NCC191284_Notice of Termination_20210929

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/29/2021 2:03:50 PM (NOT Submittal)
Approve by Morman, Alaina 10/4/2021 9:01:16 PM (NOT Request Review- NCC191284)
• The task was assigned to Morman, Alaina. The due date is: October 4, 2021 5:00 PM
9/29/2021 2:03 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC191284
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status PAST DUE
2021 Annual Fee Status PAST DUE
Nby be blank (iF not yet billed).
This permittee owes a fee that is PAST DUE and has a pending NOD or NOV. Do not approve this NOT request
until payment is resolved. If this NOT request is acceptable, payment may be waived if applicable, but that action must
be completed first (at the NOD or NOV Review step) to ensure records are routed to the correct folder in the
repository.
However, you can reject the NOT now if it is not acceptable.
Information associated with this permit:
Project Name
Lot 43 Sunset grove
Address
300 Starwood Dr, Pittsboro, NC
County
Chatham
Latitude
36.0000
Longitude
-79.0000
Permittee Listed
Easterling Fine Homes INC
Legally Responsible
Jeff Easterling
Individual
NC Reference No.
NCG01-2019-1284
E&SC Plan ID
2019-04786
Original NOI
14628
Tracking No.
Date COC Issued
8/15/2019
Prior Rescission
Cate populates only ff OOCwas already rescinded at tirre of subaittal.
Date
Reason for Rescission/Termination Request:

Reason for r Project Closed -Out
Termination of r Sale (Another Owner/Operator obtained a newCOC)
Coverage * r Mistake or Invalid Coverage
f Other
Additional We information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Ibcurrentation if applicable.
Documentation Mist beFDFformat
Project Close-out Information:
Final Close-out 3/15/2021
Inspection Approval
Project Close-out CERTIFICATE OF COMPLETION (1).pdf 34.37KB
Approval Mist be FDFformat
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 device 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).
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* Jeffrey Easterling
Title * President
Organization* Easterling Fine Homes INC>
Date * 09/29/2021
Email for [e-mail]
Confirmation *
Contact Telephone*
19192602207
NOT Certification
EPSON010.PDF 1.09MB
Form
Mist be FDF Format

Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional)
Original Permittee CCdonNotificationBmils
Email [e-mail]
Original Site Contact 0Cd on Notificaiton Errails
Email [e-mail]