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HomeMy WebLinkAboutNCC203087_Modification Review LOT 61_20210901Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 8/31/2021 2:48:51 PM (ADD TO FILE Submittal) Approve by Georgoulias, Bethany A 9/1/2021 10:04:28 AM (Construction COC ADD TO FILE Review - NCC203087) • The task was assigned to Georgoulias, Bethany A. The due date is: September 3, 2021 5:00 PM 8/31 /2021 2:48 PM Y . Ta4M1 w, NORTH CAPOLINA EnYlrenmemf& Qualay Certificate of NCC203087 Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters) No.* Information associated with this permit: Project Name Wakefield Meadows Phase 5 Lot 46 Address 1236 Tin Barn Road, Zebulon, NC County Wake Latitude 35.8573 Longitude -78.3059 Permittee Listed Woody Built LLC Legally Responsible John Woody III Individual NC Reference No. NCG01-2020-3087 E&SC Plan ID SEC-039347-2020 Original NOI 28467 Tracking No.* Date COC Issued* 07/20/2020 Prior Rescission This field will populate only if COChas already been rescinded.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 * 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 Lot 61 1711 Whispering Meadows Ct. 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 lot 61 S&EC approval.pdf 274.73KB Mast be FDFformat 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 �a [?1F'V1f Type Name* Trina Campbell Title * Office Manager Organization* Woody Built LLC Date * 08/31 /2021 Email Address* trina@woodybuilt.com Errail for confirmation Telephone Number* 9198414884 Contact nun ber if we need to reach you Note: Original permittee and site contact are copied on modification correspondence. Additional Email Additional email for confirmation (Optional) Original Permittee trina@woodybuilt.com Email Original Site Contact Johnny@woodybuilt.com Email Review Date 09/01/2021 Rescinded Since Submitted? Request Date 20210831 Formatted Review Date 20210901 Formatted