NCC191572_Modification Review_20200309

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/6/2020 12:05:18 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 3/9/2020 9:08:59 AM (Construction COC ADD TO FILE Review- NCC191572)
• The task was assigned to Georgoulias, Bethany. The due date is: March 11, 2020 5:00 PM
3/6/2020 12:05 PM

Y . Ta4M1
NORTH CAPCLINA
Emlremmentel Quality
Certificate of NCC191572
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
The Waterfront at Langtree
Address
448 Langtree Road, Mooresville, NC
County
Iredell
Latitude
35.5288
Longitude
-80.8673
Permittee Listed
NVR-Ryan Homes
Legally Responsible
Daniel Zalinsky
Individual
NC Reference No.
NCG01-2019-1572
E&SC Plan ID
MVLLE-2019-026
Original NOI
15251
Tracking No.*
Date COC Issued*
08/28/2019
Prior Rescission
This field will populate only ff ODChas already been rescinded.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 We are adding an additional .23 acres to the original eNO1 of 2.3 acres for MVLLE-
2019-26 from Iredell County
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 IRSCApproval, (lose -Out Doc, etc.)
Documentation Iredell letter of approval MVLLE 2019-026 on 3-6-
55.49KB
2020.pdf
NUst be FDFformat
North Carolina General Statute 143-215.6113 (i) provides that:
Anyperson who knowinglymakes anyfalse 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 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 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 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 NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
Type Name* Seth Foster
Title * Division Manager
Organization* NVR Ryan Homes
Date * 03/06/2020
Email Address* [e-mail]
Brrail for Confirmation
Telephone Number* 704-875-9887
Contact Number if we need to reach you
Review Date 03/09/2020
Request Date 20200306
Formatted
Review Date 20200309
Formatted