NCC200816_Modification Review_20210602

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/1/2021 9:22:18 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 6/2/2021 8:11:21 AM (Construction COC ADD TO FILE Review- NCC200816)
* Unable to change name of project on COC, but this modification will add revised approval to the permit
file.
The task was assigned to Georgoulias, Bethany A. The due date is: June 4, 2021 5:00 PM
6/1/2021 9:22 AM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC200816
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit
Project Name
Heritage Pointe Phases 1, 2, & 3
Address
Howard Road, Newport, NC
County
Carteret
Latitude
34.7983
Longitude
-76.8877
Permittee Listed
JW Land, LLC
Legally Responsible
Jeremy Jackson
Individual
NC Reference No.
NCG01-2020-0816
E&SC Plan ID
CARTE-2017-012
Original NOI
22588
Tracking No.*
Date COC Issued*
02/28/2020
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This field will populate only if CCChas already been rescinded.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 * a Additional Lots/Outparcels Approved - E&SC Revised
O Other Revision(s) to E&SC Plan
r Legally Responsible Individual and/or Site Contact Has Changed
F Multiple Reasons (List)
Name Change to "Heritage Pointe Phases 1, 2, 3 & 4". Disturbed
acreage increases to 123 acres total.
Addional IVbre information (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation
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 (Revised E&SCApproval, nose -Out Doc, etc.)
Documentation CARTE-2017-012 Approval Revised 5-21-2021.pdf 231.51KB
Mist be FDFfornat
North Carolina General Statute 143-215.6113 (i) 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 Artide or a rule implementing this Artide; 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 Artide 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).
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
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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
l" C104a
Type Name* Jeremy C. Jackson
Title * Manager
Organization* JW Land, LLC
Date * 06/01 /2021
Email Address* [e-mail]
En -ail for confirnation
Telephone Number* 2528381590
Contact nunber ff we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional en -ail for confirnation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 06/02/2021
Rescinded Since
Submitted?

Request Date 20210601
Formatted
Review Date 20210602
Formatted