SW3220902_Annual Certification Summary (2024)_20240212

Section A-Project Information
Permit Number: SW3220902 Project Town/City: Midland
Project Name: Carolina Thomas Midland Project County: Cabarrus
Permit issued: 12/12/2022 Project Status: not started
Section B-Permittee Information
Name: Carolina Thomas Development LLC Street Address: Mailing Address:
Signing Official: Kelly Rivera 6327 Burnt Poplar Rd 6327 Burnt Poplar Rd
Title: General Manager
Phone Number: 336-851-1718 Ext. Greensboro,NC 27409 Greensboro,NC 27409
Email Address: [e-mail]
Section C-Property Owner Information
Name: Carolina Thomas Development LLC Street Address: Mailing Address:
Signing Official: Kelly Rivera 6327 Burnt Poplar Rd 6327 Burnt Poplar Rd
Title: General Manager
Phone Number: 336-851-1718 Ext. Greensboro,NC 27409 Greensboro,NC 27409
Email Address: [e-mail]
Section D-Site Conformance with Permitting Conditions
Section D not applicable.
Section E-Plan to Bring the Project info Conformance
Project is in conformance with all permit conditions.
Section F-Project Certifier Information
Certifier Signing: Andrew Christ Street Address: Mailing Address:
Title: Project Manager 8518 Triad Dr 8518 Triad Dr
Phone Number: 336-544-6438
Email Address: [e-mail] Colfax,NC 27235 Colfax,NC 27235
Section G-Certification
The information in this form is true,accurate,and complete? Yes
The project is in conformance with all permit conditions? Yes
Electronically signed by Andrew Christ on February 12,2024.