NCC202754_Modification Review_20210317

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/16/2021 12:01:08 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 3/17/2021 8:08:39 AM (Construction COC ADD TO FILE Review- NCC202754)
• The task was assigned to Georgoulias, Bethany. The due date is: March 19, 2021 5:00 PM
3/16/2021 12:01 PM

Y. ,
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC202754
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name
Thatcher Woods - DR Horton Lots
Address
7776 Alcorn Road, Greensboro, NC
County
Guilford
Latitude
36.1540
Longitude
-79.9657
Permittee Listed
DR Horton, Inc.
Legally Responsible
Jessica Meyer
Individual
NC Reference No.
NCG01-2020-2754
E&SC Plan ID
20-05-GCRP-03471
Original NOI
27585
Tracking No.*
Date COC Issued*
06/30/2020
Prior Rescission
This field will populate only if CCChas already been rescinded.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 Ivbre information (e.g., new site Contact details). If lots are being added, please include specific lot nunbers.
Explanation Added three lots to the permit. 2.3 acres additional
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 IRSCApproval, (lose -Out Doc, etc.)
Documentation Thatcher Woods 48 49 50 50A 51 55A 56 61 62 67-
134.02KB
73.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
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
Type Name* Jessica Meyer
Title * NPDES Technical Compliance Administrator
Organization* DR Horton, Inc.
Date * 03/16/2021
Email Address* [e-mail]
En -ail for confin-ration
Telephone Number* 9192156561
Contact nunber if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional en -ail for confin-ation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 03/17/2021
Rescinded Since
Submitted?

Request Date 20210316
Formatted
Review Date 20210317
Formatted