NCC205670_Modification Review (LOT CLOSEOUTS)_20221205

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/1/2022 11:29:14 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 12/5/2022 8:59:41 AM (Construction COC ADD TO FILE Review - NCC205670)
• The task was assigned to Georgoulias, Bethany A. The due date is: December 6, 2022 5:00 PM
12/1/2022 11:29 AM

Certificate of NCC205670
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
Information associated with this permit:
Project Name MASON OAKS SUBDIVISION- LOTS 33, 204, 205
Address HWY US 1 @ MASON OAKS DRIVE, WAKE FOREST, NC
County Franklin
Latitude 36.0000
Longitude-79.0000
Permittee Listed NVR, Inc.
Legally Responsible MEREDITH SWEITZER
Individual
NC Reference No. NCG01-2020-5670
E&SC Plan ID 2020-00002610
Original NOI Tracking 38118
No. *
Date COC Issued* 12/09/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.
Modification Information:
Reason for • Closed -Out Lots/Outparcels in E&SC Plan
Modification* Additional Lots/Outparcels Approved - E&SC Revised
Other Revision(s) to E&SC Plan
Legally Responsible Individual and/or Site Contact Has Changed
Multiple Reasons (List)
Addional Explanation More information (e.g., new Site Contact details). If lots are being added, please include specific lot numbers.
CLOSING OUT LOTS 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23,
24, 25, 26, 27, 28, 29, 30, 31, 33, 35, 38, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54,
55, 56, 57, 67, 68, 69, 70, 75, 76, 77, 186, 187, 188, 189, 190, 191, 194, 195, 196,
197, 198, 199, 200, 201, 202, 203, 204, 205, 206, 207, 208, 209, 210, 211, 212,
213, 214, 215, 216, 217, 218, 219, 220, 221, 222, 223, 224, 225, 226, 227, 228,
229, 230, 231, 232, 233, 234, 235, 236, 237, 238, 239, 240, 241, 242, 243, 244,
245, 246, 247, 248, 249, 250, 251, 252, 253, 254, 255, 256, 257, 258, 259, 260,
261, 262, 263, 266, 268
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 (Revised E&SC Approval, Close -Out Doc, etc.)
Documentation MO 250,251_CoCJdw_11.3.22.pdf
107.28KB
MO 229,230,246,247_CoCJdw_11.7.22.pdf
107.37KB
MO 241,242,243,244,221,231_CoC idw_11.8.22.pdf
106.55KB
MO 16,28,46,47,233_CoC idw_11.8.22.pdf
107.52KB
MO 21,49_CoCJdw_11.8.22.pdf
105.96KB
MO 22,25,260_CoCJdw_11.10.22.pdf
106.97KB
MO 23,219,245_CoC idw_11.10.22.pdf
107.38KB
MO 232,238_CoC idw_11.8.22.pdf
106.95KB
MO 222,234,237_CoC idw_11.10.22.pdf
107.18KB
MO 235,236_CoC idw_11.8.22.pdf
108.08KB
MO 239,240_CoCJdw_11.7.22.pdf
107.35KB
MO 262,24,26_CoCJdw_11.10.22.pdf
107.2KB
MO 186,226,227_CoCJdw_11.15.22.pdf
107.96KB
MO 188,189,196_CoC idw_11.15.22.pdf
107.29KB
MO 190,191_CoCJdw_11.10.22.pdf
106.95KB
MO 8,20_CoC idw_11.2.22.pdf
107.07KB
MO 13,14,50_CoCJdw_11.3.22.pdf
107.36KB
MO 29,206_COC idw_11.2.22.pdf
107.03KB
MO 38,213_CoC idw_11.3.22.pdf
107.29KB
MO 51,52,53,268,200_CoC idw_11.3.22.pdf
108.16KB
MO 209,254,255,54,55,56,57_CoCJdw_11.2.22.pdf
107.26KB
MO 212,11,12_CoC idw_11.2.22.pdf
107.16KB
MO 252,253,256_CoCJdw_11.3.22.pdf
107.7KB
MO 7,214,215,216,217,218_CoC idw_11.3.22.pdf
107.39KB
MO 17,27_CoCJdw_11.3.22.pdf
107.04KB
MO 15,207,75,248,249_CoC idw_11.3.22.pdf
108.16KB
MO 18,19_CoCJdw_11.3.22.pdf
107.62KB
MO 33.204.205_CoC idw_11.3.22.pdf
108.95KB
MO 228,45,48_CoCJdw_11.7.22.pdf
107.19KB
MO194,220_CoC idw_11.10.22.pdf
107KB
MO195,261,77,187_CoCJdw_11.10.22.pdf
107.93KB
MO197_CoC idw_11.15.22.pdf
106.53KB
MO 223_CoCJdw_11.15.22.pdf
106.97KB
MO 224,225_CoC idw_11.15.22.pdf
106.73KB
MO 35,44,210,211,67,68_CoCJdw_11.2.22.pdf
108.17KB
MO198,199,208,201,258_CoCJdw_11.2.22.pdf
107.52KB
MO 9,10,257,263_CoCJdw_11.2.22.pdf
107.79KB
MO 69,70,30,31_CoCJdw_11.2.22.pdf
108.45KB
MO 76,202,203,259,266_CoCJdw_11.2.22.pdf
107.78KB
Must be PDF format
North Carolina General Statute 143-215.6B (1) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other document
filed 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 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 Article or rules of the Commission implementing this Article shall
be guilty of a 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:* The Legally Responsible Individual
• 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* JOE SCHMIDTKE
Title* VICE PRESIDENT
Organization* NVR, INC.
Date * 12/01 /2022
Email Address* [e-mail]
Email for confirmation
Telephone Number* 9199871930
Contact number 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 12/05/2022
Rescinded Since
Submitted?