NCC193346_Notice of Termination_20200824

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/24/2020 8:09:36 AM (NOT Submittal)
Approve by Georgoulias, Bethany 8/24/2020 8:23:50 AM (NOT Request Review- NCC193346)
p Applicant corrected close-out approval date from the first submittal but inadvertently uploaded the NOT
certification form twice. Reviewer will add the original copy of the Wake Co approval from the previous
submittal to the permit file.
• The task was assigned to Georgoulias, Bethany. The due date is: August 27, 2020 5:00 PM
8/24/2020 8:09 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC193346
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Willoughby lot 40
Address
528 Adkins Ridge Road, Rolesville, NC
County
Wake
Latitude
35.9297
Longitude
-78.4720
Permittee Listed
The Drees Company
Legally Responsible
Jerry Dean
Individual
NC Reference No.
NCGO1-2019-3346
E&SC Plan ID
SEC-029709-2019
Original NOI
19898
Tracking No.
Date COC Issued
1/2/2020
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 Mxe 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 7/23/2020
Inspection Approval

Project Close-out WBY 40 NOT Certification Form.pdf 337.97KB
Approval Mist be RYforrrat
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 ofthe
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* Jerry Dean
Title * Division President
Organization* The Drees Company
Date * 08/24/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 9198449288
NOT Certification WBY 40 NOT Certification Form. pdf 337.97KB
Form Mist be PDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCdonWificationErrails
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]

Georgoulias, Bethany
From: [e-mail]
Sent: Monday, August 24, 2020 7:44 AM
To: [e-mail]
Cc: Georgoulias, Bethany; McCoy, Suzanne; [e-mail];
[e-mail]
Subject: NOT Request Not Approved
This email is to notify you that your request to rescind COC No. NCC 193346 for the project Willoughby lot 40
was not approved for the following reason:
The NOT request records the final close-out inspection/approval as 8/21/2020, but the uploaded documentation
from Wake Co. is dated 7/23/2020. Please resubmit an NOT request with this discrepancy corrected.
If you have any questions, please contact The NC DEMLR Stormwater Program at [phone].
This email was automatically generated by Laserfzche. Please do not respond to this email address, as
responses are not monitored.