NCC190440_Notice of Termination_20201021

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/21/2020 10:29:35 AM (NOT Submittal)
Approve by Georgoulias, Bethany 10/21/2020 11:35:46 AM (NOT Request Review- NCC190440)
• The task was assigned to Georgoulias, Bethany. The due date is: October 26, 2020 5:00 PM
10/21/2020 10:29 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190440
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Fearrington Village - 4501 Tyrrell
Address
Tyrrell, Williams, NC
County
Chatham
Latitude
35.7917
Longitude
-79.0825
Permittee Listed
Fitch Creations, Inc.
Legally Responsible
Roy Fitch
Individual
NC Reference No.
NCG01-2019-0440
E&SC Plan ID
2019-03933
Original NOI
11641
Tracking No.
Date COC Issued
6/3/2019
Prior Rescission
Date populates only if OOCwas already rescinded at tirre of subaittal.
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 6/5/2020
Inspection Approval

Project Close-out 4501 - CERTIFICATE OF COMPLETION.pdf 234.69KB
Approval Mist be RYforrrat
Documentation
North Carolina General Statute 143-215.6E (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 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* Laura Morgan
Title * General Manager, Construction and Real Estate
Organization* Fitch Creations, Inc.
Date * 10/21 /2020
Email for [e-mail]
Confirmation *
Contact Telephone* 9195424000
NOT Certification 4501 - Tyrrell - NOT.pdf 64.9KB
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]