NCC202870_Notice of Termination_20201202

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/2/2020 1:21:44 PM (NOT Submittal)
Approve by Georgoulias, Bethany 12/2/2020 5:28:55 PM (NOT Request Review- NCC202870)
• The task was assigned to Georgoulias, Bethany. The due date is: December 7, 2020 5:00 PM
12/2/2020 1:21 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC202870
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Willoughby lot 15
Address
3022 Freeman Farm Way, Rolesville, NC
County
Wake
Latitude
35.9304
Longitude
-78.4711
Permittee Listed
The Drees Company
Legally Responsible
Jerry Dean
Individual
NC Reference No.
NCG01-2020-2870
E&SC Plan ID
SEC-039552-2020
Original NOI
27811
Tracking No.
Date COC Issued
7/9/2020
Prior Rescission
Date populates only if COCwas already rescinded at tirre of subrrittal.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 * U Mistake or Invalid Coverage
r Other
Add ional MDre information about the basis of this request, if needed.
Explanation I had piggybacked on the Modification Form
for Willoughby lot 15. But closing out
Willoughby lot 61 here.
Supporting Upload Supporting Docurrentation if applicable.
Documentation Mast beFDFforrrat
Project Close-out Information:

Final Close-out 11/30/2020
Inspection Approval
Project Close-out WBY 61 SEC-040155-2020 Certificate of
Approval 163.35KB
Completion_11-30-20.pdf
Documentation
Mist be RYforrrat
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 Artide 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 device or method required to be operated or maintained under this Artide 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* Jerry Dean
Title * Division President
Organization* The Drees Homes Company
Date * 12/02/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 919.256.5432
NOT Certification WBY 61 NOT Certification form.pdf
Form Mist be RY Forrrat
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCdonWificationBmils
Email [e-mail]
Original Site Contact OCd on %tificaiton Errails
Email [e-mail]
348.33KB