NCC200053_Modification Review_20200127

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/24/2020 12:20:30 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 1/27/2020 9:23:04 AM (Construction COC ADD TO FILE Review- NCC200053)
• The task was assigned to Georgoulias, Bethany. The due date is: January 29, 2020 5:00 PM
1 /24/2020 12:20 PM

Y. ,
NORTH CAPCLINA
Emlremmentel Quality
Certificate of NCC200053
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
The Cove at Mackintosh
Address
4595 Bonner Bridge Parkway, Burlington, NC
County
Guilford
Latitude
36.0000
Longitude
-80.0000
Permittee Listed
DR Horton, Inc.
Legally Responsible
Jessica Meyer
Individual
NC Reference No.
NCG01-2020-0053
E&SC Plan ID
652, 621, 634, 585
Original NOI
20220
Tracking No.*
Date COC Issued*
01/07/2020
Prior Rescission
This field will populate only ff OOChas already been rescinded.
Date
Modification Information:
Reason for f Closed -Out Lots/Outparcels in E&SC Plan
Modification* r Additional Lots/Outparcels Approved - E&SC Revised
r Other Revision(s) to E&SC Plan
r Multiple Reasons (List)
Addional ivbre infornation if necessary
Explanation It has come to my attention that I have listed the wrong Project number for Phase
2A. I listed 585 and the correct number is 648. 585 was the permit fee amount. The
correct project #'s should be 621, 634, 648, and 652. See email from Brandon
Holt, City of Burlington attached. Sorry about that. That was my fault. I read the
wrong line on the 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)
Supporting Upload Supporting Documentation (Fevised E&SCApproval, nose -Out Doc, etc.)
Documentation The Cove COC email - Brandon Holt.pdf 878.91KB
Mast be PDFfornat
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 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, 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
Type Name*
Jessica Meyer
Title *
NPDES Technical Compliance Administrator
Organization*
DR Horton, Inc.
Date *
01 /24/2020
Email Address*
[e-mail]
Bmil for Owfirnation
Telephone Number*
919-215-6561
Contact Ninber if we need to reach you
Date Formatted
20200124