NCC215215_Modification Review LOTS 169-170 177_20211006

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/5/2021 10:50:17 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 10/6/2021 4:27:51 PM (Construction COC ADD TO FILE Review -
NCC215215)
• The task was assigned to Georgoulias, Bethany A. The due date is: October 8, 2021 5:00 PM
10/5/2021 10:50 AM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC215215
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit:
Project Name Stockbridge at Tanglewood Phase 2
Address 3800 Union Street, Elizabeth City, NC
County Pasquotank
Latitude 36.2891
Longitude-76.2825
Permittee Listed NVR, Inc.
Legally Responsible Gregg Knapp
Individual
NC Reference No. NCG01-2021-5215
E&SC Plan ID Pasqu-2015-014
Original NOI 64893
Tracking No.*
Date COC Issued* 09/20/2021
Prior Rescission This field will populate only if CCChas already been rescinded.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 Nbre information (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation Added Lots 169, 170,177
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 Letter of Approval Stockbridge at Tanglewood (Ryan
749.33KB
Homes) - Lots 169 170 177.pdf
Stockbridge 20 lots map.pdf 947.26KB
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 A tide 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 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).
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 NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
�1137 `el
Type Name* Greg Knapp
Title * Vice President
Organization* WR
Date * 10/05/2021
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 8043045938
Contact nun ber 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 confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 10/06/2021
Rescinded Since
Submitted?

Request Date 20211005
Formatted
Review Date 20211006
Formatted