NCC205080_Modification Review_20210226

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/26/2021 9:47:43 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 2/26/2021 10:00:09 AM (Construction COC ADD TO FILE Review- NCC205080)
• The task was assigned to Georgoulias, Bethany. The due date is: March 3, 2021 5:00 PM
2/26/2021 9:47 AM

Y . Ta4M1
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC205080
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
Proximity at Northlake Phase 2
Address
8721 Reames Rd, Charlotte, NC
County
Mecklenburg
Latitude
35.3362
Longitude
-80.8546
Permittee Listed
Proximity at Northlake Phase 2, LLC
Legally Responsible
Neil Kapadia
Individual
NC Reference No.
NCG01-2020-5080
E&SC Plan ID
LDGP-2020-00231
Original NOI
35131
Tracking No.*
Date COC Issued*
11/10/2020
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This field will populate only if CCChas already been rescinded.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 (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation original COC was for early grading package;the municipal permit ID was updated
when final approval for plan set was issued. the denuded acreage and area has
remained unchanged
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 _NEW Grading Letter of Approval - Proximity at
91.15KB
Northlake Phase 2.pdf
Mast be R Ffornat
North Carolina General Statute 143-215.6B (i) provides that:
Anyperson who knowinglymakes anyfalse 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 knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho 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 notto 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
� �c/� x 0?
Type Name* Neil Kapadia
Title * Manager
Organization * Proximity at Northlake Phase 2, LLC
Date * 02/26/2021
Email Address* [e-mail]
En -ail for confirmation
Telephone Number* 704-806-7615
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 email for confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 02/26/2021

Rescinded Since
Submitted?
Request Date 20210226
Formatted
Review Date 20210226
Formatted