NCC230481_Notice of Termination (DEQ INITIATED)_20230425

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Tev.Holloman 4/25/2023 9:25:14 AM (NOT Submittal)
Approve by bethany.georgoulias 4/25/2023 9:30:46 AM (NOT Request Review - NCC230481)
0 DEMLR Stormwater Billing Specialist initiated NOT process because COC was inadvertently issued
instead of rejected at the payment step for non-payment. This will complete the rescission and
applicant will be notified. Email correspondence will be added to the file.
• The task was assigned to DEMLR NCG01 NOT Review Team. The due date is: April 28, 2023 5:00 PM
4/25/2023 9:25:15 AM
• The task was assigned to Kieu Tran by round robin distribution 4/25/2023 9:25:15 AM
• bethany.georgoulias reassigned the task to bethany.georgoulias 4/25/2023 9:28:55 AM

Holloman, Tevye L
From: Holloman, Tevye L
Sent: Tuesday, April 25, 2023 9:19 AM
To: '[e-mail]'; [e-mail]
Cc: Georgoulias, Bethany; [e-mail];[e-mail]
Subject: RE: [External] Construction Stormwater General Permit Coverage
Good morning,
The COC was issued by mistake and will be rescinded immediately for lack of payment.
/r
Tevye (Tev) Holloman
Administrative Billing Specialist
DEMLR Stormwater Program
Office: [phone]
[e-mail]
North Carolina Department of Environmental Quality
Division of Energy, Mineral, and Land Resources Stormwater Program
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
Website: hUp://deq.nc.gov/about/divisions/energ,Y-mineral-land-resources/stormwater
t r - A-
... DE�T3
From: [e-mail] <[e-mail]>
Sent: Tuesday, April 25, 2023 9:13 AM
To: [e-mail]
Cc: Holloman, Tevye L <[e-mail]>; Georgoulias, Bethany<[e-mail]>;
[e-mail]; [e-mail]
Subject: [External] Construction Stormwater General Permit Coverage
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Dear Construction General Permit Permittee:
You have been granted coverage under North Carolina's NPDES General Stormwater Permit for Construction Activities.
Your Certificate of Coverage (COC) number is NCC230481, and your COC is attached.

This COC has been issued for South Fork LLC - Lot 4 in Iredell County, in response to the Notice of Intent (NCI)
application submitted on 2/17/2023.
You are required to follow the conditions of the NCG010000 General Permit (or NCG250000 General Permit, if
applicable) for the duration of your construction activity. You will be covered by this COC until you submit an electronic
Notice of Termination (eNCT), provided you remain current with your annual permit fees.
Remember, you must submit the ORIGINAL SIGNED NOI CERTIFICATION FORM that was uploaded to the eNCI to the
Stormwater Program at the address on that form. The original signed NCI Certification Form is required to fulfill federal
application requirements.
If you have any questions, please contact the Stormwater Program at [phone], or visit https://deg.nc.gov/NCG01.
The NC DEMLR Stormwater Program
512 N. Salisbury Street, Archdale Building 6th Floor, 1612 Mail Service Center, Raleigh, NC 27699-1612
ARPA grant funding indicated? No
ARPA Project No. (if applicable):
This email was automatically generated by Laserfiche. Please do not respond to this email address, as responses are not
monitored.

E
Use this form to submit a Notice of Termination (NOT) request for a project covered under the N.C. NPDES
General Permit for Construction Activities NCG010000 (or NCG250000). If approved, the Certificate of Coverage
(COC) will be rescinded.
Certificate of NCC230481
Coverage (COC) No.* Enter the Certificate of Coverage Number
2020 Annual Fee Status 2021 Annual Fee Status 2022 Annual Fee Status
May be blank if N/A May be blank if N/A May be blank if N/A
2023 Annual Fee Status
May be blank if N/A
Information associated with this permit
Project Name South Fork LLC - Lot 4
Lots Covered by this This information is especially helpful when more lots were added with Modifications since the original permit
Permit COC (if
issuance.
applicable)
No longer visible on the initial form (data not captured from initial application)
Address
Barley Park Ln, Mooresville, NC
County
Iredell
Latitude
35.6238
Longitude
-80.8028
Permittee Listed
SOUTH FORK-MOORESVILLE LLC
Legally Responsible
Kathryn Godley
Individual
NC Reference No.
NCG01-2023-0481
E&SC Plan ID
MVLLE-2023-031
Original NOI Tracking
127676
No.
Date COC Issued
4/25/2023
Prior Rescission Date
Date populates only if COC was already rescinded at time of submittal.
Reason for Rescission/Termination Request:
Reason for �_) Project Closed -Out
Termination of Q Sale (Another Owner/Operator obtained new COC)
Coverage* Q Mistake or Invalid Coverage
Other
Additional More information about the basis of this request, if needed.
Explanation COC issued by mistake instead of rejected at the payment step

Supporting Upload Supporting Documentation if applicable.
Documentation Must be PDF format
Project Close-out Information:
Erosion Control Plan
Close-out Date
Erosion Control Plan Must be PDF format
Close-out
Documentation
North Carolina General Statute 143-215.613 (1) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other document
filed 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 under this 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 of the Commission implementing this Article shall
be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
*

Type Name* Tevye Holloman
Title* DEMLR Stormwater Billing Specialist
Organization* DEQ
Date * 04/25/2023
Email for [e-mail]
Confirmation *
Contact Telephone* 9197079649
NOT Certification NCC230481 email mistake COC.pdf 1011.99KB
Form Must be PDF Format
Is this COC Already Ensure this COC has not been rescinded since submittal!
Rescinded?
Additional Email CC'd on Notification Emails
(Optional) [e-mail]
Original Permittee CC'd on Notification Emails
Email [e-mail]

Original Site Contact cc'd on Notificaiton Emails
Email [e-mail]