NCC191853_Notice of Termination_20210730

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/30/2021 3:09:36 PM (NOT Submittal)
Approve by Morman, Alaina 8/2/2021 4:46:29 PM (NOT Request Review- NCC191853)
• The task was assigned to Morman, Alaina. The due date is: August 4, 2021 5:00 PM
7/30/2021 3:09 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC191853
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
McKee Pond
Address
Hamstead Pond, Charotte, NC
County
Mecklenburg
Latitude
35.0821
Longitude
-80.7178
Permittee Listed
Eastwood Construction
Legally Responsible
Marc Battiste
Individual
NC Reference No.
NCG01-2019-1853
E&SC Plan ID
LDGP-2019-00169
Original NOI
15835
Tracking No.
Date COC Issued
9/13/2019
Prior Rescission
Date populates only if OOC was already rescinded at tirre of subaittal.
Date
Reason for Rescission/Termination Request:
Reason for
F Project Closed -Out
Termination of
r Sale (Another Owner/Operator obtained a new COC)
Coverage *
O Mistake or Invalid Coverage
r Other
Addional Nbre information about the basis of this request, if needed.
Explanation Closing out lot grading permit for subdivision
Supporting Upload Supporting Dxurrentation if applicable.
Documentation Mist beFDFforrrat

Project Close-out Information:
Final Close-out 7/30/2021
Inspection Approval
Project Close-out McKee Pond _Grading Permit NOT.pdf 85.07KB
Approval Mast be FDFforrrat
Documentation
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* Marc Battiste
Title * VP of Construction
Organization* Eastwood Homes
Date * 07/30/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 704-399-4663
NOT Certification MGENOT20210730_15081302.pdf
Form Mast be FDF Format
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional) [e-mail]
Original Permittee CCd on Wification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]
635.75KB