NCC205892_Notice of Termination (ADMINISTRATIVE)_20210329

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Selkane, Aziza 3/29/2021 3:52:22 PM (NOT Submittal)
Approve by Georgoulias, Bethany 3/29/2021 6:18:19 PM (NOT Request Review- NCC205892)
* Administrative termination of invalid COC for non-payment. Certification statement not applicable.
• Morman, Alaina reassigned the task to Georgoulias, Bethany 3/29/2021 4:00 PM
The task was assigned to Morman, Alaina. The due date is: April 1, 2021 5:00 PM 3/29/2021 3:52 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC205892
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
Wedgefield, Phase 11113 - Lots 67-69 & 72-74
Address
Cloverwood Lane, McLauchlin Township, NC
County
Hoke
Latitude
35.0000
Longitude
-79.0000
Permittee Listed
Furr Construction and Development, Inc.
Legally Responsible
Harold Furr
Individual
NC Reference No.
NCG01-2020-5892
E&SC Plan ID
HOKE-2021-022
Original NOI
39528
Tracking No.
Date COC Issued
2/12/2021
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 *
F Mistake or Invalid Coverage
r Other

Add ional Mxe information about the basis of this request, if needed.
Explanation On 2/15/21, 1 emailed Adam Furr explaining
that the issuance of the COC NCC205892
was a mistake, and a payment needs to be
submitted to keep the coverage.
On 2/23/21, 1 called Adam Furr and talked to
him, also emailed him.
On 3/03/21, 1 talked to Adam again and
explained the importance of making the
payment or the COC will be rejected. Also
emailed him as well.
On 3/11/21, Annette Lucas, Supervisor,
spoke to Adam Furr and called his dad
Chuck Furr and left a voicemail message,
but have not received a return call.
On 3/16/2021, 1 emailed Adam and provided
the e-payment link again.
On 3/16/2021, Adam confirmed he would
take care of it.
On 3/18/2021, Emailed Adam that a payment
has not been received.
Supporting Upload Supporting DDcurrentation if applicable.
Documentation Mast bePDFforrrat
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mist beRYformat
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 device 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).
F 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
0 5Z4_ ° Aww
Type Name* Aziza Selkane
Title * Billing Specialist for Stormwater

Organization* NCDEQ
Date * 03/29/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9197073710
NOT Certification NCG01-eNOT-Certification-Form-20201215-
Form 841.45KB
DEMLR-SW.PDF
Mast be PDF Format
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Additional Email
CCd on Notification BTails
(Optional)
Original Permittee
0Cd on Wification BTails
Email
[e-mail]
Original Site Contact
CCd on Notificaiton Emils
Email
[e-mail]