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HomeMy WebLinkAboutNCC221232_MODIFICATION Supporting Doc (LEG RESP CHANGE)_20240815 IN CGIDI Leg lily Responsible individual Change F r,,,n � j Use this form when: The person wh is legally respo isible fo the permit has changed, but there is NO CH NGE in t e project name or ownership. **If the projf ct name has cha iged, or if the ownership of the project has changed, do NOT usa this form.** Instead,you nust suk mit a new NCG01 electronic Notice of Intent( NOI)'. Directions: Print this fo m, complete, sc in and u iload to the Construction Stormwater Permit ODIFIC TION Form. Then, mail I he original form to the NC DEMLR Stormwater Program at: Division of Energy Mineral&Land Resources Stormwater Progr m 512 N.Salisbury Street,61h Floor(Office 640K) 1612 Mail Service Center Raleigh, NC 27699-1612 DO NOTMAIL THIS FPItM U YOUR MODIFICATION HAS BEEN REVIEWED AND S COMPLETE. THE FO M Y M 1 Ui OMP TED WITH AN ORIGINAL SIGNATURE(NOTJCCEMEJ� IGIT L CFR 122.22] Certificate of CIverage (COC) Number: NCC221232 Name of Proje : Summerhav n West Legally Respo ible Organizational Entity: DR Horton, Inc. PREVIOUS Leg Ily Responsible Individual: less Meyer NEW Legally Responsible individual: Nil Uldrick The following section is to be completed and signed by the NEW Legally Responsible I divi�'uall Per NC Genera Statute 143-215 6B(i), a y person who knowingly makes any false statement, rE presentation, or certification 'n any applicatio , record, report,plan, or other document filed or requ red to be maintained under this Arti le or a rule implementing this Article. . .shall be guilty of a Class 2 mis emea or which may include a fine r at to exceed ten ffiousand dollars ($10,000). Page 1 of 2 CG01. L ly Responsible Individual Change I' THE FORM YO J MA U5 MPL TED WITH AN ORIGINAL SIGNATURE(NOT GITA ) � CFR 122.22] 10 Und:71 natty f la , I ertify t at(check all boxes to indicate your agreement): am I he person responsible fo the construction activities of this project,for satisfying the requi emerits pf this permit, a�d for any civil or criminal penalties incurred d e to viol tions of this perm t. I will bide by II conditions of he NCGO10000 General Permit and the approved Erosion and Sedin ent C opn rol Plan. Lag' If the approved Erosioi and Sediment Control Plan is not compliant with Part II (Stormwater Pollution PreVE ntion!Plan)of the NCG01 000 General Permit I will nonetheless ensure that all conditions of Part l of the permit are met on the project at all times. I undi rstan'd that coverage under this permit will constitute the permit requremerts for the isch rge(s') and is enf:)rceable in the same manner as an individual permit. This rm has been reviewed a id is urate and complete to the best of my know e 'e. %6 *Signature: . 8/15/2 24 � Date. Print Name of igned: Neil UI ric Title: Divisioii Stormwater Co pl�ance Specialist III Mailing Addre s: 4150 Mendenhall Oaks Pkwy, High Point, NC 27265 Street Address Same as abov Email Address: NRUldrick@driorl:on.com Phone Number: 3368999240 *IMPORTANT N TE. This form must be signed by a responsible corporate officer that owns or op erates the construction a tivity,such as a presfdent,secretary, treasurer, or vice president, or a manager that is authorized in c ccordance with Part IV,Section 8, Item (6)of the NCGO10000 permit. For more infor, atio on signatory equrements,see Part IV,Section B, Item(6)of the,NCGQ1O f0 permit. Page 2 of 2