NCC190471_Notice of Termination_20201208

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/8/2020 10:16:33 AM (NOT Submittal)
Approve by Georgoulias, Bethany 12/8/2020 3:12:09 PM (NOT Request Review- NCC190471)
• The task was assigned to Georgoulias, Bethany. The due date is: December 11, 2020 5:00 PM
12/8/2020 10:16 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190471
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee OPEN
Status
Information associated with this permit:
Project Name
Stevens Grove - Lot 38-B (#395895)
Address
1056 Arborfield Drive, Matthews, NC
County
Mecklenburg
Latitude
35.1050
Longitude
-80.7590
Permittee Listed
Paragon Homes of Charlotte, Inc.
Legally Responsible
Mitch Genda
Individual
NC Reference No.
NCG01-2019-0471
E&SC Plan ID
395895
Original NOI
11647
Tracking No.
Date COC Issued
6/4/2019
Prior Rescission
Cute populates only if CCCwas already rescinded at tirre of submttal.
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 *
r Mistake or Invalid Coverage
r Other
Addional IVbre information about the basis of this request, if needed.
Explanation
Supporting upload Supporting DDcurrentation if applicable.
Documentation NLstbeFOFformat
Project Close-out Information:

Final Close-out 12/7/2020
Inspection Approval
Project Close-out Lot 38 Final Inspection.pdf 96.78KB
Approval Mast be FCFforrrat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Pnyperson 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 e)ceed ten thousand
dollars ($10,000).
rJ 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* Mitch Genda
Title * President/Owner
Organization* Paragon Homes Of Charlotte
Date * 12/08/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 7048890218
NOT Certification (NOT).pdf 34.54KB
Form Mast be PDF Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on Wification BTails
Email [e-mail]
Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]