NCC201890_Notice of Termination_20210513

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/13/2021 7:52:27 AM (NOT Submittal)
Approve by Morman, Alaina 5/17/2021 4:12:43 PM (NOT Request Review- NCC201890)
• The task was assigned to Morman, Alaina. The due date is: May 18, 2021 5:00 PM 5/13/2021 7:52 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC201890
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
OPEN
K/hy be blank (if not yet billed).
Information associated
with this permit:
Project Name
Holden Creek Preserve Phase 5 ( Lots #139,140,184,185,192,193)
Address
Richlands Cliffs Drive and Porter Hill Drive, Youngsville Township, NC
County
Franklin
Latitude
36.0206
Longitude
-78.4949
Permittee Listed
Caviness & Cates Building and Development Company
Legally Responsible
Christopher Cates
Individual
NC Reference No.
NCG01-2020-1890
E&SC Plan ID
FRANK-2020-026
Original NOI
25291
Tracking No.
Date COC Issued
5/20/2020
Prior Rescission
Cate populates only if COCwas already rescinded at time of submittal.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 *
r Mistake or Invalid Coverage
r Other
Addional IVbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Documentation if applicable.
Documentation MstbeRYforrrat

Project Close-out Information:
Final Close-out 5/13/2021
Inspection Approval
Project Close-out Holden Creek Preserve Lots
Approval 37.42KB
139,140,184,185,192,193 -closeout letter. pdf
Documentation
Mist be FDFforrrat
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 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 ofthe
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* CHRISTOPHER E. CATES
Title * VICE PRESIDENT
Organization * Caviness & Cates Building and Development Company
Date * 05/13/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9107787902
NOT Certification Holden Creek Preserve Lots
Form 139,140,184,185,192,193 NOT.pdf
Mist be FDF Fornat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Erails
(Optional)
Original Permittee CCdonWificationBmils
Email [e-mail]
Original Site Contact 0Cd on Notificaiton BTails
Email [e-mail]
365.27KB