NCC190030_Modification Review LOTS 318-351_20191007

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/4/2019 5:04:28 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 10/7/2019 10:22:10 AM (Construction COC ADD TO FILE Review- NCC190030)
• The task was assigned to EADS\bageorgoulias. The due date is: October 9, 2019 5:00 PM
10/4/2019 5:04 PM

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NORTH CAROUNA
e'vorwMienfal Quanty
Certificate of NCC190030
Coverage (COC) Enter the Certificate of Coverage Number (Use capital letters)
No. *
Information associated with this permit
Project Name
Croasdaile Farm North SD
Address
Meadowcreek, Arborwood & Lauralwood Drives, Durham, NC
County
Durham
Latitude
36.0557
Longitude
-78.9403
Permittee Listed
Homes by Dickerson, Inc.
Legally Responsible
Brant Chesson
Individual
NC Reference No.
NCG01-2019-0030
E&SC Plan ID
5224-02
Original NOI
10021
Tracking No.*
Date COC Issued*
04/11/2019
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Modification Information:
Reason for r Closed -Out Lots/Outparcels in E&SC Plan
Modification* f• Additional Lots/Outparcels Approved - E&SC Revised
r Other Revision(s) to E&SC Plan
f Multiple Reasons (List)
Ad d io n al Ivbre information if necessary
Explanation Added single family building lots 318 - 351
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).

Supporting Upload Supporting Wcur antation (Revised E&SCApproval, (lose -Out Doc, etc.)
Documentation Phase 2 EC Letter of Approval.pdf 136.94KB
Mist be FIDF format
North Carolina General Statute 143-215.613 (1) provides that:
Any person who knowingly makes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained underthis Article or a rule implementing this Article; or who knowinglymakes 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 guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
I7 I, as an authorized representative, 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.
"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
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Type Name* Jonathan M. Showalter
Title * COO, VP Homes by Dickerson
Organization* Homes by Dickerson
Date * 10/04/2019
Email Address* [e-mail]
Email for Confirmation
Telephone Number* 919-291-3695
Contact Namber if we need to reach you
Date Formatted 20191004