NCC232679_Modification Review (OWNER-NAME CHANGE)_20241014

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 10/8/2024 1:21:42 PM (ADD TO FILE Submittal)
Approve by bethany.georgoulias 10/14/2024 9:39:29 AM(Construction COC ADD TO FILE Review-NCC232679)
0 This is actually an ownership sale/transfer where all contacts remain the same(including leg.
responsible official),We will be able to handle this transfer more formally in the new system,and this
permittee will be notified to resubmit the same request with the documentation in AccessDEQ so that
permit record data can be updated/new version of the COC can be issued.Currently,this info is only
"added to the permit file"in the Laserfiche repository.As we prepare to test the new system,this
serves as a useful case to outline the owner name change and ownership transfer modification
processes/review criteria.
The permittee uploaded the revised FRO form with this request but not the revised Plan approval.
Reviewer obtained the E&SC approval documentation reflecting the new name(same E&SC ID
number)by email from Aaron Kaatz on 10/9/2024.Also verified Entity Name on NC Secretary of State
(SOS)website business entity search.
• The task was assigned to bethany.georgoulias.The due date is: October 11,2024 5:00 PM
10/8/2024 1:21:42 PM

Ago Permit for DEQMODIFICATION
Construction0i00
0000
Certificate of NCC232679
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 May be blank if N/A
2023 Annual Fee Status 2024 Annual Fee Status
May be blank if N/A PAID
May be blank if N/A
Information associated with this permit:
Project Name Wallbrook-Townhomes
Address 200 S. Main St, Rolesville, NC
County Wake
Latitude 35.9128
Longitude -78.4741
Permittee Listed Wallbrook Landco, LLC
Legally Responsible James Austin Williams
Individual At the time of Modification Request(not looked up again at review)
NC Reference No. NCG01-2023-2679
E&SC Plan ID SEC-084327-2022
Original NOI Tracking 158452
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Prior Rescission Date This field will populate only if COC has already been rescinded.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) Entity name and address changed
Addional Explanation
More information(e.g.,new Site Contact details).If lots are being added,please include specific lot numbers.
Entity changed. Not individual.

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.)
Updated FRO-Signed.pdf 557.22KB
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
��(�iJhir fl�YGbarJ
Type Name* J Austin Williams
Title* Manager
Organization* CRP/C4 Wallbrook Village Owner, LLC
Date* 10/08/2024
Email Address* [e-mail]
Email for confirmation
Telephone Number* 7046216430
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 10/14/2024
Rescinded Since
Submitted?
Current Effective Date Current Expiration Date Permit Version
4/1/2024 3/31/2029 2.00