NCC192859_Notice of Termination_20201201

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/1/2020 3:20:46 PM (NOT Submittal)
Approve by Georgoulias, Bethany 12/3/2020 10:04:11 AM (NOT Request Review- NCC192859)
• The task was assigned to Georgoulias, Bethany. The due date is: December 4, 2020 5:00 PM
12/1/2020 3:21 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC192859
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
MONTREAUX SUB PH1 Lot 17
Address
10336 Grafton Road, Raleigh, NC
County
Wake
Latitude
35.9419
Longitude
-78.6787
Permittee Listed
Speight Built, LLC
Legally Responsible
Ryan Speight
Individual
NC Reference No.
NCG01-2019-2859
E&SC Plan ID
SEC-027778-2019
Original NOI
18723
Tracking No.
Date COC Issued
11/21/2019
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Date populates only if OOCwas already rescinded at tirre of subaittal.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 10/20/2020
Inspection Approval

Project Close-out SEC-027778-2019 Certificate of Completion.pdf 136.66KB
Approval Mist be FDFforrrat
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* Ryan Speight
Title * Owner
Organization* Speight Built, LLC
Date * 12/01 /2020
Email for [e-mail]
Confirmation *
Contact Telephone* 919-889-5694
NOT Certification NCG01 Notice of Termination (NOT) 20.12.1.pdf 15.87MB
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since submttal!
Rescinded?
Original Permittee CCdonWificationErrails
Email [e-mail]
Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]