NCC202080_Modification Review_20210208

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/5/2021 10:55:53 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 2/8/2021 7:30:02 AM (Construction COC ADD TO FILE Review- NCC202080)
• The task was assigned to Georgoulias, Bethany. The due date is: February 10, 2021 5:00 PM
2/5/2021 10:55 AM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of
NCC202080
Coverage (COC)
Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated
with this permit:
Project Name
Lots at Creek Park
Address
8013 Creek Park Drive, Denver, NC
County
Lincoln
Latitude
35.4675
Longitude
-81.0247
Permittee Listed
Taylor Morrison
Legally Responsible
Thomas Johnson
Individual
NC Reference No.
NCG01-2020-2080
E&SC Plan ID
20-ML-02
Original NOI
25773
Tracking No.*
Date COC Issued*
06/01/2020
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This field will populate only if CCChas already been rescinded.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 Nbre information if needed (e.g., new Site Contact details can be included here)
Explanation Purchased additional lots 27-28, 46-48, 102-110, 164
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 Lincoln County Approval Lots 27-28, 46-48, 102-
1.22MB
110, 164.pdf
Wst be FDFformat
North Carolina General Statute 143-215.6113 (i) 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 guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
� 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* Thomas Johnson
Title * VP of Land Development
Organization* Taylor Morrison
Date * 02/05/2021
Email Address* [e-mail]
En -ail for confirmation
Telephone Number* 7046218395
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 02/08/2021
Rescinded Since
Submitted?

Request Date 20210205
Formatted
Review Date 20210208
Formatted