HomeMy WebLinkAboutNCC193081_Notice of Termination_20201208Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/8/2020 1:48:32 PM (NOT Submittal)
Approve by Georgoulias, Bethany 12/9/2020 1:35:59 PM (NOT Request Review- NCC193081)
• The task was assigned to Georgoulias, Bethany. The due date is: December 11, 2020 5:00 PM
12/8/2020 1:48 PM
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NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC193081
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee OPEN
Status
Information associated with this permit:
Project Name
Papillon Park Lot 25
Address
2220 Duskywing Dr, Raleigh, NC
County
Wake
Latitude
35.9622
Longitude
-78.7118
Permittee Listed
Legacy Custom Homes
Legally Responsible
Alex Elledge
Individual
NC Reference No.
NCG01-2019-3081
E&SC Plan ID
SEC-026236-2019
Original NOI
19029
Tracking No.
Date COC Issued
12/10/2019
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Cute populates only if CCCwas already rescinded at tirre of submttal.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 10/28/2020
Inspection Approval
Project Close-out PA 25 - SEC-026236-2019 Certificate of
Approval 136.71 KB
Completion.pdf
Documentation
Mast be FL7Fforrrat
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 Arficle; 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 Arficle 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
lo/
Type Name* Alex Elledge
Title * Project Manager
Organization * Legacy Custom Homes
Date * 12/08/2020
Email for alex@legacycustomhomes.com
Confirmation *
Contact Telephone* 9196169441
NOT Certification PA 25 - NCG01-eNOT-Certification-Form.pdf
Form Mast be PDF Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on Notification Errails
Email alex@legacycustomhomes.com
Original Site Contact CCd on Notificaiton Bmils
Email alex@legacycustomhomes.com
448.94KB