NCC190446_Notice of Termination_20210805

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 8/5/2021 1:00:03 PM(NOT Submittal)
Approve by Morman,Alaina 8/10/2021 1:37:29 PM(NOT Request Review-NCC190446)
• The task was assigned to Morman,Alaina.The due date is:August 10,2021 5:00 PM
8/5/2021 1:00 PM

" RequestNOT • Construction Stormwater
1 i
�a•aThis formto request Notice of • • for •co\erage under •
NORTH CAROLINA General - for • i i• Activities Qr�arrry
Certificate of NCC190446
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status PAID
2021 Annual Fee Status PAID
fvby be blank(if not yet billed).
Information associated with this permit:
Project Name San Marino S/D( Lots#84,85,and 250)
Address E. Ravano Drive and San Periro Drive,Wilders Township, NC
County Johnston
Latitude 35.6496
Longitude -78.3761
Permittee Listed Cates Building , Inc.
Legally Responsible Christopher Cates
Individual
NC Reference No. NCG01-2019-0446
E&SC Plan ID JC#17-013-P
Original NOI 11629
Tracking No.
Date COC Issued 6/3/2019
Prior Rescission Cate populates only if COC was already rescinded at tirre of subrrittal.
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 inforrration about the basis of this request,if needed.
Explanation
Supporting upload Supporting Documentation if applicable.
Documentation Mist beRYforrrat

Project Close-out Information:
Final Close-out 8/5/2021
Inspection Approval
Project Close-out 84, 85, 250, 75, 76, 77, 83, 90, 94 and 251 Lot
Approval 535.33KB
closeout letter.pdf
Documentation
Mast be FCFforrrat
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* CHRISTOPHER E. CATES
Title* PRESIDENT
Organization* CATES BUILDING INC
Date* 08/05/2021
Email for [e-mail]
Confirmation
Contact Telephone* 9107787902
NOT Certification San Marino(Lots 84,85,and 250)NOT.pdf 388.45KB
Form Mast be Ft7F Format
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Bmils
(Optional)
Original Permittee CCd on Wification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]

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