NCC204067_Modification Review LOT 675_20210602

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/1/2021 8:53:45 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 6/2/2021 7:46:30 AM (Construction COC ADD TO FILE Review- NCC204067)
The task was assigned to Georgoulias, Bethany A. The due date is: June 4, 2021 5:00 PM
6/1/2021 8:53 AM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of
NCC204067
Coverage (COC)
Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated
with this permit:
Project Name
Chapel Ridge Lots 85, 121, 499, 676
Address
Chapel Ridge Drive, Pittsboro, NC
County
Chatham
Latitude
35.7965
Longitude
-79.2121
Permittee Listed
Capitol City Homes
Legally Responsible
Jason Morrow
Individual
NC Reference No.
NCG01-2020-4067
E&SC Plan ID
2020-05683
Original NOI
31375
Tracking No.*
Date COC Issued*
09/22/2020
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This field will populate only if CCChas already been rescinded.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 Ivbre information (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation Add Chapel Ridge Lot 675
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 CHAPEL RIDGE --CAPITOL CITY --LOT 675--
7.13MB
EROSION --SHEET 1 -5.pdf
Land Disturbing Permit Application and FRO Form
111.91KB
Rev. 4-22-2020 - SIGNED.pdf
Letter of Approval_Chapel Ridge Lot 675.pdf 138.6KB
Mast be FDFformat
North Carolina General Statute 143-215.66 (1) 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).
17 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
Type Name* Jason Morrow
Title * Managing Partner
Organization* Capitol City Homes
Date * 06/01 /2021
Email Address* [e-mail]
Errail for confirrration
Telephone Number* 9198720048
Contact nun ber if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional errail for confirrration
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 06/02/2021

Rescinded Since
Submitted?
Request Date 20210601
Formatted
Review Date 20210602
Formatted