NCC190433_Notice of Termination_20201231

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/31/2020 10:16:28 AM (NOT Submittal)
Approve by Georgoulias, Bethany 1/4/2021 7:21:52 AM (NOT Request Review- NCC190433)
• The task was assigned to Georgoulias, Bethany. The due date is: January 5, 2021 5:00 PM
12/31 /2020 10:16 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190433
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status PAID
2021 Annual Fee Status Nbybeblank (if not yet billed)
Information associated with this permit:
Project Name
The Enclave at Deep River Plantation - Phase II
Address
4203 River Birch Loop, High Point, NC
County
Guilford
Latitude
36.0429
Longitude
-79.9459
Permittee Listed
EBSCO Enclave Phase II, LLC
Legally Responsible
Leslie Yeilding
Individual
NC Reference No.
NCG01-2019-0433
E&SC Plan ID
EN-19-0134
Original NOI
11529
Tracking No.
Date COC Issued
6/3/2019
Prior Rescission
Date populates only if OOC was already rescinded at tirre of submittal.
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
Ad d i o n a I Nbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Docurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 12/11/2020
Inspection Approval
Project Close-out Surety Release.pdf
Approval Mast be FDFforrrat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
1.43MB
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 anyrecording or monitoring deice or method required to be operated or maintained under this Article or rules ofthe
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine notto exceed 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
fa6r' L Y441
Type Name* Leslie L. Yeilding
Title * President and General Manager
Organization* EBSCO Enclave Phase 11, LLC
Date * 12/31 /2020
Email for [e-mail]
Confirmation *
Contact Telephone* [phone]
NOT Certification NOT Cert - Stormwater - Enclave II.pdf 435.79KB
Form Mast be FDF Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
CCd on Notification Errails
[e-mail]
CCd on Notification Errails
[e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]