HomeMy WebLinkAboutNCC191049_Notice of Termination_20200131Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/31/2020 3:22:58 PM (NOT Submittal)
Approve by Georgoulias, Bethany 2/4/2020 12:57:24 PM (NOT Request Review- NCC191049)
• Georgoulias, Bethany reassigned the task to Georgoulias, Bethany 2/4/2020 9:33 AM
• The task was assigned to Morman, Alaina by round robin distribution 1/31/2020 3:23 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: February 5, 2020 5:00
PM 1/31/2020 3:23 PM
1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC191049
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Stonewater S/D Phase 4, Lot 120
Address
237 Teague St., Wake Forest, NC
County
Wake
Latitude
35.9300
Longitude
-78.5031
Permittee Listed
ICG Homes, LLC
Legally Responsible
Ryan Perry
Individual
NC Reference No.
NCG01-2019-1049
E&SC Plan ID
SWF-020568-2019
Original NOI
13821
Tracking No.
Date COC Issued
7/24/2019
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
Date
Reason for Rescission/Termination Request:
Reason for F Project Closed -Out
Termination of r Sale (Another Owner/Operator will apply for a new COC)
Coverage * O Mistake or Invalid Coverage
r Other
Addional We inforrration about the basis of this request, if needed.
Explanation
Supporting upload Supporting Docurrentation if applicable.
Documentation Mist beFDFforrrat
Project Close-out Information:
Final Close-out 11/7/2019
Inspection Approval
Project Close-out STW120 - SEC-012312-2019_Certificate of
Approval 119.43KB
Completion_Lot120.pdf
Documentation
Mast be FL7Fforrrat
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes anyfalse 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 underthis Article; orwho falsifies, tampers with, or knowinglyrenders
inaccurate anyrecording 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 notto 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
?,K ` •tom
Type Name* Ryan Perry
Title * Owner
Organization* ICG Homes, LLC
Date * 01 /31 /2020
Email for hbrazell@icghomes.com
Confirmation *
Contact Telephone* 919-876-5802
NOT Certification STW120 - NCG01 NOT Cert Form.pdf 332.08KB
Form Mast be PDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?