NCC190290_Modification LOT 597 Review_20210308

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/8/2021 9:18:40 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 3/8/2021 2:02:50 PM (Construction COC ADD TO FILE Review- NCC190290)
• The task was assigned to Georgoulias, Bethany. The due date is: March 11, 2021 5:00 PM
3/8/2021 9:18 AM

Y. ,
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of
NCC190290
Coverage (COC)
Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated
with this permit:
Project Name
Chapel Ridge - Triple A Homes
Address
163 Birdie Ct, Pittsboro, NC
County
Chatham
Latitude
35.7894
Longitude
-79.2329
Permittee Listed
Triple A Homes
Legally Responsible
Gerry Felton
Individual
NC Reference No.
NCG01-2019-0290
E&SC Plan ID
2019-03668
Original NOI
11059
Tracking No.*
Date COC Issued*
05/16/2019
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This field will populate only if COChas already been rescinded.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 We information (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation adding another lot to this permit.
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 ERSC Approval, (lose -Cut Doc, etc.)
Documentation CR 597 Soil Erosion Sedimentation Co Approval.pdf 287.61KB
Mast be PDFfon-rat
North Carolina General Statute 143-215.66 (1) 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 Article 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 Article 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).
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
f 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
" fm�k
Type Name* Gerry Felton
Title * VP
Organization * Triple A Homes
Date * 03/08/2021
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 9498120991
Contact nun ber if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email Additional email for confirmation
(Optional)
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 03/08/2021
Rescinded Since
Submitted?

Request Date 20210308
Formatted
Review Date 20210308
Formatted