NCC202380_Notice of Termination_20210129

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/29/2021 5:31:19 PM (NOT Submittal)
Approve by Morman, Alaina 2/2/2021 8:38:37 AM (NOT Request Review- NCC202380)
• The task was assigned to Morman, Alaina. The due date is: February 3, 2021 5:00 PM
1 /29/2021 5:31 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC202380
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status May be blank (if not yet billed)
Information associated with this permit:
Project Name
The Legacy at Jordan Lake - Lot 265
Address
14 Stone Bridge Crossing, Chapel Hill, NC
County
Chatham
Latitude
36.0000
Longitude
-79.0000
Permittee Listed
M/I Homes of Raleigh, LLC
Legally Responsible
Nick Campbell
Individual
NC Reference No.
NCG01-2020-2380
E&SC Plan ID
2020-03582
Original NOI
26599
Tracking No.
Date COC Issued
6/8/2020
Prior Rescission
Date populates only if COCwas already rescinded at tirre of subrrittal.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 *
U Mistake or Invalid Coverage
r Other
Ad d i o n a I Nbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Dxurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 12/21/2020
Inspection Approval
Project Close-out CERTIFICATE OF COMPLETION.pdf 176.27KB
Approval Mist be FDFforrrat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes anyfalse 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 knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho falsifies, tampers with, or knowingly renders
inaccurate anyrecording 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 notto 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
Type Name* Nicholas Campbell
Title * Land Development Manager
Organization * M/I Homes of Raleigh, LLC
Date * 01 /29/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9192780582
NOT Certification Legacy 4A2 Lot 265 eNOT.pdf
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional)
Original Permittee CCd on Wification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton Frrails
Email [e-mail]
1.66MB