NCC205483_Modification Review LOTS 177-179_20201215

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/14/2020 5:01:21 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 12/15/2020 7:27:16 AM (Construction COC ADD TO FILE Review- NCC205483)
• The task was assigned to Georgoulias, Bethany. The due date is: December 17, 2020 5:00 PM
12/14/2020 5:01 PM

Y. ,
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of
NCC205483
Coverage (COC)
Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated
with this permit:
Project Name
MAGNOLIA CREEK PHASE 3 LOTS 180 AND 183
Address
BRIDGEWATER DRIVE, DURHAM, NC
County
Durham
Latitude
36.0579
Longitude
-78.8831
Permittee Listed
NVR, Inc.
Legally Responsible
MEREDITH SWEITZER
Individual
NC Reference No.
NCG01-2020-5483
E&SC Plan ID
6205
Original NOI
37308
Tracking No.*
Date COC Issued*
11/30/2020
Prior Rescission
This field will populate only if CCChas already been rescinded.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
r Legally Responsible Individual and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional Mxe inforrration if needed (e.g., new Site Contact details can be included here)
Explanation This is an amendment adding lots 177, 178, and 179 in Magnolia Creek
subdivision to this COC.
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 (Pevised E&SCApproval, nose -Out Doc, etc.)
Documentation MG CREEK- LOTS 177, 178, 179- LD PERMIT.pdf 61.2KB
MG CREEK- LOTS 177, 178, 179- PLANS.pdf 5.25MB
Mast be FDFfornat
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowingly makes anyfalse 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 guiltyofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
17 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
jot Im/M
Type Name* JOE SCHMIDTKE
Title * VICE PRESIDENT
Organization* NVR, Inc.
Date * 12/14/2020
Email Address* [e-mail]
Errail for confirnation
Telephone Number* 9199871930
Contact number if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email Additional en -ail for confirnation
(Optional)
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 12/15/2020
Rescinded Since
Submitted?

Request Date 20201214
Formatted
Review Date 20201215
Formatted