NCC202732_Notice of Termination_20210310

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/10/2021 10:36:15 AM (NOT Submittal)
Approve by Morman, Alaina 3/11/2021 3:04:20 PM (NOT Request Review- NCC202732)
• The task was assigned to EADS\amorman1. The due date is: March 15, 2021 5:00 PM
3/10/2021 10:36 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC202732
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
Oak Springs Subdvision
Address
Oak Spring Road, Indian Trail, NC
County
Union
Latitude
35.0980
Longitude
-80.6570
Permittee Listed
JBH Development, LLC
Legally Responsible
Bart Hopper
Individual
NC Reference No.
NCG01-2020-2732
E&SC Plan ID
UNION-2020-059
Original NOI
27557
Tracking No.
Date COC Issued
6/29/2020
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
Date
Reason for Rescission/Ternnination Request:
Reason for
r Project Closed -Out
Termination of
r Sale (Another Owner/Operator obtained a new COC)
Coverage *
r Mistake or Invalid Coverage
r Other Sale (Another Owner/Operator obtained new COC)
Ad d i o n a I Ivbre information about the basis of this request, if needed.
Explanation

Supporting Upload Supporting Documentation if applicable.
Documentation Oak Springs Project I Financial -Responsibility -Form
149.02KB
- Signed.pdf
NCG01-eNO1-Certification-Form-Signed.pdf 82.44KB
Oak Spring Proj I Certificate of Coverage.pdf 36.22KB
NUst be FDFfornat
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mist beFDFforrrat
Approval
Documentation
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 of the
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
Type Name* Bart Hopper
Title * Manager
Organization* JBH Development, LLC
Date * 03/10/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 7048054801
NOT Certification Hopper Oak Springs Subdivision NOT Form.pdf 364.67KB
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) [e-mail]

Original Permittee GCdonWtificationBiails
Email [e-mail]
Original Site Contact CCd on Kbtificaiton Bmils
Email [e-mail]