NCC204866_Contact Update Request (LEG RESP CHANGE)_20210610

Use this form when:
The person who is legally responsible for the permit has changed, but there is NO CHANGE in the project name
or ownership.
**If the project name has changed, or if the ownership of the project has changed, do NOT use this farm.**
Instead, you must submit a new NCG01 electronic Notice of Intent (eNOI).
Directions:
Print this form, complete, scan and upload to the Construction Stormwater Permit MODIFICATION Form.
Then, mail the original form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6th Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
�.Iff No
.,..
Certificate of Coverage (COC) Number: NCC204866
Name of Project: Elementary School E51 Pond Breach & French Drain
Legally Responsible Organizational Entity: Wake County Board of Education
PREVIOUS Legally Responsible Individual: Don Haydon Jr
NEW Legally Responsible Individual: David Neter
The following section is to be completed and signed by the NEW Legally Responsible Individual.
Per NC General Statute 143-215.68 (i), any person who knowingly makes any false statement, representation,
or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may
include a fine not to exceed ten thousand dollars ($10,000).
Page 1 of 2

Under penalty of law, I certify that (check all boxes to indicate your agreement):
F� |amthe person responsible for the construction activities ofthis pnoJect for satisfying the
requirements of this permit, and for any civil or criminal penalties incurred due to violations of this
permit.
R] | will abide byall conditions ofthe NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
X1 if the approved Erosion and Sediment Control Plan is not compliant with Part 11 (Stormwater Pollution
Prevention Plan) ofthe NCGO10000 General Permit. | will nonetheless ensure that all conditions of
Part Unfthe permit are met onthe project atall times.
�V I understand that coverage under this permit will constitute the permit requirements for the
discharge(s) and is enforceable in the same manner as an individual permit.
W This form has been reviewed and is accurate and complete to the best of my knowledge.
*Signature: 9—� �� Date:
Print Name of Signed, David Neter
Title: Chief Business Officer/Interim Chief of Facilities & Operations
-Street Address: 5625 Dillard Drive, Cary NC 27518
Email Address: [e-mail]
Phone Number:
*IMPORTANT NOTE., This form must be signed byoresponsible corporate officer that owns or operates the
construction activity, such usopresident, secretary, treasurer, orvice president, oromanager that is
authorized /naccordance with Part IV, Section B,Item (6) ofthe NCG01U0D0permit.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCGO10000 permit.
Page 2 of 2

Georgoulias, Bethany
From: Hannah Banks <[e-mail]>
Sent: Thursday, June 10, 2021 2:22 PM
To: Georgoulias, Bethany
Cc: Renee C. Pfeifer; Shelley Foley _ Staff - PlanningConstruction
Subject: [External] Modification Request - Elem. School 51 Pond Breach - NCC204866
Attachments: eN01 modification signed owner info.pdf
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Bethany,
I wanted to follow up on this modification application that was submitted yesterday. Looks like we may have hit send
before uploading our owner form. Attached is a copy of that form and the hard copy will be put in the mail tomorrow,
arriving to your mailing address early next week. Let me know if there are any other questions that may arise as we are
assisting WCPSS in obtaining their modified COC for this site.
Thanks!
Hannah Banks, El
Civil Designer
CLH design, p.a.
Collaborative Landscape Architecture and Civil Engineering
400 Regency Forest Drive, Suite 120
Cary, NC 27518
919.319.6716, ext. 4024
Twitter I Linkedln I Facebook I Instagram I clhdesignpa.com
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