NCC204222_Notice of Termination_20210411

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/11/2021 12:17:59 PM (NOT Submittal)
Approve by Morman, Alaina 4/12/2021 9:25:50 AM (NOT Request Review- NCC204222)
• The task was assigned to Morman, Alaina. The due date is: April 15, 2021 5:00 PM
4/11/2021 12:18 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC204222
Coverage (COC)
Enter the Certificate of Coverage Ninber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
May be blank (if not yet billed).
Information associated
with this permit:
Project Name
Murray Place Subdivision
Address
5305 Murray Road, Winston Salem, NC
County
Forsyth
Latitude
36.1868
Longitude
-80.3083
Permittee Listed
Weidl Properties, LLC
Legally Responsible
Robert Weidl
Individual
NC Reference No.
NCG01-2020-4222
E&SC Plan ID
EN2000148
Original NOI
31737
Tracking No.
Date COC Issued
9/25/2020
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.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 obtained a new COC)
Coverage *
r Mistake or Invalid Coverage
r Other Developer selling lots to home builder. Home builder has
amended EC plan to cover home building phase of development.
Add ional We information about the basis of this request, if needed.
Explanation True Homes COC is NCC211854

Supporting upload Supporting Documentation if applicable.
Documentation True homes FRO for Murray RD SFD.pdf
Mast be FDFformat
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mast beFDFforrrat
Approval
Documentation
North Carolina General Statute 143-215.613 (i) provides that:
97.21 KB
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Artide or a rule implementing this Artide; 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 Artide 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).
fJ 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 Weidl
Title * Member -Manager
Organization* Weidl Properties, LLC
Date * 04/11 /2021
Email for [e-mail]
Confirmation *
Contact Telephone* 336-577-7775
NOT Certification NCG01-eNOT-Murray Place - signed.pdf 1.99MB
Form Mast be FDF Format
Is this COCAlready Ensure this OOChas not been rescinded since subnittal!
Rescinded?
Additional Email CCd on Notification Emails
(Optional) [e-mail]
Original Permittee CCd on Notification BTails
Email [e-mail]

Original Site Contact OCd on Wificaiton BTails
Email [e-mail]