NCC201658_Notice of Termination_20210609

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/9/2021 9:18:24 AM (NOT Submittal)
Approve by Morman, Alaina 6/10/2021 9:21:17 AM (NOT Request Review- NCC201658)
• The task was assigned to Morman, Alaina. The due date is: June 14, 2021 5:00 PM 6/9/2021 9:18 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC201658
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status PAST DUE
fvby be blank (if not yet billed).
This permittee owes a fee that is PAST DUE and has a pending NOD or NOV. Do not approve this NOT request
until payment is resolved. If this NOT request is acceptable, payment may be waived if applicable, but that action must
be completed first (at the NOD or NOV Review step) to ensure records are routed to the correct folder in the
repository.
However, you can reject the NOT now if it is not acceptable.
Information associated with this permit:
Project Name
Woodbridge Meadows, Phase V - Lots 39-43
Address
Lenity Lane, Jonesboro Township, NC
County
Lee
Latitude
35.4193
Longitude
-79.1442
Permittee Listed
H&H Constructors, Inc.
Legally Responsible
Brian Walker
Individual
NC Reference No.
NCG01-2020-1658
E&SC Plan ID
LEE-2020-033
Original NOI
24727
Tracking No.
Date COC Issued
4/24/2020
Prior Rescission
Cate populates only if OOCwas already rescinded at tirre of subaittal.
Date
Reason for Rescission/Termination Request:

Reason for r Project Closed -Out
Termination of r Sale (Another Owner/Operator obtained a newCOC)
Coverage * r Mistake or Invalid Coverage
f Other
Add ional We information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Ibcurrentation if applicable.
Documentation Mist beFDFforrrat
Project Close-out Information:
Final Close-out 12/23/2020
Inspection Approval
Project Close-out LEE-2020-033 CO.pdf
Approval Mist be FDFforrrat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
48.5KB
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 device 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).
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
Type Name* Brian Walker
Title * Agent
Organization * H&H Constructors LLC
Date * 06/09/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 19107782876
NOT Certification LEE-2020-033 NOT.pdf 351.53KB
Form Mist be FDF Forrrat

Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email 0Cd on Notification Errails
(Optional) [e-mail]
Original Permittee 0Cd onNotificationErrails
Email [e-mail]
Original Site Contact 0Cd on Notificaiton Errails
Email [e-mail]