NCC213374_Modification Review_20210813

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 8/13/2021 2:09:01 PM(ADD TO FILE Submittal)
Approve by Morman,Alaina 8/13/2021 2:59:17 PM(Construction COC ADD TO FILE Review-NCC213374)
• The task was assigned to Morman,Alaina.The due date is:August 18,2021 5:00 PM
8/13/2021 2:09 PM

EESS - 1 •
NORYH CAIiOLINA
EnYlrenmemf&Quality
Certificate of NCC213374
Coverage (COC) Enter the Certificate of Coverage Ninber(Use capital letters)
No.*
Information associated with this permit:
Project Name Grandover Parcel N
Address Postbridge Road, Greensboro, NC
County Guilford
Latitude 35.9985
Longitude -79.9007
Permittee Listed Koury Ventures Limited Partnership
Legally Responsible Richard Vanore
Individual
NC Reference No. NCG01-2021-3374
E&SC Plan ID 3044
Original NOI 54581
Tracking No.*
Date COC Issued* 06/04/2021
Prior Rescission This field will populate only if COC has already been rescinded.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 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 revision to the disturbed area, new area is 12.60 acres
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 ERSC Approval,(lose-Cut Doc,etc.)
Documentation Parcel N-EROSION.pdf 9.98MB
Approval Letter 3044-REVISED ACREAGE.pdf 378.26KB
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).
PF 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
p(4tJp"A
Type Name* Blake Jones
Title* Vice President-Construction Division
Organization* Koury Corporation
Date* 08/13/2021
Email Address* [e-mail]
Emil for confin-ration
Telephone Number* 3363122387
Contact nunber if 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 confin-ation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 08/13/2021
Rescinded Since
Submitted?

Request Date 20210813
Formatted
Review Date 20210813
Formatted