NCC190185_Notice of Termination_20200124

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/24/2020 9:41:47 AM (NOT Submittal)
Approve by Clark, Paul 1/24/2020 11:12:21 AM (NOT Request Review- NCC190185)
NOT Certification Form with box checked included in file (sent via separate email).
• The task was assigned to Clark, Paul by round robin distribution 1/24/2020 9:41 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 29, 2020 5:00
PM 1/24/2020 9:41 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190185
Coverage (COC) Enter the Certificate of Coverage Ninber
No.*
Information associated with this permit
Project Name
Sunnyvale
Address
Mount Carmel Church Rd, Lexington, NC
County
Davidson
Latitude
36.0000
Longitude
-80.0000
Permittee Listed
D.R. Horton
Legally Responsible
Meredith Armeni
Individual
NC Reference No.
NCG01-2019-0185
E&SC Plan ID
David-2019-024
Original NOI
10717
Tracking No.
Date COC Issued
5/6/2019
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.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 will apply for a new COC)
Coverage * r Mistake or Invalid Coverage
r Other Replaced with new COC
Add ional
We information about the basis of this request, if needed.
Explanation
New COC replaced this COC due to
additional acreage, new address and new
responsible party. New COC has been
uploaded below.
Supporting
upload Supporting Cbcurrentation if applicable.
Documentation
Sunnyvale Certificate of Coverage.pdf 40.16KB
Mast be PDFforrrat

Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mist beFDFforrrat
Approval
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* Jessica Meyer
Title * NPDES Technical Compliance Administrator
Organization* DR Horton, Inc.
Date * 01 /24/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 919-215-6561
NOT Certification Sunnyvale NCC190185 NOT Certification Form.pdf 391.89KB
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?