NCC213436_Notice of Termination_20210802

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/2/2021 2:39:05 PM (NOT Submittal)
Approve by Morman, Alaina 8/4/2021 4:12:20 PM (NOT Request Review- NCC213436)
• The task was assigned to Morman, Alaina. The due date is: August 5, 2021 5:00 PM
8/2/2021 2:39 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC213436
Coverage (COC)
Enter the Certificate of Coverage Ninber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
May be blank (if not yet billed).
Information associated
with this permit:
Project Name
Briarcliffe Village SFD Construction
Address
Zuni Ct, Winston Salem, NC
County
Forsyth
Latitude
36.0000
Longitude
-80.0000
Permittee Listed
The Veritas Group, Inc
Legally Responsible
Michael Enscore
Individual
NC Reference No.
NCG01-2021-3436
E&SC Plan ID
500853
Original NOI
54827
Tracking No.
Date COC Issued
6/14/2021
Prior Rescission
Date populates only if OOC was already rescinded at tirre of subaittal.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 new COC)
Coverage *
F Mistake or Invalid Coverage
r Other
Addional Ivbre information about the basis of this request, if needed.
Explanation This was entered as a new eNOI rather than
a modification to the original. NCC211661
has been modified to include all the
disturbed area for the site and will be
modified for any future lots.

Supporting upload Supporting Ibcurrentation if applicable.
Documentation Termination Documentation Lots 6 & 7 - Briarcliffe
Village SFD Construction. pdf
Mast be FDFforrret
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mast beFDFforrrat
Approval
Documentation
North Carolina General Statute 143-215.613 (i) provides that:
97.61 KB
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 A tide; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case under this 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).
fJ 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* Michael S. Enscore
Title * President / Owner
Organization* The Veritas Group, Inc.
Date * 08/02/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 336-404-1522
NOT Certification Signed NCC213436 - NCG01-eNOT-Certification-
Form 69.11 KB
Form-20210514-DEML R-SW. pdf
Mast be FDF Forrrat
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Additional Email 0Cd on Notification Errails
(Optional)

Original Permittee CCdonNotificationEn-ails
Email [e-mail]
Original Site Contact GCd on Notificaiton B-mils
Email [e-mail]