NCC190151_Notice of Termination_20191024

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/24/2019 3:31:30 PM (NOT Submittal)
Approve by Farkas, Jim J 10/29/2019 12:20:26 PM (NOT Request Review- NCC190151)
• The task was assigned to Farkas, Jim J by round robin distribution 10/24/2019 3:31 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 29, 2019 5:00
PM 10/24/2019 3:31 PM

STME
NORTH CAROLINA
Ernvlronmental Qualily
Certificate of NCC190151
Coverage (COC) Enter the Certificate of Coverage Number
No. *
Information associated with this permit
Project Name
Falls Reserve Lot 29
Address
1000 Yellow Warbler Lane, Raleigh, NC
County
Wake
Latitude
35.9750
Longitude
-78.6650
Permittee Listed
Jordan's Construction, Inc.
Legally Responsible
Michael Jordan
Individual
NC Reference No.
NCG01-2019-0151
E&SC Plan ID
SEC-014906-2019
Original NOI
10552
Tracking No.
Date COC Issued
5/2/2019
Prior Rescission
lhis field will populate only if 0OChas already been rescinded.
Date
Reason for Rescission/Termination Request:
Reason for
r Project Closed -Out
Termination of
r Sale (Another Owner/Operator will apply for a new COC)
Coverage *
r Mistake or Invalid Coverage
r Other
Addional Nbre information about the basis of this request, if needed.
Explanation
Supporting 1pload Supporting Documentation if applicable.
Documentation WstbeFDFformat
Project Close-out Information:
Jn a1LUUFF1Widl1
Final Close-out 10/18/2019
Inspection Approval

Project Close-out FRE29 Land Disturbance Certificate of
Approval 148.86KB
Completion.pdf
Documentation
Mast be FCF format
North Carolina General Statute 143-215.6B (i) 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 knowinglymakes 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 guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
17 I, as an authorized representative, hereby request rescission of coverage under
the NPDES Stormwater Permit for the subject facility. 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.
"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
Type Name* Michael Jordan
Title * President
Organization* Jordan's Construction, Inc.
Date * 10/24/2019
Email for [e-mail]
Confirmation *
Contact Telephone* 9193004048
NOT Certification FRE29 Notice of Termination LID COC.pdf 240.73KB
Form Mist be FDF Format