NCC201928_Notice of Termination_20210602

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/2/2021 9:27:44 AM (NOT Submittal)
Approve by Morman, Alaina 6/3/2021 2:02:24 PM (NOT Request Review- NCC201928)
• The task was assigned to Morman, Alaina. The due date is: June 7, 2021 5:00 PM 6/2/2021 9:27 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC201928
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
Wendell Falls Lots 1105-1104 & 1182-1191
Address
Stagecoach trail, Wendell, NC
County
Wake
Latitude
35.7750
Longitude
-78.4300
Permittee Listed
Mattamy Homes
Legally Responsible
Victoria Parsons
Individual
NC Reference No.
NCG01-2020-1928
E&SC Plan ID
SEC-035809-2020
Original NOI
25363
Tracking No.
Date COC Issued
5/11/2020
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Cate populates only if COCwas already rescinded at time of submittal.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 4/30/2021
Inspection Approval
Project Close-out SEC-035809-2020 Certificate of
Approval Completion_MultipleLots_PermitClosure_4-30-21 360.28KB
Documentation
(002).pdf
Wst 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 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 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
Kc6L yMw
Type Name* Victoria L Parsons
Title * CAD/Permit Technician
Organization* Mattamy Homes LLC
Date * 06/02/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9192333886
NOT Certification NCG01-eNOT-Certification-Form-20210514-
Form 110.14KB
DEMLR-SW.pdf
Mast be FDF Format
Is this COC Already Ensure this COChas not been rescinded since submittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional)
Original Permittee 0Cd on Wification BTails
[e-mail]

Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]