NCC223478_Modification Review ADD LOTS 21-54_20230126

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/19/2023 1:10:07 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 1/26/2023 11:38:12 AM (Construction COC ADD TO FILE Review - NCC223478)
* Legally responsible person updated 1/26/2023.
The task was assigned to Georgoulias, Bethany A. The due date is: January 24, 2023 5:00 PM
1/19/2023 1:10 PM

Certificate of NCC223478
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
Information associated with this permit:
Project Name Tupelo Junction Lots for Garman Homes
Address Lebanon Road, Mebane, NC
County Orange
Latitude 36.1100
Longitude-79.2550
Permittee Listed Garman Homes, LLC
Legally Responsible Dan Rosati
Individual
NC Reference No. NCG01-2022-3478
E&SC Plan ID LDP22-0082
Original NOI Tracking 108649
No. *
Date COC Issued* 10/07/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.
Modification Information:
Reason for Closed -Out Lots/Outparcels in E&SC Plan
Modification* Additional Lots/Outparcels Approved - E&SC Revised
Other Revision(s) to E&SC Plan
Legally Responsible Individual and/or Site Contact Has Changed
• Multiple Reasons (List)
Additional Lots Approved, Legally Responsible Individual has
Changed
Addional Explanation More information (e.g., new Site Contact details). If lots are being added, please include specific lot numbers.
Contact Information for Cosmo Muti provided on NCG01 Legally Responsible
Individual Form attached.
Tupelo Junction lots 21-54 have been added to the Orange County E&SC Land
Disturbing 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 (Revised E&SC Approval, Close -Out Doc, etc.)
Documentation 2023.01.18. Tupelo SLEC - NCG01-Legally-
139.76KB
Responsible -Change -Form - Signed.pdf
COA 2 Tupelo Junction Lots 1-54 Garman
269.21 KB
Homes.pdf
D1.X.Detail Sheets-D1.1.pdf 1.45MB
Must be PDF format
North Carolina General Statute 143-215.613 (1) provides that:
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; or who knowingly makes a false statement of a material
fact in a rulemaking proceeding or contested case under this 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 guilty of a Class 2 misdemeanor which may include 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:* • The Legally Responsible Individual
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
G'Amw 6llWa'
Type Name* Cosmo Muti
Title* Triad Market Leader
Organization * Garman Homes, LLC
Date * 01 /19/2023
Email Address* [e-mail]
Email for confirmation
Telephone Number* 336-552-4532
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 01/26/2023

Rescinded Since
Submitted?