NCC203039_Notice of Termination_20210415

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/15/2021 3:25:37 PM (NOT Submittal)
Approve by Morman, Alaina 4/19/2021 3:27:11 PM (NOT Request Review- NCC203039)
• The task was assigned to Morman, Alaina. The due date is: April 20, 2021 5:00 PM
4/15/2021 3:25 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC203039
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
Chandler Pointe Phase 4 DR Horton Lots
Address
Longshadow St., Rural Hall, NC
County
Forsyth
Latitude
36.2145
Longitude
-80.3152
Permittee Listed
DR Horton, Inc.
Legally Responsible
Jessica Meyer
Individual
NC Reference No.
NCG01-2020-3039
E&SC Plan ID
EN2000102
Original NOI
28221
Tracking No.
Date COC Issued
7/20/2020
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 *
U 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 Dxurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 4/6/2021
Inspection Approval
Project Close-out sir CHANDLER POINTE NORTH SD PHI -IV 4-6-21 for
Approval 79.57KB
N.O.T.pdf
Documentation
Mast be FOFforrrat
North Carolina General Statute 143-215.66 (1) provides that:
Pnyperson who knowinglymakes anyfalse statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Atide or a rule implementing this Atide; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Atcle; orwho falsifies, tampers with, or knowinglyrenders
inaccurate anyrecording or monitoring deice or method required to be operated or maintained under this Prtide or rules of the
Commission implementing this Atcle shall be guiltyofa Class 2 misdemeanor which mayinclude a fine notto 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* Jessica
Title * NPDES Technical Compliance Administrator
Organization* DR Horton, Inc.
Date * 04/15/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 919-215-6561
NOT Certification Chandler Pointe PH NOT Certification Form.pdf
Form Mast be PDF Forrrst
Is this COC Already Ensure this OCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification BTails
(Optional) [e-mail]
Original Permittee CCdonWificationErrails
Email [e-mail]
Original Site Contact OCd on Notificaiton BTails
Email [e-mail]
401.57KB