NCC200044_Notice of Termination_20210211

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/11/2021 8:55:07 AM (NOT Submittal)
Approve by Morman, Alaina 2/15/2021 11:04:49 AM (NOT Request Review- NCC200044)
• The task was assigned to Morman, Alaina. The due date is: February 16, 2021 5:00 PM
2/11/2021 8:55 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC200044
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
OPEN
K/hy be blank (if not yet billed).
Information associated
with this permit:
Project Name
Wendell Falls Phase 8A Erosion Control (lots 1092-1104)
Address
Big Barn Dr, Wendell, NC
County
Wake
Latitude
35.7720
Longitude
-78.4270
Permittee Listed
Mattamy Homes
Legally Responsible
Victoria Parsons
Individual
NC Reference No.
NCG01-2020-0044
E&SC Plan ID
SEC-030372-2019
Original NOI
20206
Tracking No.
Date COC Issued
2/28/2020
Prior Rescission
Cate populates only if COCwas already rescinded at time of submittal.
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 IVbre information about the basis of this request, if needed.
Explanation
Supporting upload Supporting Documentation if applicable.
Documentation MstbeRYforrrat

Project Close-out Information:
Final Close-out 2/8/2021
Inspection Approval
Project Close-out SEC-030372-2019_Certificate of Completion_2-8-21
Approval 141.75KB
WF Phase 8A.pdf
Documentation
Mist 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
K46h,6k L IM4"
Type Name* Victoria L Parsons
Title * Permit Coordinator
Organization* Mattamy Homes
Date * 02/11 /2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9192333886
NOT Certification NCG01-eNOT-Certification-Form-20201215-
Form DEMLR-SW.pdf
Mist be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email OCd on Notification Errails
(Optional) [e-mail]
Original Permittee CCdonWificationErrails
Email [e-mail]
Original Site Contact 0Cd on Notificaiton BTails
Email [e-mail]
1005.39KB