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HomeMy WebLinkAboutNCC191652_Modification Review_20200623Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 6/22/2020 2:36:54 PM (ADD TO FILE Submittal) Approve by Georgoulias, Bethany 6/23/2020 12:22:06 PM (Construction COC ADD TO FILE Review- NCC191652) • The task was assigned to Georgoulias, Bethany. The due date is: June 25, 2020 5:00 PM 6/22/2020 2:37 PM Y . Ta4M1 NORTH CAPOLINA EnYlrenmemf& Qualay Certificate of NCC191652 Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters) No.* Information associated with this permit Project Name City Contract City of Hickory Riverwalk Address 2035 12th Street Drive NW, Hickory, NC County Burke Latitude 35.7654 Longitude -81.3686 Permittee Listed City of Hickory Legally Responsible Warren Wood Individual NC Reference No. NCG01-2019-1652 E&SC Plan ID BURKE-2019-017 Original NOI 15360 Tracking No.* Date COC Issued* 09/03/2019 Prior Rescission This field will populate only if COChas already been rescinded.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 * r Additional Lots/Outparcels Approved - E&SC Revised F Other Revision(s) to E&SC Plan r Legally Responsible Individual Has Changed r Multiple Reasons (List) Addional We inforrration if necessary Explanation City Riverwalk project has been revised for value engineering. 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 Upload Supporting Documentation (%vised ERSC Approval, (lose -Out Doc, etc.) Documentation LOAwPR revision 6-10-2020.docxpdf 1.01MB Mast be FDFfon-rat North Carolina General Statute 143-215.66 (1) provides that: Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other documentfiled 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 underthis 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 e)ceed ten thousand dollars ($10,000). rJ 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:* r The Legally Responsible Individual r 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 w't nw Type Name* Warren Wood Title * City Manager Organization * City of Hickory Date * 06/22/2020 Email Address* wwood@hickorync.gov Errail for confirrration Telephone Number* 828-323-7412 Contact nurrber if we need to reach you Note: Original permittee and site contact are copied on modification correspondence. Additional Email Chris.Brown@mcgillassociates.com (Optional) Additional errail for confirrration Original Permittee wwood@hickorync.gov Email Original Site Contact kgreer@hickorync.gov Email Review Date 06/23/2020 Rescinded Since Submitted? Request Date 20200622 Formatted Review Date 20200623 Formatted