HomeMy WebLinkAboutNCC192055_Notice of Termination_20201230Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/30/2020 2:33:28 PM (NOT Submittal)
Approve by Georgoulias, Bethany 1/4/2021 7:39:33 AM (NOT Request Review- NCC192055)
• The task was assigned to Georgoulias, Bethany. The due date is: January 4, 2021 5:00 PM
12/30/2020 2:33 PM
1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC192055
Coverage (COC) Enter the Certificate of Coverage Nimber
No.*
2020 Annual Fee Status OPEN
2021 Annual Fee Status May be blank (if not yet billed)
Information associated with this permit:
Project Name
Glenmere Subdivision Lot 82
Address
535 Glenmere Dr., Knightdale, NC
County
Wake
Latitude
35.7783
Longitude
-78.4762
Permittee Listed
ICG Homes, LLC
Legally Responsible
Ryan Perry
Individual
NC Reference No.
NCG01-2019-2055
E&SC Plan ID
SEC-025114-2019
Original NOI
16288
Tracking No.
Date COC Issued
9/26/2019
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
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 *
O 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 Dxurrentation if applicable.
Documentation Mist beFDFformat
Project Close-out Information:
Final Close-out 4/21/2020
Inspection Approval
Project Close-out GLM082 - SEC-025114-2019 - LDP - Cert. of
Approval 118.58KB
Completion.pdf
Documentation
Mast be Ft7Fforrrat
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 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 ofthe
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to 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
Type Name* Ryan Perry
Title * Owner
Organization* ICG Homes, LLC
Date * 12/30/2020
Email for hbrazell@icghomes.com
Confirmation *
Contact Telephone* 803-348-1944
NOT Certification GLM082 - NCG01 - NOT Cert. Form.pdf 826.21 KB
Form Mast be PDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
CCd on Notification Erails
CCd on Notification Erails
rperry@icghomes.com
Original Site Contact CCd on Notificaiton BTails
Email hbrazell@icghomes.com