NCC191572_Modification Review_20200924

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/24/2020 9:58:01 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 9/24/2020 12:43:16 PM (Construction COC ADD TO FILE Review- NCC191572)
• The task was assigned to Georgoulias, Bethany. The due date is: September 29, 2020 5:00 PM
9/24/2020 9:58 AM

Y. ,
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC191572
Coverage (COC) Enter the Certificate of Coverage Ninber (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This field will populate only if COChas already been rescinded.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 Legally Responsible Individual Has Changed
r Multiple Reasons (List)
Addional Nbre information if necessary
Explanation We are adding an additional .78 acres to the original eNOI of 2.3 acres for MVLLE-
2019026 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). For changes to the legally responsible individual, you must upload this form.

Supporting Upload Supporting Documentation (%vised IRSCApproval, (lose -Out Doc, etc.)
Documentation WF Iredell letter of approval MVLLE2019-026 on 7-
81.03KB
29-20.pdf
Wst 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
Type Name* Seth Foster
Title * Division Manager
Organization* NVR Ryan Homes
Date * 09/24/2020
Email Address* [e-mail]
En -ail for confin-ration
Telephone Number* 704-949-3060
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 09/24/2020
Rescinded Since
Submitted?

Request Date 20200924
Formatted
Review Date 20200924
Formatted