NCC190350_Notice of Termination_20201207

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/7/2020 5:21:48 PM (NOT Submittal)
Approve by Georgoulias, Bethany 12/8/2020 9:43:12 AM (NOT Request Review- NCC190350)
p A new COC was obtained to correct a mistake on the original eNO/ for this COC, it should have been
subsequently rescinded by the permittee. Annual fee payment has been waived, and the NOD is resolved.
• The task was assigned to Georgoulias, Bethany. The due date is: December 10, 2020 5:00 PM
12/7/2020 5:21 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC190350
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee
WAIVED
Status
Information associated
with this permit:
Project Name
Chapel Ridge Lot 277
Address
26 Brushwood, Pittsboro, NC
County
Chatham
Latitude
35.7906
Longitude
-79.2228
Permittee Listed
ICG Homes, LLC
Legally Responsible
Ryan Perry
Individual
NC Reference No.
NCG25-2019-0350
E&SC Plan ID
2019-04258
Original NOI
11268
Tracking No.
Date COC Issued
5/22/2019
Prior Rescission
Cute populates only if COCwas already rescinded at tirre of subnittal.
Date
Reason for Rescission/Termination Request:
Reason for
r Project Closed -Out
Termination of
r Sale (Another Owner/Operator will apply for a new COC)
Coverage *
F Mistake or Invalid Coverage
r Other
Addional IVbre information about the basis of this request, if needed.
Explanation This was rescinded and NCC191807 was the
new one. This one was not terminated with a
NOT by ICG.

Supporting Upload Supporting Documentation if applicable.
Documentation NCC190350_Emails RE Request to Submit New
eNO1_20190910.pdf
Mast be FDFformat
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mist beFDFformat
Approval
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
209KB
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 Amide; 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 of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
I7 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
?,K ` •tom
Type Name* Ryan Perry
Title * Owner
Organization* ICG Homes, LLC
Date * 12/07/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 803-348-1944
NOT Certification CRG277 - NOT - NCC190350 - OLD One - NCG01
Form 807.04KB
Cert. Form.pdf
Mast be FDF Format
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]