NCC200413_Notice of Termination_20201217

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/17/2020 11:45:02 AM (NOT Submittal)
Approve by Georgoulias, Bethany 12/17/2020 3:05:30 PM (NOT Request Review- NCC200413)
• The task was assigned to Georgoulias, Bethany. The due date is: December 22, 2020 5:00 PM
12/17/2020 11:45 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC200413
Coverage (COC) Enter the Certificate of Coverage Ninber
No.*
2020 Annual Fee Status
2021 Annual Fee Status N/A
Information associated with this permit
Project Name
The Preserve At Tidewater - Sydes Lots
Address
Needlerush Road, Sneads Ferry, NC
County
Onslow,
Latitude
34.5237
Longitude
-77.4036
Permittee Listed
A. Sydes Construction, Inc.
Legally Responsible
Anthony Sydes
Individual
NC Reference No.
NCG01-2020-0413
E&SC Plan ID
ONSLO-2019-044
Original NOI
21300
Tracking No.
Date COC Issued
2/10/2020
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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
r Sale (Another Owner/Operator will apply for a new COC)
Coverage *
r Mistake or Invalid Coverage
r Other COC No. NCC204914 currently covers the same project
Ad d i o n a I We inforrration about the basis of this request, if needed.
Explanation Multiple COC numbers were mistakenly
acquired for the same project, COC No.
NCC204914 is the most recent, and the
others should be terminated.

Supporting upload Supporting Documentation if applicable.
Documentation Mist beFDFforrrat
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mast beFDFforrrat
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* Anthony W. Sydes
Title * President
Organization* A. Sydes Construction, Inc.
Date * 12/17/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 9104556956
NOT Certification SKM_C45820121710280.pdf 61.58KB
Form Mast be RY Format
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional) [e-mail]
Original Permittee CCd on Notification Brails
Email [e-mail]

Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]