NCC190385_Notice of Termination_20210503

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/3/2021 1:47:06 PM (NOT Submittal)
Approve by Georgoulias, Bethany A 5/4/2021 10:05:31 AM (NOT Request Review- NCC190385)
• Georgoulias, Bethany A reassigned the task to Georgoulias, Bethany A 5/4/2021 10:04 AM
The task was assigned to Morman, Alaina. The due date is: May 6, 2021 5:00 PM 5/3/2021 1:47 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC190385
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
PAID
2021 Annual Fee Status
OPEN
K/hy be blank (if not yet billed).
Information associated
with this permit:
Project Name
LEXINGTON SUBDIVISION
Address
156 LEANGTON DRIVE, APEX, NC
County
Chatham
Latitude
35.7773
Longitude
-78.9584
Permittee Listed
HEARTHSTONE LUXURY HOMES LLC dba/Arthur Rutenberg
Homes of the Triangle
Legally Responsible
JEFF LOGSDON
Individual
NC Reference No.
NCG01-2019-0385
E&SC Plan ID
2019-04624
Original NOI
11402
Tracking No.
Date COC Issued
5/28/2019
Prior Rescission
Date populates only if COCwas already rescinded at tirre of submttal.
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
Add ional We information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting DDcurrentation if applicable.
Documentation NLstbeFDFforrrat

Project Close-out Information:
Final Close-out 5/3/2021
Inspection Approval
Project Close-out CERTIFICATE OF COMPLETION Lexington 11.pdf 139.95KB
Approval Mast be PDFforrrat
Documentation
North Carolina General Statute 143-215.613 (i) 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 Artide or a rule implementing this Artide; 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 device or method required to be operated or maintained under this Artide or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
17 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* Jeff Logsdon
Title * President / Owner
Organization* Hearthstone Luxury Homes
Date * 05/03/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 7039656917
NOT Certification NCG01 Notice of Termination (NOT) Certification
Form 545.58KB
Form.pdf
Mast be PDF Forrrat
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
0Cd on Notification Errails
CCd on Notification Errails
[e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]