NCC200080_Notice of Termination_20210831

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/31/2021 12:39:49 PM (NOT Submittal)
Approve by Morman, Alaina 9/3/2021 1:26:12 PM (NOT Request Review- NCC200080)
• The task was assigned to Morman, Alaina. The due date is: September 3, 2021 5:00 PM
8/31 /2021 12:39 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC200080
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status PAID
Nhy be blank (if not yet billed).
Information associated with this permit:
Project Name
Sanctuary at Yates Mill Lot 16
Address
2325 Sanctuary Drive, Raleigh, NC
County
Wake
Latitude
35.7148
Longitude
-78.7326
Permittee Listed
Herring Homes
Legally Responsible
Brian Herring
Individual
NC Reference No.
NCG01-2020-0080
E&SC Plan ID
SEC-030212-2019
Original NOI
20171
Tracking No.
Date COC Issued
1/9/2020
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
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
Terminate both Lot 16 and Lot 33.
Supporting
upload Supporting Docurrentation if applicable.
Documentation
Mist beRFforrrat

Project Close-out Information:
Final Close-out 8/23/2021
Inspection Approval
Project Close-out Certificate of Completion - Sanctuary Lot 33.pdf 192.96KB
Approval Certificate of Completion.pdf 116.02KB
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 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 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
atlrl �`�drrr�r�oo�c
Type Name* Nataleigh Carscaddon
Title * Permits Coordinator
Organization* Herring Homes
Date * 08/31 /2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9192689127
NOT Certification SAN 33 LDP Notice of Termination Form
Form (signed).pdf
Must be RY Forrrat
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 Errails
Email [e-mail]
38.57KB