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HomeMy WebLinkAboutNCC203231_Modification Review LOTS 204 344_20210415Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 4/14/2021 2:22:06 PM (ADD TO FILE Submittal) Approve by Georgoulias, Bethany 4/15/2021 6:30:16 AM (Construction COC ADD TO FILE Review- NCC203231) • The task was assigned to Georgoulias, Bethany. The due date is: April 19, 2021 5:00 PM 4/14/2021 2:22 PM Y . Ta4M1 NORTH CAPOLINA EnYlrenmemf& Qualay Certificate of NCC203231 Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters) No.* Information associated with this permit Project Name 75 Leven Links Lane Address 75 Leven Links Ln, Pinehurst, NC County Moore Latitude 35.1903 Longitude -79.4307 Permittee Listed Homes by Dickerson INC Legally Responsible Jonathan Showalter Individual NC Reference No. NCG01-2020-3231 E&SC Plan ID 20-3200 Original NOI 28911 Tracking No.* Date COC Issued* 07/29/2020 Prior Rescission This field will populate only if CCChas already been rescinded.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 Ivbre information (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers. Explanation Modifying to add lots 204 and 344 Pinehurst national 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 Docurrentation (%vised EBSC Approval, (lose -Out Doc, etc.) Documentation 48-0204 Minor EC Approval.pdf 100.42KB 48-0344 Minor EC Approval.pdf 101.27KB Wst be FDFforrrat North Carolina General Statute 143-215.6113 (i) provides that: Anyperson who knowinglymakes anyfalse 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 knowinglymakes a false statement of a material fact in a rulemaking proceeding or contested case underthis Article; orwho 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 notto 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:* r The Legally Responsible Individual f 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 �i�rar�f�ar 4 Ss/'tco-r�-r�~Rt Type Name* Jonathan M Showalter Title * COO / VP Organization* Homes by Dickerson INC Date * 04/14/2021 Email Address* jon@homesbydickerson.com Emil for confin-ration Telephone Number* 9198474447 Contact nunber if we need to reach you Note: Original permittee and site contact are copied on modification correspondence. Additional Email korourke@homesbydickerson.com (Optional) Additional en -ail for confin-ation Original Permittee operations@homesbydickerson.com Email Original Site Contact csteyne@homesbydickerson.com Email Review Date 04/15/2021 Rescinded Since Submitted? Request Date 20210414 Formatted Review Date 20210415 Formatted