NCC203847_Modification Review_20201118

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/17/2020 2:29:47 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 11/18/2020 7:09:49 AM (Construction COC ADD TO FILE Review- NCC203847)
• The task was assigned to Georgoulias, Bethany. The due date is: November 20, 2020 5:00 PM
11/17/2020 2:30 PM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC203847
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name
Speedway Substation
Address
2410 Wallace Road, Midland, NC
County
Cabarrus
Latitude
35.2196
Longitude
-80.5294
Permittee Listed
Swinerton Builders, A Corporation
Legally Responsible
David Grubb, Jr.
Individual
NC Reference No.
NCG01-2020-3847
E&SC Plan ID
CABAR-2021-009
Original NOI
30823
Tracking No.*
Date COC Issued*
09/03/2020
Prior Rescission
This field will populate only if CCChas already been rescinded.
Date
Modification Information:
Reason for r Closed -Out Lots/Outparcels in E&SC Plan
Modification * r 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)
Addional Nbre information if necessary
Explanation Update to LOD extents for grading - total area remains the same.
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 CABAR-2021-009-11052020.pdf 100.77KB
Mast 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 Article or a rule implementing this Artide; 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 e)ceed ten thousand
dollars ($10,000).
rJ 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* David Grubb, Jr.
Title * Vice President
Organization* SWnerton Builders
Date * 11 /17/2020
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 760-520-5415
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 11/18/2020
Rescinded Since
Submitted?

Request Date 20201117
Formatted
Review Date 20201118
Formatted