NCC203972_Modification Review ADD LOTS 165-170_20210618

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/18/2021 10:21:55 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 6/18/2021 2:59:15 PM (Construction COC ADD TO FILE Review -
NCC203972)
• The task was assigned to Georgoulias, Bethany A. The due date is: June 23, 2021 5:00 PM
6/18/2021 10:22 AM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC203972
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name
Townes at Courtney Creek
Address
2624 NC HWY 55, Durham, NC
County
Durham
Latitude
35.9480
Longitude
-78.8901
Permittee Listed
NVR Inc. d/b/a Ryan Homes
Legally Responsible
Jordan Riley
Individual
NC Reference No.
NCG01-2020-3972
E&SC Plan ID
6128-11
Original NOI
31228
Tracking No.*
Date COC Issued*
09/11/2020
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This field will populate only if CCChas already been rescinded.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 * 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 (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation ADDITION OF LOTS 165, 166, 167, 168, 169, 170
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 ESCApproval, (lose -Cut Doc, etc.)
Documentation JCN 6297-11 LD Permit. pdf 132.7KB
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 DBA RYAN HOMES
Date * 06/18/2021
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 06/18/2021
Rescinded Since
Submitted?

Request Date 20210618
Formatted
Review Date 20210618
Formatted