NCC200659_Notice of Termination_20210302

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/2/2021 1:22:31 PM (NOT Submittal)
Approve by Morman, Alaina 3/3/2021 2:39:37 PM (NOT Request Review- NCC200659)
* Willoughby Lots 33 and 34 will no longer be covered under NCC200659 as this COC is being
permanently closed.
• The task was assigned to Morman, Alaina. The due date is: March 5, 2021 5:00 PM 3/2/2021 1:22 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC200659
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
OPEN
K/hy be blank (if not yet billed).
Information associated
with this permit:
Project Name
Willoughby Lots 33-36, 40&41
Address
Adkins Ridge Road, Rolesville, NC
County
Wake
Latitude
35.9300
Longitude
-78.4720
Permittee Listed
The Drees Company
Legally Responsible
Jerry Dean
Individual
NC Reference No.
NCG01-2020-0659
E&SC Plan ID
SEC-030184-2019
Original NOI
22084
Tracking No.
Date COC Issued
2/19/2020
Prior Rescission
Cate populates only if COCwas already rescinded at time of submittal.
Date
Reason for Rescission/Termination Request:
Reason for
r Project Closed -Out
Termination of
r Sale (Another Owner/Operator obtained 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 Documentation if applicable.
Documentation MstbeRYforrrat

Project Close-out Information:
Final Close-out 11/30/2020
Inspection Approval
Project Close-out WBY lots SEC-030184-2020 Certificate of
Approval 164.95KB
Completion_11-30-20_Lots35-36,40,41.pdf
Documentation
Mast be Ft7Fforrrat
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 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
Type Name* Jerry Dean
Title * Division President
Organization* The Drees Homes Company
Date * 03/02/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 919.256.5432
NOT Certification WBY NOT form. pdf
Form Mast be Ft7F Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Erails
(Optional)
Original Permittee CCd on Wification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]
359.16KB