NCC202049_Notice of Termination_20210525

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/25/2021 11:46:22 AM (NOT Submittal)
Approve by Morman, Alaina 5/28/2021 5:30:16 PM (NOT Request Review- NCC202049)
• The task was assigned to Morman, Alaina. The due date is: May 28, 2021 5:00 PM
5/25/2021 11:46 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC202049
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
OPEN
May be blank (if not yet billed).
Information associated
with this permit:
Project Name
Hickory Downs Lot 4 - Arnold Residence
Address
185 Hunter Glen Ln, Siler City, NC
County
Chatham
Latitude
35.7386
Longitude
-79.3372
Permittee Listed
The Tuscan Group, Inc
Legally Responsible
Kirk Metty
Individual
NC Reference No.
NCG01-2020-2049
E&SC Plan ID
2020-03164
Original NOI
25675
Tracking No.
Date COC Issued
5/18/2020
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Cate populates only if COCwas already rescinded at time of submittal.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 Nbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Documentation if applicable.
Documentation NtastbeRYforrrat

Project Close-out Information:
Final Close-out 5/24/2021
Inspection Approval
Project Close-out erosion control CERTIFICATE OF
Approval 122.84KB
COMPLETION —Hickory Downs Lot 4.pdf
Documentation
Mast be FCFforrrat
North Carolina General Statute 143-215.66 (1) 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 Article; 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 anyrecording or monitoring deice 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 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* Kirk Metty
Title * President
Organization* The Tuscan Group, Inc
Date * 05/25/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9192352077
NOT Certification NOT 20210525.pdf
Form Mast be Ft7F Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Erails
(Optional)
Original Permittee CCd on Wtification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]
1.91 MB