NCC200349_Modification Review_20200220

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/19/2020 12:18:53 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 2/20/2020 8:44:40 AM (Construction COC ADD TO FILE Review- NCC200349)
• The task was assigned to Georgoulias, Bethany. The due date is: February 24, 2020 5:00 PM
2/19/2020 12:18 PM

Y. ,
NORTH CAPCLINA
Emlremmentel Quality
Certificate of NCC200349
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
4609 Montgomery
Address
4609 Montgomery, Pittsboro, NC
County
Chatham
Latitude
35.7930
Longitude
-79.0850
Permittee Listed
Fitch Creations, Inc.
Legally Responsible
Laura Morgan
Individual
NC Reference No.
NCG01-2020-0349
E&SC Plan ID
2020-00727
Original NOI
21184
Tracking No.*
Date COC Issued*
01/30/2020
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This field will populate only ff OOChas already been rescinded.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 ivbre infornation if necessary
Explanation Adding 2 additional lots in the same neighborhood (4612 and 4614 - Montgomery).
Disturbed area for 4612 is 0.28 ac.
Disturbed area for 4614 is 0.24 ac.
Total additional disturbed area is 0.52 ac.
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 Ibcurrentation (Fbvised E&SCApproval, nose -Out Doc, etc.)
Documentation 4612 - Letter of Approval.pdf 288.33KB
4614 - Letter of Approval.pdf 287.97KB
Mast be PDFfornat
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes anyfalse statement, representation, or cerfification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho falsifies, tampers with, or knowingly renders
inaccurate anyrecording or monitoring device or method required to be operated or maintained under this Article or rules ofthe
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine notto 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
Type Name* Laura F. Morgan
Title * General Manager, Real Estate and Construction
Organization* Fitch Creations, Inc.
Date * 02/19/2020
Email Address* [e-mail]
BTail for Confirnation
Telephone Number* [phone]
Contact N inber if we need to reach you
Date Formatted 20200219