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HomeMy WebLinkAboutNCC205092_Modification Review_20220317Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 3/15/2022 11:29:28 AM (ADD TO FILE Submittal) Approve by Georgoulias, Bethany A 3/17/2022 7:00:23 AM (Construction COC ADD TO FILE Review - NCC205092) The task was assigned to Georgoulias, Bethany A. The due date is: March 18, 2022 5:00 PM 3/15/2022 11:29 AM i �M1 itowl�a NORTH CAROLINA EnNlmnmrnfel QuoN1y Certificate of NCC205092 Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters) Information associated with this permit: Project Name Atlantic Packaging - Print Shop Addition Address 1107 E. 5th Street, Tabor City, NC County Columbus Latitude 34.1568 Longitude-78.8626 Permittee Listed WELS Holdings, LLC. Legally Responsible Russell Carter Individual NC Reference No. NCG01-2020-5092 E&SC Plan ID COLUM-2021-003 Original NOI Tracking 35265 No. * Date COC Issued* 11/17/2020 Prior Rescission Date This field will populate only if COC has already been rescinded. Modification Information: Reason for Closed -Out Lots/Outparcels in E&SC Plan Modification* Additional Lots/Outparcels Approved - E&SC Revised Other Revision(s) to E&SC Plan Legally Responsible Individual and/or Site Contact Has Changed Multiple Reasons (List) Addional Explanation More information (e.g., new Site Contact details). If lots are being added, please include specific lot numbers. Increase in disturbed area from 2.6 acres to 4.85 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 Documentation (Revised E&SC Approval, Close -Out Doc, etc.) Documentation COLUM-2021-003 Approval Revised 2-25-2022 307.48KB (3).pdf Must be PDF format North Carolina General Statute 143-215.613 (1) provides that: Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other document filed 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 under this 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 guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). * 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:* • The Legally Responsible Individual 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 Type Name* Russell M. Carter Title* Manager Organization* WELS Holdings, LLC. Date * 03/15/2022 Email Address* rusty@atlanticpkg.com Email for confirmation Telephone Number* 9103430624 Contact number if we need to reach you Note: Original permittee and site contact are copied on modification correspondence. Additional Email djohnson.ae@gmail.com (Optional) Additional email for confirmation Original Permittee rusty@atlanticpkg.com Email Original Site Contact lexj@atlanticpkg.com Email Review Date 03/17/2022 Rescinded Since Submitted? Request Date 20220315 Formatted Review Date 20220317 Formatted