NCC201074_Modification Review (Contact Changes)_20230427

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 4/17/2023 11:11:21 AM (ADD TO FILE Submittal)
Approve by bethany.georgoulias 4/27/2023 1:18:33 PM (Construction COC ADD TO FILE Review-NCC201074)
•Legally responsible individual change form provided via email on 4/27/2023.
• The task was assigned to bethany.georgoulias.The due date is:April 20,2023 5:00 PM
4/17/2023 11:11:22 AM

Ago DEQMODIFICATION
Construction Permit for 0i00
0000
Certificate of NCC201074
Coverage(COC)No.* Enter the Certificate of Coverage Number(Use capital letters)
Information associated with this permit:
Project Name Pfizer Pharmaceuticals GTx2 Contractor Parking
Address Oak Park Road,Sanford, NC
County Lee
Latitude 35.5301
Longitude -79.1826
Permittee Listed Wyeth Holdings LLC
Legally Responsible Tony Mulcahy
Individual At the time of Modification Request(not looked up again at review)
NC Reference No. NCG01-2020-1074
E&SC Plan ID LEE-2020-028
Original NOI Tracking 23115
No.*
Date COC Issued* 03/19/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.
Modification Information:
Reason for Modification*
Closed-Out Lots/Outparcels in E&SC Plan
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) 3 requested modifications: (1)Legally Responsible Individual changed(2)Site Contact
changed(3)Annual fee due date extention

Addional Explanation
More information(e.g.,new Site Contact details).If lots are being added,please include specific lot numbers.
Three permit modifications are requested for this respective stormwater permit:
(1 &2)Since the permit's initiation in 2020 the site contact and responsible individual have both changed.The
new contacts are listed below:
Legally Responsible Person:Jon Tucker/919-566-4310/[e-mail]
Site Contact(Authorized Responsible Person): Connor Jarvis/919-566-5210/[e-mail]
(3)Due to the changing in responsibility of this permit's ownership the payment communications for its 4/1/2023
due date was not directly escalated from the division to the current site contact and a Notice of Deficiency was
issued due to late payment.A timely payment is now being coordinated. It is respectfully requested that a due
date extension is provided to lift the Notice of Deficiency.
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 Documentation
Upload Supporting Documentation(Revised E&SC Approval,Close-Out Doc,etc.)
NCC201074 Annual Fee Invoice_20230301 (002).pdf 788.25KB
Must be PDF format
Is this project funded with ARPA(American Rescue Plan Act)grant funds?
No
Yes
This question was added to the eNOI on 2/3/2023 and will not be answered in applications submitted prior to that date.
North Carolina General Statute 143-215.613(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
�`��ar�rot IU�f t�rr
Type Name* Connor W Jarvis
Title* Environmental Manager
Organization* Pfizer

Date* 04/17/2023
Email Address* [e-mail]
Email for confirmation
Telephone Number* 919-566-5210
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 04/27/2023
Rescinded Since
Submitted?