NCC205305_Modification Review_20240129

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 1/26/2024 7:53:52 AM (ADD TO FILE Submittal)
Approve by bethany.georgoulias 1/29/2024 1:24:42 PM (Construction COC ADD TO FILE Review-NCC205305)
• The task was assigned to bethany.georgoulias.The due date is:January 31,2024 5:00 PM
1/26/2024 7:53:53 AM

Ago Permit for DEQMODIFICATION
Construction0i00
0000
Certificate of NCC205305
Coverage(COC)No.* Enter the Certificate of Coverage Number(Use capital letters)
2020 Annual Fee Status 2021 Annual Fee Status 2022 Annual Fee Status
May be blank if N/A PAID PAID
May be blank if N/A May be blank if N/A
2023 Annual Fee Status 2024 Annual Fee Status
PAID May be blank if N/A
May be blank if N/A
Information associated with this permit:
Project Name NCC-GUILF-2021-Contract 2018-051A, Davie Street Streetscape Improvements
Address 200 N.to 339 S. Davie Street,Greensboro, NC
County Guilford
Latitude 36.0718
Longitude -79.7891
Permittee Listed City of Greensboro
Legally Responsible Jason Geary
Individual At the time of Modification Request(not looked up again at review)
NC Reference No. NCG01-2020-5305
E&SC Plan ID GUILF-2021-003
Original NOI Tracking 36479
No.*
Date COC Issued* 12/02/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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)
Addional Explanation
More information(e.g.,new Site Contact details).If lots are being added,please include specific lot numbers.
The previous erosion control permit had expired.A new erosion control permit has been obtained.

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.)
2018-051A_Approval_with_Modifications-Contractor copy.pdf 806.84KB
Must be PDF format
Is this project funded with ARPA(American Rescue Plan Act)grant funds?
No
Yes
This question was added to the eNOl 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
cTJ s miff
Type Name* Jason S. Geary, PE
Title* Deputy Director, Engineering&Inspections
Organization* City of Greensboro
Date* 01/26/2024
Email Address* [e-mail]
Email for confirmation
Telephone Number* [phone]
Contact number if we need to reach you
Note:Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional email for confirmation
Original Permittee [e-mail]
Email

Original Site Contact [e-mail]
Email
Review Date 01/29/2024
Rescinded Since
Submitted?