NCC190410_Notice of Termination_20200124

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/24/2020 11:10:19 AM (NOT Submittal)
Approve by Georgoulias, Bethany 1/24/2020 11:53:03 AM (NOT Request Review- NCC190410)
• McCoy, Suzanne reassigned the task to Georgoulias, Bethany 1/24/2020 11:15 AM
• The task was assigned to McCoy, Suzanne by round robin distribution 1/24/2020 11:10 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 29, 2020 5:00
PM 1/24/2020 11:10 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190410
Coverage (COC) Enter the Certificate of Coverage Ninber
No.*
Information associated with this permit
Project Name
The Cove at Mackintosh
Address
4595 Bonnar Bridge Parkway, Burlington, NC
County
Guilford
Latitude
36.0568
Longitude
-79.5416
Permittee Listed
D.R. Horton
Legally Responsible
Meredith Armeni
Individual
NC Reference No.
NCG01-2019-0410
E&SC Plan ID
648
Original NOI
11436
Tracking No.
Date COC Issued
5/30/2019
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
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 Submitted for New COC
Add ional Nbre inforrration about the basis of this request, if needed.
Explanation New COC was issued due to additional
acreage, new address and new responsible
party. New COC attached.
Supporting upload Supporting Lbcurrentation if applicable.
Documentation The Cove at Mackintosh Certificate of Coverage.pdf 40.57KB
Mast be FOFfornat
Project Close-out Information:

Final Close-out
Inspection Approval
Project Close-out Mist beFDFformat
Approval
Documentation
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 deice 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
011edde;_'ZZ (_Aef
Type Name* Jessica Meyer
Title * NPDES Technical Compliance Administrator
Organization* DR Horton
Date * 01 /24/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 919-215-6561
NOT Certification The Cove NCC190410 NOT Certification Form.pdf 390.34KB
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?