NCC193226_Modification Review_20200619

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/18/2020 1:49:11 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 6/19/2020 1:54:25 PM (Construction COC ADD TO FILE Review- NCC193226)
• The task was assigned to Georgoulias, Bethany. The due date is: June 23, 2020 5:00 PM
6/18/2020 1:49 PM

Y. ,
NORTH CAPOLINA
EnYlrenmemf& Qnalay
Certificate of NCC193226
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name
Mass Grading Improvements for the Aberdeen Carolina & Western
Railway Site
Address
967 NC Highway 211 E, Candor, NC
County
Montgomery
Latitude
35.3018
Longitude
-79.7173
Permittee Listed
ACWR Shops, LLC
Legally Responsible
Jennifer White
Individual
NC Reference No.
NCG01-2019-3226
E&SC Plan ID
MONTG-2020-002
Original NOI
19529
Tracking No.*
Date COC Issued*
12/18/2019
Prior Rescission
This field will populate only ff ODChas already been rescinded.
Date
Modification Information:
Reason for O Closed -Out Lots/Outparcels in E&SC Plan
Modification* 0 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)
Ad d io n al We information if necessary
Explanation Changes to Grading and Storm Drainage Plan
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 Docurrentation (%vised BRSCApproval, (lose -Out Doc, etc.)
Documentation 19171-1062 Grading and Storm Drainage Plans -
9.43MB
Sealed and Signed.pdf
Mist be FDFfornat
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).
� 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
r 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 NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
PA TOCZ A).
Type Name* Patrick N. Elder
Title * Associate Director of Business Development & Real Estate
Organization * Aberdeen Carolina & Western Railway
Date * 06/18/2020
Email Address* [e-mail]
Emil for confin-ration
Telephone Number* 7044970260
Contact nunber if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email Additional errailfor confirrration
(Optional)
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 06/19/2020
Rescinded Since
Submitted?

Request Date 20200618
Formatted
Review Date 20200619
Formatted