NCC201012_Notice of Termination_20201019

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/19/2020 1:53:05 PM (NOT Submittal)
Approve by Georgoulias, Bethany 10/19/2020 2:37:44 PM (NOT Request Review- NCC201012)
• The task was assigned to Georgoulias, Bethany. The due date is: October 22, 2020 5:00 PM
10/19/2020 1:53 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC201012
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Georgetown Estates Phase Two
Address
Evermay Ct, Jacobs Creek Cir, Volta Drive, McKinnon Farm Rd,
Rockfish, NC
County
Cumberland
Latitude
34.9931
Longitude
-78.9873
Permittee Listed
Armstrong Builders, LLC
Legally Responsible
George Armstrong
Individual
NC Reference No.
NCG01-2020-1012
E&SC Plan ID
Cumbe-2020-121
Original NOI
23042
Tracking No.
Date COC Issued
3/16/2020
Prior Rescission
Date populates only if COCwas already rescinded at tirre of submttal.
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 *
r Mistake or Invalid Coverage
r Other
Add Tonal IVbre inforr ation about the basis of this request, if needed.
Explanation
Supporting upload Supporting DDcunentation if applicable.
Documentation Mist beFDFfornat
Project Close-out Information:

Final Close-out 10/7/2020
Inspection Approval
Project Close-out Inspection Reports Lots 34, 68, 77, 137 & 159.pdf 199.85KB
Approval Mast be PDFforrrat
Documentation
North Carolina General Statute 143-215.613 (i) 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 of the
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* George H Armstrong
Title * President
Organization* Armstrong Builders, LLC
Date * 10/19/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 9108643232
NOT Certification NOT Phase 2 Lots 34, 68, 77, 137, 159.pdf 180.19KB
Form Wst be RY Format
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCdonWificationErrails
Email [e-mail]
Original Site Contact CCd on Notificaiton BTails
Email [e-mail]