NCC211820_Modification Review_20210908

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/7/2021 2:39:40 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 9/8/2021 7:55:25 AM (Construction COC ADD TO FILE Review- NCC211820)
The task was assigned to Georgoulias, Bethany A. The due date is: September 10, 2021 5:00 PM
9/7/2021 2:39 PM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC211820
Coverage (COC) Enter the Certificate of Coverage Ninber (use capital letters)
No.*
Information associated with this permit:
Project Name Windy Gap Dining Hall & Infrastructure Expansion
Address 120 Coles Cove Road, Weaverville, NC
County Buncombe
Latitude 35.7438
Longitude-82.5106
Permittee Listed Young Life
Legally Responsible Paul Sherrill
Individual
NC Reference No. NCG01-2021-1820
E&SC Plan ID
Original NOI
Tracking No.
ER02021-000023
48457
Date COC Issued* 03/26/2021
Prior Rescission This field will populate only if COChas already been rescinded.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 * 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 Nbre information (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation Added additional areas of disturbance to facilitate material storage and a small
rework of the project plans.
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 Lee_2021-09-07_LOD Approval.pdf 583.27KB
APPROVED_YLC011_2021-08-16_Revison_C-1.pdf 864.41KB
Mast be FDFfornat
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 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
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
�rx�, �. t u �� • �r'll
Type Name* Paul Sherrill
Title * Vic President of Administrative Services
Organization* Young Life
Date * 09/07/2021
Email Address* [e-mail]
Errail for confirnation
Telephone Number* 719-391-1960
Contact number if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional errail for confirrration
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 09/08/2021
Rescinded Since
Submitted?

Request Date 20210907
Formatted
Review Date 20210908
Formatted