NCC190560_Notice of Termination_20201030

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/30/2020 7:41:54 PM (NOT Submittal)
Approve by Georgoulias, Bethany 11/2/2020 8:12:28 AM (NOT Request Review- NCC190560)
• The task was assigned to Georgoulias, Bethany. The due date is: November 4, 2020 5:00 PM
10/30/2020 7:42 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190560
Coverage (COC) Enter the Certificate of Coverage Ninber
No.*
Information associated with this permit
Project Name
Jordans Ridge -(Lots 1-7)
Address
Forester Dr & Woodford Ln, McNeill Twp., NC
County
Moore
Latitude
35.2391
Longitude
-79.2822
Permittee Listed
H & H Constructors, Inc.
Legally Responsible
Brian Walker
Individual
NC Reference No.
NCG01-2019-0560
E&SC Plan ID
MOORE-2019-062
Original NOI
11955
Tracking No.
Date COC Issued
6/12/2019
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 * F Mistake or Invalid Coverage
r Other
Add ional Nbre inforrration about the basis of this request, if needed.
Explanation Project never started. No DENR was ever
processed
Supporting upload Supporting Docurrentation if applicable.
Documentation Mist beFDFfornat
Project Close-out Information:

Final Close-out
Inspection Approval
Project Close-out Mast bePDFfornat
Approval
Documentation
North Carolina General Statute 143-215.613 (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 Artide; 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 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
olhgw waewt
Type Name* Brian Walker
Title * Agent
Organization* H&HConstructors, Inc.
Date * 10/30/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 910-486-4864
NOT Certification NOT Jordans Ridge 1-7.pdf 179KB
Form Mast be RY Forrrat
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on Kbtification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton Erreils
Email [e-mail]