NCC200342_Notice of Termination_20200914

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/14/2020 5:46:05 PM (NOT Submittal)
Approve by Georgoulias, Bethany 9/22/2020 10:29:45 AM (NOT Request Review- NCC200342)
p Submitter uploaded the Certificate of Coverage instead of the NOT Certification form but provided it
upon request via e-mail. The document will be added to the final permit records.
• The task was assigned to Georgoulias, Bethany. The due date is: September 17, 2020 5:00 PM
9/14/2020 5:46 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC200342
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Beaver Pond Trail Lot Grading
Address
5700 Beaver Pond Trail, Pfafftown, NC
County
Forsyth
Latitude
36.2055
Longitude
-80.3276
Permittee Listed
LRIG, LLC
Legally Responsible
Bruce Hubbard
Individual
NC Reference No.
NCG01-2020-0342
E&SC Plan ID
EN1900181
Original NOI
21100
Tracking No.
Date COC Issued
1/28/2020
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
Date
Reason for Rescission/Termination Request:
Reason for F Project Closed -Out
Termination of r Sale (Another Owner/Operator will apply for a new COC)
Coverage * O Mistake or Invalid Coverage
r Other
Addional We inforrration 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 8/20/2020
Inspection Approval

Project Close-out sir BEAVER POND TRAIL LOTS 8-20-20.pdf 127.63KB
Approval Mist be RYfornil
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
Type Name* Bruce R. Hubbard
Title * Ass't Mgr of LRIG, LLC
Organization* LRIG, LLC
Date * 09/14/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 3367230303
NOT Certification Certificate of Coverage.pdf 35.81 KB
Form Mist be PDF 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]

Georgoulias, Bethany
From: Shane Wagoner <[e-mail]>
Sent: Tuesday, September 22, 2020 10:18 AM
To: Georgoulias, Bethany
Cc: [e-mail]
Subject: [External] Re: Construction SW Notice of Termination Request Received - NCC200342
Attachments: NCC200342 (Not) Certification Form.pdf
• 1 External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
[e-mail]
Bethany - My apology. See attached. We mailed the hard copy and forgot to email this to you. If you need
something more, let me know.
Shane Wagoner
Director of Residential Development & Finance
Hubbard Commercial, LLC
1598 Westbrook Plaza Dr., Suite 200
Winston-Salem, NC 27103
Phone [phone]
Cell 336-816-1793
Fax [phone]
swa og nerghubbardcommercial.com
N.C. Licensed General Contractor 473786 and 72920
N.C. Licensed Real Estate Agent 4254950
President of Home Builders Association 2013
Confidentiality: The information in this electronic mail may contain confidential, sensitive and/or protected information intended only for the
addressee(s). Any other person, including anyone who believes he/she might have received it due to an addressing error, is requested to notify this
sender immediately by return e-mail, and shall delete it without further reading and retention. The information shall not be forwarded or shared unless
in compliance with Hubbard Realty of Winston-Salem, Inc. policies on confidentiality, and/or the written permission of this sender. If the reader of this
e-mail is not the intended recipient, you are hereby notified that any reading, dissemination, distribution, copying, or other use of this e-mail and
attachments is strictly prohibited and should be deleted immediately.
On Tue, Sep 22, 2020 at 7:51 AM Georgoulias, Bethany <bethany_geor og uliaskncdenr.gov> wrote:
Good morning,
I have not received a copy of the signed NOT Certification Form. I held this NOT request for over a week and will need
to reject it by noon today unless you provide that.

Thank you,
Bethany Georgoulias
From: Georgoulias, Bethany
Sent: Tuesday, September 15, 2020 10:35 AM
To: [e-mail]
Cc: [e-mail]
Subject: RE: Construction SW Notice of Termination Request Received
Importance: High
Mr. Hubbard,
The Notice of Termination request submitted included the appropriate close-out document, but instead of the NOT
certification form, the original COC was uploaded. Please complete the attached NOT Certification form for COC No.
NCC200342 and email it to me so I can process the request as complete. The signed form must also be mailed in, per
EPA requirements — refer to the instructions on the form. I will hold this request in the queue until tomorrow.
Thank you,
Bethany Georgoulias
Environmental Engineer
Stormwater Program, Division of Energy, Mineral, and Land Resources
N.C. Department of Environmental Quality
919 707 3641 office
[e-mail]
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)

Website: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
Ql�
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle
your requests by phone or email. We appreciate your patience as we continue to serve the public during this
challenging time.
From: [e-mail] [mailto:[e-mail]]
Sent: Monday, September 14, 2020 5:46 PM
To:[e-mail]
Cc: [e-mail]; [e-mail]
Subject: Construction SW Notice of Termination Request Received
Thank you for submitting a Notice of Termination (NOT) request for Beaver Pond Trail Lot Grading.
If your application is approved, you will receive e-mail confirmation when coverage under the Construction
Stormwater permit COC is terminated. You will also be notified if additional information is needed or if the
request cannot be approved.
If you have any questions, please contact the Stormwater Program Assistant at [e-mail] or
[phone]. The COC no. is NCC200342.
Be sure to add laserfiche(a�ncdenr.gov to your contacts to avoidfuture e-mails about this application from
going into Spam falters.
The NC DEMLR Stormwater Program
512 N. Salisbury Street, Archdale Building 6th Floor, 1612 Mail Service Center, Raleigh, NC 27699-1612
This email was automatically generated by Laserfache. Please do not respond to this email address, as
responses are not monitored.