NCC190798_Modification Review_20200902

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/1/2020 4:19:24 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 9/2/2020 2:49:39 PM (Construction COC ADD TO FILE Review- NCC190798)
p Confirmed with permittee via e-mail that some lots are still under construction and COC should remain
active.
• The task was assigned to Georgoulias, Bethany. The due date is: September 4, 2020 5:00 PM
9/1/2020 4:19 PM

Y . Ta4M1
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of
NCC190798
Coverage (COC)
Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated
with this permit:
Project Name
Sunset Bluffs Homes by Dickerson Residential Lots Erosion Control
Address
Plowridge Road, Fuquay-Varina, NC
County
Wake
Latitude
35.6280
Longitude
-78.8047
Permittee Listed
Homes by Dickerson
Legally Responsible
Jonathan Showalter
Individual
NC Reference No.
NCG01-2019-0798
E&SC Plan ID
EC-2019-10
Original NOI
12942
Tracking No.*
Date COC Issued*
07/01/2019
Prior Rescission
This field will populate only if COChas already been rescinded.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
O Other Revision(s) to E&SC Plan
r Legally Responsible Individual Has Changed
r Multiple Reasons (List)
Addional Nbre information if necessary
Explanation Closing out all lots under both EC-2019-10 and EC-2019-24
Lots 251, 253, 258, 261-266, 269, 272-276, 384-386
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 Documentation (%vised IRSCApproval, (lose -Out Doc, etc.)
Documentation Certificate of Completion EC-2019-24.pdf 32.74KB
Certificate of Completion EC-2019-10.pdf 32.71 KB
Wst be FDFfornat
North Carolina General Statute 143-215.6113 (i) 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 Artide 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 Artide 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).
� 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
K q dX.WOW
Type Name* Jon Showalter
Title * COO / VP
Organization* Homes by Dickerson INC
Date * 09/01 /2020
Email Address* [e-mail]
En -ail for confin-ration
Telephone Number* 919-847-4447
Contact nunber if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional en -ail for confin-ation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 09/02/2020
Rescinded Since
Submitted?

Request Date 20200901
Formatted
Review Date 20200902
Formatted