NCC190575_Notice of Termination_20201211

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/11/2020 1:45:12 PM (NOT Submittal)
Approve by Georgoulias, Bethany 12/11/2020 2:21:26 PM (NOT Request Review- NCC190575)
• The task was assigned to Georgoulias, Bethany. The due date is: December 16, 2020 5:00 PM
12/11/2020 1:45 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190575
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee PAID
Status
Information associated with this permit:
Project Name
Stonehaven - RRB
Address
2337 Great Laurel Court, Greenville, NC
County
Pitt
Latitude
35.5825
Longitude
-77.4375
Permittee Listed
ROCKY RUSSELL BUILDERS, INC.
Legally Responsible
ROCKY RUSSELL
Individual
NC Reference No.
NCG01-2019-0575
E&SC Plan ID
ESCP-2019-0018
Original NOI
12051
Tracking No.
Date COC Issued
6/11/2019
Prior Rescission
Cute populates only if CCCwas already rescinded at time of submittal.
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
Add ional Mare information about the basis of this request, if needed.
Explanation All lots have homes and sold.
Supporting Upload Supporting Cbcurnentation if applicable.
Documentation NLstbeFOFformat
Project Close-out Information:

Final Close-out 12/11/2020
Inspection Approval
Project Close-out NOT Letter-Stonehaven-RRB.pdf 149.19KB
Approval Mast be RYforrrat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes anyfalse 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 knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho 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 notto 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
.6le 14-1111,
Type Name* Rocky E. Russell
Title * President
Organization* Rocky Russell Builders, Inc.
Date * 12/11 /2020
Email for [e-mail]
Confirmation *
Contact Telephone * [e-mail]
NOT Certification 20201211135338907.pdf 58.49KB
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 [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]