 04/29/2019
Prior Rescission This field will populate only if COChas already been rescinded.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 * a Additional Lots/Outparcels Approved - E&SC Revised
O Other Revision(s) to E&SC Plan
r Legally Responsible Individual Has Changed
F Multiple Reasons (List)
Legally Responsible Person & Site contact change
Addional MDre information if necessary
Explanation New site contact is Kenny Johnson, 910-443-2355, [e-mail]
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 Docurrentation (%vised IRSCApproval, (lose -Out Doc, etc.)
Documentation NCG01-Legal ly-Responsible- Ind ividual-Change-
100.03KB
Form-11.23.20.pdf
Mist be FDFformat
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).
� 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* Nick Cassala
Title * Vice President
Organization * NNP IV -Cape Fear River, LLC a Delaware, LLC by Newland Real
Estate Group, LLC, A Delaware, LLC its agent/development
manager
Date * 11 /23/2020
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 9104432355
Contact number if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional email for confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 12/05/2020

Rescinded Since
Submitted?
Request Date 20201123
Formatted
Review Date 20201205
Formatted