NCC203825_Modification Review_20201005

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/5/2020 9:40:10 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 10/5/2020 1:09:44 PM (Construction COC ADD TO FILE Review- NCC203825)
• The task was assigned to Georgoulias, Bethany. The due date is: October 8, 2020 5:00 PM
10/5/2020 9:40 AM

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NORTH CAPOLINA
EnYlrenmemf& Qnalay
Certificate of NCC203825
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name
Sanctuary
Address
2337 Sanctuary Drive, Raleigh, NC
County
Wake
Latitude
35.7150
Longitude
-78.7340
Permittee Listed
Upright Builders Inc
Legally Responsible
Wes Carroll
Individual
NC Reference No.
NCG01-2020-3825
E&SC Plan ID
SEC-043381-2020
Original NOI
30773
Tracking No.*
Date COC Issued*
09/02/2020
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This field will populate only if COChas already been rescinded.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
f Multiple Reasons (List)
Addional IVbre information 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). For changes to the legally responsible individual, you must upload this form.

Supporting Upload Supporting Documentation (%vised ERSC Approval, (lose -Cut Doc, etc.)
Documentation SYM 13 SEC-043381-2020_Approval-
S&EConstruction Plan ReviewChecklist-V.2 WM 8- 290.02KB
27-20 (4).pdf
Mast be FDFformat
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 A tide 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).
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
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
was c,ap.,o ou_
Type Name* Wes Carroll
Title * President
Organization* Upright Builders Inc.
Date * 10/05/2020
Email Address* [e-mail]
Errail for confirrration
Telephone Number* 919-858-8383
Contact number if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email Additional email for confirmation
(Optional)
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 10/05/2020
Rescinded Since
Submitted?

Request Date 20201005
Formatted
Review Date 20201005
Formatted