NCC193248_Modification Review_20200310

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/10/2020 8:18:58 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 3/10/2020 8:54:44 AM (Construction COC ADD TO FILE Review- NCC193248)
• The task was assigned to Georgoulias, Bethany. The due date is: March 13, 2020 5:00 PM
3/10/2020 8:19 AM

Y. ,
NORTH CAPCLINA
Emlremmentel Quality
Certificate of
NCC193248
Coverage (COC)
Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated
with this permit:
Project Name
Duplin County Airport - NC Forest Service Hangar Complex
Address
260 Airport Road, Kenansville, NC
County
Duplin
Latitude
35.0000
Longitude
-77.9847
Permittee Listed
Duplin County
Legally Responsible
George Futrelle
Individual
NC Reference No.
NCG01-2019-3248
E&SC Plan ID
DUPLI-2020-012
Original NOI
19698
Tracking No.*
Date COC Issued*
12/20/2019
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This field will populate only ff OOChas already been rescinded.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 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 ESCApproval, (lose -Cut Doc, etc.)
Documentation 02282004.PDF 742.35KB
Mast be FDFfon-rat
North Carolina General Statute 143-215.66 (1) 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 � 7"6
Type Name* George Futrelle
Title * Assistant County Manager / Airport Director
Organization* Duplin County, NC
Date * 03/10/2020
Email Address* [e-mail]
57ail for Confirmation
Telephone Number* 910-296-2188
Contact Nbrrber if we need to reach you
Review Date 03/10/2020
Request Date 20200310
Formatted
Review Date 20200310
Formatted