NCC190676_Modification Review (Lot 30)_20210128

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/28/2021 10:28:51 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 1/28/2021 2:48:13 PM (Construction COC ADD TO FILE Review- NCC190676)
• The task was assigned to Georgoulias, Bethany. The due date is: February 2, 2021 5:00 PM
1/28/2021 10:29 AM

Y . Ta4M1
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC190676
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit:
Project Name Lot#39 Sunset Grove
Address 197 Boxwood Drive, Pittsboro, NC
County
Latitude
Chatham
35.7573
Longitude-79.0773
Permittee Listed Halcyon Homes, LLC
Legally Responsible Austin Robertson
Individual
NC Reference No. NCG01-2019-0676
E&SC Plan ID 2019-04835
Original NOI 12524
Tracking No.*
Date COC Issued* 06/20/2019
Prior Rescission This field will populate only if COChas already been rescinded.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 and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional Nbre infornation if needed (e.g., new Site Contact details can be included here)
Explanation We are wanting to clear Lot#30 Sunset Grove under the initial active permit shown
on Lot#39 Sunset Grove. I have attached the approval letter from Chatham County
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 (Fevised E&SCApproval, nose -Out Doc, etc.)
Documentation Letter of Approval_Sunset Grove Lot 30 -- Storm
287.58KB
water. pdf
Mast be FDFfornat
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 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
Type Name* Austin Robertson
Title * Operations Manager
Organization* Halcyon Homes, LLC
Date * 01 /28/2021
Email Address* [e-mail]
Errail for confirrration
Telephone Number* 9193375245
Contact number if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email Additional en -ail for confirnation
(Optional)
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 01/28/2021
Rescinded Since
Submitted?

Request Date 20210128
Formatted
Review Date 20210128
Formatted