NCC190619_Modification Review_20191120

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/20/2019 12:28:12 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 11/20/2019 1:57:03 PM (Construction COC ADD TO FILE Review- NCC190619)
• The task was assigned to Georgoulias, Bethany. The due date is: November 25, 2019 5:00 PM
11/20/2019 12:28 PM

NORTH CAPCLINA
Emlremmentel Quality
Certificate of NCC190619
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
Shoals at Lea's Marina
Address
Factory Road, Hampstead, NC
County
Pender
Latitude
34.3570
Longitude
-77.6910
Permittee Listed
WLI Investments, LLC
Legally Responsible
D Logan
Individual
NC Reference No.
NCG01-2019-0619
E&SC Plan ID
PENDE-2019-011
Original NOI
12357
Tracking No.*
Date COC Issued*
06/17/2019
Prior Rescission
This field will populate only ff OOChas already been rescinded.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 Multiple Reasons (List)
Addional Mare inforrration if necessary
Explanation
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).

Supporting Upload Supporting Documentation (%vised E&SCApproval, (lose -Out Doc, etc.)
Documentation PERMIT - MODIFIED - PENDE-2019-011 Approval
297.48KB
Revised 103019.pdf
Wst be FDFformat
North Carolina General Statute 143-215.6113 (i) provides that:
Any person who knowingly makes anyfalse 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 guiltyofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
17 I, as an authorized representative, 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.
'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
b ZJ�&p
Type Name*
D Logan
Title *
Manager
Organization*
WLI Investments, LLC
Date *
11/20/2019
Email Address*
[e-mail]
B7ail for Confirrration
Telephone Number*
910-332-3524
Contact Number if we need to reach you
Date Formatted
20191120