NCC203776_Modification Review_20210713

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/12/2021 5:22:50 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 7/13/2021 6:58:43 AM (Construction COC ADD TO FILE Review -
NCC203776)
• The task was assigned to Georgoulias, Bethany A. The due date is: July 15, 2021 5:00 PM
7/12/2021 5:22 PM

Y. ,
w,
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of
NCC203776
Coverage (COC)
Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated
with this permit:
Project Name
BRUNSWICK PLANTATION LOTS
Address
SOUTH MIDDLETON DRIVE, NW, CALABASH, NC
County
Brunswick
Latitude
33.9454
Longitude
-78.5740
Permittee Listed
LENNAR CAROLINAS, LLC
Legally Responsible
JASON BYHAM
Individual
NC Reference No.
NCG01-2020-3776
E&SC Plan ID
BRUNS-2021-011
Original NOI
30528
Tracking No.*
Date COC Issued*
09/01/2020
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This field will populate only if CCChas already been rescinded.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 We information (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation Purchased new lots- Hamptons (930, 949, 963, 964, & 965) and Beaufort (321,
326, & 328)
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 (Pevised E&SCApproval, nose -Out Doc, etc.)
Documentation BRUNS-2021-011 Approval Revised 7-9-2021.pdf 231.26KB
Mist be FDFfornat
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 Artide or a rule implementing this Artide; 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 Artide or rules of the
Commission implementing this Article shall be guiltyofa 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
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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
JA-FOA)-$1VA111
Type Name* JASON BYHAM
Title * DIVISION PRESIDENT
Organization* LENNARCAROLINAS, LLC
Date * 07/12/2021
Email Address* [e-mail]
En -ail for confirnation
Telephone Number* 8433277971
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 en -ail for confin-ration
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 07/13/2021
Rescinded Since
Submitted?

Request Date 20210712
Formatted
Review Date 20210713
Formatted