NCC202431_Notice of Termination_20210406

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/6/2021 2:01:11 PM (NOT Submittal)
Approve by Morman, Alaina 4/7/2021 4:27:09 PM (NOT Request Review- NCC202431)
• The task was assigned to Morman, Alaina. The due date is: April 9, 2021 5:00 PM 4/6/2021 2:01 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC202431
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
Raymond Dr. Woodlands at Timberlake
Address
512 Raymond Dr., 520 Raymond Dr., 524 Raymond Dr., Wendell, NC
County
Wake
Latitude
35.7860
Longitude
-78.3596
Permittee Listed
RHC Construction & Realty, Inc
Legally Responsible
Robert Cameron
Individual
NC Reference No.
NCG01-2020-2431
E&SC Plan ID
SEC-037230-2020
Original NOI
26787
Tracking No.
Date COC Issued
6/11/2020
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of submittal.
Date
Reason for Rescission/Termination Request:
Reason for
r Project Closed -Out
Termination of
r Sale (Another Owner/Operator obtained a new COC)
Coverage *
O 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 Docurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 2/17/2021
Inspection Approval
Project Close-out SEC-037230-2020 Certificate of
Approval Completion_MultipleLots_PermitClosure_2-17- 165.56KB
Documentation
21.pdf
Mist be FDFforrrat
North Carolina General Statute 143-215.613 (i) 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 A tide; 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 any recording or monitoring device 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 notto exceed ten thousand
dollars ($10,000).
17 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* Robert Cameron
Title * President
Organization* RHC Construction, Inc.
Date * 04/06/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 919-217-2444
NOT Certification NOT Certification Form.pdf
Form Mist be FDF Forrrat
Is this COC Already Ensure this COChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional)
Original Permittee 0Cd on %tification BTails
Email [e-mail]
Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]
51.81 KB