NCC190248_Notice of Termination_20210128

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/28/2021 2:18:06 PM (NOT Submittal)
Approve by Morman, Alaina 1/29/2021 3:55:16 PM (NOT Request Review- NCC190248)
• The task was assigned to Morman, Alaina. The due date is: February 2, 2021 5:00 PM
1 /28/2021 2:18 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190248
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
Basal Creek Townhomes (Phase 1) and Westec Way (Phase 2)
Address
NC 55 and Schnapps Lane, Fuquay-Varina, NC
County
Wake
Latitude
35.6189
Longitude
-78.8087
Permittee Listed
D.R. Horton, Inc.
Legally Responsible
Jessica Meyer
Individual
NC Reference No.
NCG01-2019-0248
E&SC Plan ID
EC-2018-07
Original NOI
10904
Tracking No.
Date COC Issued
5/10/2019
Prior Rescission
Date populates only if OOC was already rescinded at tirre of subaittal.
Date
Reason for Rescission/Termination Request:
Reason for
r Project Closed -Out
Termination of
F Sale (Another Owner/Operator will apply for a new COC)
Coverage *
r Mistake or Invalid Coverage
r Other
Ad d i o n a I We inforrration about the basis of this request, if needed.
Explanation Another entity was permitted for the property
under NCC205372 and DR Horton plans to
obtain a different COC for lots at this location
to prevent confusion about overlap or the
original transfer.

Supporting Upload Supporting Ebcurrentation if applicable.
Documentation Mast bePDFforrrat
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mist beRYfornat
Approval
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowinglymakes anyfalse statement, representation, or certification in anyapplication, record, report, plan, or other
document filed 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 under this Article; or who falsifies, tampers with, or knowinglyrenders
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 may include 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* Jessica Meyer
Title * NPDES Technical Compliance Administrator
Organization* DR Horton, Inc.
Date * 01 /28/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9192156561
NOT Certification Basal Creek NOT Form.pdf
Form Mast be PDF Fornat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Erails
(Optional)
Original Permittee CCdon%tificationEn-ails
Email [e-mail]
372.71 KB

Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]