NCC200147_Notice of Termination_20210106

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/6/2021 10:14:25 AM (NOT Submittal)
Approve by Morman, Alaina 1/6/2021 11:26:45 AM (NOT Request Review- NCC200147)
• The task was assigned to Morman, Alaina. The due date is: January 11, 2021 5:00 PM
1/6/2021 10:14 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC200147
Coverage (COC) Enter the Certificate of Coverage Ninber
No.*
2020 Annual Fee Status
2021 Annual Fee Status OPEN
May be blank (if not yet billed).
Information associated with this permit:
Project Name
Lot 5 Montreaux Subdivsion
Address
1216 Hannahs View Dr, Raleigh, NC
County
Wake
Latitude
35.9431
Longitude
-78.6753
Permittee Listed
HJ Morris Construction Inc
Legally Responsible
Henry Morris
Individual
NC Reference No.
NCG01-2020-0147
E&SC Plan ID
SEC-029862-2019
Original NOI
20483
Tracking No.
Date COC Issued
1/14/2020
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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
Addional Nbre infornation about the basis of this request, if needed.
Explanation New home Sold and closed
Supporting upload Supporting Qbcurrentation if applicable.
Documentation Mast beRYforrrat

Project Close-out Information:
Final Close-out 8/13/2020
Inspection Approval
Project Close-out Lot 5 Montreaux- SEC-029862-2019 Certificate of
Approval 135.74KB
Completion.pdf
Documentation
Mast be FDFforrrat
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).
rJ 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
� 19��' rl 19W
Type Name* Henry J Morris
Title * President
Organization * HJ Morris Construction, Inc.
Date * 01 /06/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9193450514
NOT Certification Lot 5 Montreaux NOT Certification Form _0001.pdf 348.56KB
Form Mast be PDF Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
CCd on Notification Erails
CCd on Notification Erails
[e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]