NCC200173_Modification Review_20200601

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/1/2020 10:15:29 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 6/1/2020 3:16:51 PM (Construction COC ADD TO FILE Review- NCC200173)
• The task was assigned to Georgoulias, Bethany. The due date is: June 4, 2020 5:00 PM
6/1/2020 10:15 AM

Y . Ta4M1
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC200173
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit:
Project Name John Deere New Entrance
Address 6501 S. NC 55 Hwy, Fuquay-Varina, NC
County Wake
Latitude 35.5800
Longitude-78.7541
Permittee Listed Deere and Company
Legally Responsible Siva Sundaresan
Individual
NC Reference No. NCG01-2020-0173
E&SC Plan ID EC-2019-22
Original NOI 20671
Tracking No.*
Date COC Issued* 01/16/2020
Prior Rescission This field will populate only if CCChas already been rescinded.
Date
Modification Information:
Reason for r Closed -Out Lots/Outparcels in E&SC Plan
Modification * r Additional Lots/Outparcels Approved - E&SC Revised
F Other Revision(s) to E&SC Plan
r Legally Responsible Individual Has Changed
r Multiple Reasons (List)
Addional Wre inforrration if necessary
Explanation NWP 39 and NCDWR 401 approval for the sewer line tie-in portion of the ongoing
facility improvement secondary access road project. No scope change occurred,
but the permit was received and documentation was submitted to the Town for an
amended E&SC approval letter.
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). For changes to the legally responsible individual, you must upload this form.

Supporting Upload Supporting Ibcurrentation (Fbvised E&SCApproval, nose -Out Doc, etc.)
Documentation JohnDeereNewEntrance_EC Approval_5.28.20.pdf 100.1 KB
SAW-2000-20358 - NWP 39
4.95MB
Verification_SIGNED.pdf
John Deere Plan.pdf 100.7KB
Mist be FDFformat
North Carolina General Statute 143-215.66 (1) 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 Atcle; orwho falsifies, tampers with, or knowinglyrenders
inaccurate anyrecording 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 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.
Specify if you are:* r The Legally Responsible Individual
f Authorized Responsible Person*
*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* Siva Sundaresan
Title * Global Director Commercial Mowing & Golf Equipment
Organization* Deere & Company
Date * 06/01 /2020
Email Address* [e-mail]
grail for confirmation
Telephone Number* 919-285-0341
Contact nun ber if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional email for confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 06/01/2020

Rescinded Since
Submitted?
Request Date 20200601
Formatted
Review Date 20200601
Formatted