NCC200922_Notice of Termination_20200522

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/22/2020 7:32:04 AM (NOT Submittal)
Approve by Georgoulias, Bethany 5/22/2020 3:02:43 PM (NOT Request Review- NCC200922)
New COC No. NCC202172 was issued for this project on 512212020.
• The task was assigned to Georgoulias, Bethany. The due date is: May 27, 2020 5:00 PM
5/22/2020 7:32 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC200922
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Robinson Village Lots 60-62
Address
6409, 6413 and 6417 Brawley Ann Drive, Charlotte, NC
County
Mecklenburg
Latitude
35.2450
Longitude
-80.6735
Permittee Listed
Ryan Homes
Legally Responsible
Kevin Connery
Individual
NC Reference No.
NCG01-2020-0922
E&SC Plan ID
LDGP-2020-00021
Original NOI
22882
Tracking No.
Date COC Issued
3/10/2020
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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
F Other This CofC is being rescinded and replaced by NCC202172.
Addional We information about the basis of this request, if needed.
Explanation
Supporting upload Supporting Docurrentation if applicable.
Documentation Mist beFDFforrrat
Project Close-out Information:
Final Close-out
Inspection Approval

Project Close-out Mast beFDFformat
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).
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
Yip+! CIIAIA Y
Type Name* Kevin Connery
Title * Division Manager
Organization* Ryan Homes
Date * 05/22/2020
Email for [e-mail]
Confirmation *
Contact Telephone* [phone]
NOT Certification NOT Cert form.pdf 37.57KB
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on Wification Errails
Email [e-mail]
Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]