NCC202639_Notice of Termination_20210702

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/2/2021 1:46:17 PM (NOT Submittal)
Approve by Morman, Alaina 7/7/2021 12:39:06 PM (NOT Request Review- NCC202639)
• The task was assigned to Morman, Alaina. The due date is: July 7, 2021 5:00 PM 7/2/2021 1:46 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC202639
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status OPEN
Nby be blank (if not yet billed).
Information associated with this permit:
Project Name
Longview (Lots 85-94)
Address
22 Ezekiel Street, Durham, NC
County
Durham
Latitude
36.0210
Longitude
-78.9595
Permittee Listed
Eastwood Homes of Raleigh, LLC
Legally Responsible
Andy Crawford
Individual
NC Reference No.
NCG01-2020-2639
E&SC Plan ID
6146-01
Original NOI
27317
Tracking No.
Date COC Issued
6/23/2020
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Cate populates only if COCwas already rescinded at time of submittal.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 7/2/2021
Inspection Approval
Project Close-out Longview Lots 85-94 Letter of Termination 6146-01
Approval 45.55KB
COD.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 Article or a rule implementing this Article; 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 Article 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* Andy Crawford
Title * Vice President
Organization* Eastwood Homes of Raleigh, LLC
Date * 07/02/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9194272962
NOT Certification Longview Lots 85-94_Notice of Termination
b
Form NOT_NCG01 Permit.pdf
Mist e FDF Fornat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Erails
(Optional)
Original Permittee CCd on Wification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton Fireils
Email [e-mail]
292.61 KB