NCC205749_Modification Review_20210406

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/1/2021 5:53:58 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 4/6/2021 2:33:19 PM (Construction COC ADD TO FILE Review- NCC205749)
p Legally responsible person and entity is still appropriate; E&SC documents have been updated.
• The task was assigned to Georgoulias, Bethany. The due date is: April 6, 2021 5:00 PM
4/1/2021 5:54 PM

NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC205749
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name
Cullowhee Mtn Church
Address
985 Cullowhee Mountain Road, Cullowhee, NC
County
Jackson
Latitude
35.2820
Longitude
-83.1882
Permittee Listed
The BCNC Inc
Legally Responsible
Jesse Crisp
Individual
NC Reference No.
NCG01-2020-5749
E&SC Plan ID
17-113
Original NOI
38798
Tracking No.*
Date COC Issued*
12/11/2020
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This field will populate only if CCChas already been rescinded.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 * a Additional Lots/Outparcels Approved - E&SC Revised
r Other Revision(s) to E&SC Plan
F Legally Responsible Individual and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional Nbre inforrration (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation Jesse Crisp who is listed as the legally responsible person on this serves as a
Board member for The BCNC Inc. which is The Bridge Church NC. We just
purchased this property from Tinsel Town Properties who was the previous owner
the EC plan was under. We don't want to change the EC plan we just want to make
sure our names are on it and that we are in compliance. But, what I'm looking at on
this form shows us as already legally responsible so we just need to know what to
do.

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 (Devised E&SCApproval, Close -Cut Doc, etc.)
Documentation EC PERMIT 17-113 Modified Owner, The BCNC Inc
96.42KB
03.23.21.pdf
LOA The BCNC, Inc. 17-113, Modified 03.23.21.pdf 108.47KB
Mast be PDFformat
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 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
IT 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* Josh Hyde
Title * Lead Pastor
Organization* The BCNC Inc. The Bridge Church NC
Date * 04/01 /2021
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 828-507-6258
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 04/06/2021
Rescinded Since
Submitted?
Request Date 20210401
Formatted
Review Date 20210406
Formatted