NCC193070_Modification Review_20201020

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/19/2020 1:11:47 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 10/20/2020 7:36:09 AM (Construction COC ADD TO FILE Review- NCC193070)
* Previous submittal included ownership deed documentation that will be added to the file with this
modification.
• The task was assigned to Georgoulias, Bethany. The due date is: October 22, 2020 5:00 PM
10/19/2020 1:11 PM

Y. ,
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC193070
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name East College Park - Evergreen - All SF Lots
Address Maple St, Hill St, N Carver St, N Fisher St, Pender St, Boyer St, Raleigh, NC
County Wake
Latitude 35.7824
Longitude-78.6157
Permittee Listed Evergreen Construction Co, Inc
Legally Responsible Timothy Morgan
Individual
NC Reference No. NCG01-2019-3070
E&SC Plan ID
Original NOI
Tracking No.
Wake-2018-027
19177
Date COC Issued* 12/09/2019
Prior Rescission This field will populate only if COChas already been rescinded.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 Mire information if necessary
Explanation supplementing additional supporting docs to earlier modification showing lot
ownership
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 -Out Doc, etc.)
Documentation WAKE-2021-022_20201013_LOA.pdf
266.17KB
WAKE-2021-023_20201013_LOA. pdf
266.2KB
WAKE-2021-024_20201013_LOA. pdf
266.19KB
WAKE-2021-025_20201013_LOA. pdf
266.21 KB
WAKE-2021-026_20201013_LOA. pdf
266.6KB
Mist be FDFfon-rat
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 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).
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
Type Name* Rod Miller
Title * Project Manager
Organization* Evergreen Construction Company
Date * 10/19/2020
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 9198482041
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 errail for confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 10/20/2020

Rescinded Since
Submitted?
Request Date 20201019
Formatted
Review Date 20201020
Formatted