NCC205514_Modification Review_20210111

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/8/2021 3:09:38 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 1/11/2021 10:28:08 AM (Construction COC ADD TO FILE Review- NCC205514)
• The task was assigned to Georgoulias, Bethany. The due date is: January 13, 2021 5:00 PM
1 /8/2021 3:09 PM

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NORTH CAPOLINA
EnYlmnmPnf& Qualify
Certificate of
NCC205514
Coverage (COC)
Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated
with this permit:
Project Name
Quail Glen Lots 44-47
Address
SR 2215, Black River, NC
County
Harnett
Latitude
35.4640
Longitude
-78.8020
Permittee Listed
Ryan Homes
Legally Responsible
Joe Schmidtke
Individual
NC Reference No.
NCG01-2020-5514
E&SC Plan ID
HARNE-2021-064
Original NOI
37454
Tracking No.*
Date COC Issued*
12/07/2020
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This field will populate only if COChas already been rescinded.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 and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional We information if needed (e.g., new Site Contact details can be included here)
Explanation ADDITION OF LOTS 126, 127, 128
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 OG0126, 127, 128 LETTER OF APPROVAL.pdf 452.09KB
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 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 Article 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
jot lro/w
Type Name* JOE SCHMIDTKE
Title * VICE PRESIDENT
Organization* NVR, Inc.
Date * 01 /08/2021
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 9199871930
Contact nun ber 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 01/11/2021
Rescinded Since
Submitted?

Request Date 20210108
Formatted
Review Date 20210111
Formatted