NCC190976_Notice of Termination_20201103

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 11/3/2020 12:08:10 PM (NOT Submittal)
Approve by Georgoulias, Bethany 11/4/2020 8:38:00 AM (NOT Request Review- NCC190976)
p Sales contract uploaded was insufficient documentation of transfer. The permittee provided copy of the
Deed via e-mail on 1114 (will be added to permit file).
• The task was assigned to Georgoulias, Bethany. The due date is: November 6, 2020 5:00 PM
11 /3/2020 12:08 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190976
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Panther Creek Subdivision (Wake County Side)
Address
7810 Mt. Pleasant Rd., Willow Springs, NC
County
Wake
Latitude
35.5662
Longitude
-78.6472
Permittee Listed
Gray Wolf Development
Legally Responsible
Wade Corbett
Individual
NC Reference No.
NCG01-2019-0976
E&SC Plan ID
SEC-018186-2019
Original NOI
13542
Tracking No.
Date COC Issued
7/17/2019
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 F Sale (Another Owner/Operator will apply for a new COC)
Coverage * r Mistake or Invalid Coverage
r Other
Addional
Nbre inforrration about the basis of this request, if needed.
Explanation
Supporting
Upload Supporting Docurrentation if applicable.
Documentation
Panther Creek - Executed Contract H&H JSJ
1.21 MB
041819. pdf
Must be FDF forrrat
Project Close-out Information:

Final Close-out
Inspection Approval
Project Close-out Mast beFOFforrrat
Approval
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* Dennis Peacock
Title * VP of Construction
Organization * Gray Wolf Development, LLC
Date * 11/03/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 9199347788
NOT Certification doc02846420201103130528.pdf
Form Mast be FDF Format
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on %tification Bmils
Email [e-mail]
Original Site Contact CCd on %tificaiton Errails
Email [e-mail]
809.81 KB