NCC211861_Modification Review (Site Contact Update)_20240923

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 9/22/2024 8:20:33 PM (ADD TO FILE Submittal)
Approve by bethany.georgoulias 9/23/2024 11:00:11 AM(Construction COC ADD TO FILE Review-NCC211861)
•Site contact updated 9/23/2024.
• The task was assigned to bethany.georgoulias.The due date is: September 26,2024 5:00 PM
9/22/2024 8:20:35 PM

9/23/24, 10:53 AM North Carolina Secretary of State Search Results
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online -
Add Entity to My Email Notification List • View Filings • Print a Pre-Populated Annual Report form • Print
an Amended a Annual Report form
Limited Liability Company
Legal Name
MONTROSE LLC
Information
Sosld: 1331152
Status: Current-Active O
Date Formed: 8/1/2013
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentgnnuaL Report Status:
Registered Agent: Foess, Michael F
Addresses
Principal Office Reg Office Mailing
15905 Brookway Dr, Ste 4208 15905 Brookway Dr., Ste 4208 PO Box 644
Huntersville, NC 28078 Huntersville, NC 28078 Cornelius, NC 28031
Reg Mailing
PO Box 644
Cornelius, NC 28031
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Executive Manager
Michael F Foess
PO Box 644
Cornelius NC 28031
https://www.sosnc.gov/online_services/search/Business_Registration_ResuIts 1/1

Ago Permit for DEQMODIFICATION
Construction0i00
0000
Certificate of NCC211861
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 May be blank if N/A PAID
May be blank if N/A
2023 Annual Fee Status 2024 Annual Fee Status
PAID PAID
May be blank if N/A May be blank if N/A
Information associated with this permit:
Project Name Independence Townes
Address 2933 Matthews Indian Trail Road, Stallings, NC
County Union
Latitude 35.0990
Longitude -80.6820
Permittee Listed Orissa Holding, LLC
Legally Responsible Joe Childress
Individual At the time of Modification Request(not looked up again at review)
NC Reference No. NCG01-2021-1861
E&SC Plan ID UNION-2020-026
Original NOI Tracking 48423
No.*
Date COC Issued* Effective Date at Submittal
04/01/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.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.
New site contact is:
Michael Foess
Montrose, LLC
[e-mail]
704-828-6096
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.)
Bailey Mills Change in Site Contact Letter 09.22.2024.pdf 266.89KB
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
�ir�`�iFtldtPJJ
Type Name* Joe Childress
Title* Authorized Agent
Organization* Orissa Holding, LLC
Date* 09/22/2024
Email Address* [e-mail]
Email for confirmation

Telephone Number* 704-467-0147
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 09/23/2024
Rescinded Since
Submitted?
Current Effective Date Current Expiration Date Permit Version
4/1/2024 3/31/2029 2.00