NCC204560_Modification LOTS 62 63 Review_20210105

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/5/2021 11:41:31 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 1/5/2021 12:05:07 PM (Construction COC ADD TO FILE Review- NCC204560)
• The task was assigned to Georgoulias, Bethany. The due date is: January 8, 2021 5:00 PM
1/5/2021 11:41 AM

Y . Ta4M1
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC204560
Coverage (COC) Enter the Certificate of Coverage Ninber (use capital letters)
No.*
Information associated with this permit
Project Name
Lots 62-65 Avalaire Subdivision
Address
Avalaire Pines Drive and Bailey Hill Drive, Barton's Creek, NC
County
Chatham
Latitude
35.9128
Longitude
-78.6275
Permittee Listed
Loyd Builders, LLC
Legally Responsible
Frank Loyd, III
Individual
NC Reference No.
NCG01-2020-4560
E&SC Plan ID
SEC-044219-2020
Original NOI
32789
Tracking No.*
Date COC Issued*
10/21/2020
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This field will populate only if CCChas already been rescinded.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 * F Additional Lots/Outparcels Approved - E&SC Revised
r Other Revision(s) to E&SC Plan
r Legally Responsible Individual and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional We inforrration if needed (e.g., new Site Contact details can be included here)
Explanation This modification is to add Lot 62 and Lot 63 to this certificate of coverage
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 Approval-
284.17KB
S&E_SingleLot_PlanReviewChecklist_Septic.pdf
Approval-
283.21 KB
S&E_SingleLot_PlanReviewChecklist_Septic.pdf
Wst be FDFfornat
North Carolina General Statute 143-215.6113 (i) 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).
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
f 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
e"
Type Name* Frank R. Loyd III
Title * Manager
Organization* Loyd Builders, LLC
Date * 01 /05/2021
Email Address* [e-mail]
En -ail for confin-ration
Telephone Number* 919 387 1455
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 01/05/2021

Rescinded Since
Submitted?
Request Date 20210105
Formatted
Review Date 20210105
Formatted