NCC200666_Modification Review_20201207

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/4/2020 5:21:04 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 12/7/2020 7:25:09 AM (Construction COC ADD TO FILE Review- NCC200666)
• The task was assigned to Georgoulias, Bethany. The due date is: December 9, 2020 5:00 PM
12/4/2020 5:21 PM

Y . Ta4M1
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC200666
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
Chatham Park Section 5.1 North - Wendover Parkway Phase 1, 2 & 3
Address
Thompson Street, Pittsboro, NC
County
Chatham
Latitude
35.7310
Longitude
-79.1560
Permittee Listed
Chatham Park Investors LLC
Legally Responsible
Tim Smith
Individual
NC Reference No.
NCG01-2020-0666
E&SC Plan ID
2019-02869
Original NOI
22015
Tracking No.*
Date COC Issued*
02/20/2020
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This field will populate only if CCChas already been rescinded.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 and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional Nbre information if needed (e.g., new Site Contact details can be included here)
Explanation LOA for Revised SCM 6 & 8, dated 4/8/2020
LOA for Revised Culvert -Erosion Control, dated 11/30/2020
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 (Pevised E&SCApproval, Close -Out Doc, etc.)
Documentation 200408_Wendover Parkway_Letter of Approval
288.44KB
Revised Plan.pdf
201201_Wendover Parkway_Letter_of Approval_...
1.13MB
11-30-2020. pdf
Mast be FDFformat
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this 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 Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which may include a fine not to exceed 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
Type Name* Robin Rose
Title * Manager
Organization* Chatham Park Investors LLC
Date * 12/04/2020
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 919-481-3000 x 5
Contact number if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional email for confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 12/07/2020

Rescinded Since
Submitted?
Request Date 20201204
Formatted
Review Date 20201207
Formatted