NCC203956_Notice of Termination (Recovered)_20210902

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NOT Request Review - NCC203956
D E Q, Notice of Termination (NOT) Request -
NORTHOAROLINA
Department of Environmental Duality NPDES Stormwater Permit for Construction
Activities
Use this form to submit a Notice of Termination (NOT) request for a project covered under the N.C. NPDES
General Permit for Construction Activities NCGO10000 (or NCG250000). If approved, the Certificate of
Coverage (COC) will be rescinded.
Certificate of NCC203956
Coverage (COC) Enter the Certificate of Coverage Number
No. *
2020 Annual Fee Status
May be blank if N/A
2023 Annual Fee Status
May be blank if N/A
2021 Annual Fee Status
OPEN
May be blank if N/A
2022 Annual Fee Status
May be blank if N/A
This permittee has an OPEN fee. If this NOT request is acceptable, you will have the option to waive that fee, but that
is only available AFTER the Notice of Termination (NOT) has been approved (when the permit status becomes
INACTIVE). If it is appropriate to waive the OPEN fee, it may help to assign that annual fee task to yourself
immediately following this approval so you remember to resolve the outstanding fee.
Information associated with this permit:
Project Name CRL02AO20
Lots Covered by this This information is especially helpful when more lots were added with Modifications since the original permit
Permit COC (if issuance.
applicable) No longer visible on the initial form (data not captured from initial application)
Address 720 Avenue of the Carolinas, Southern Pines, NC
County Moore
Latitude 35.2283
Longitude-79.3802
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Permittee Listed
H&H Constructors of Fayetteville, LLC
Legally Responsible Brian Walker
Individual
NC Reference No. NCG01-2020-3956
E&SC Plan ID 20-3616
Original NOI 31124
Tracking No.
Date COC Issued 9/11/2020
Prior Rescission Date populates only if COC was already rescinded at time of submittal.
Date
Reason for Rescission/Termination Request:
Reason for Project Closed -Out
Termination of Sale (Another Owner/Operator obtained new COC)
Coverage* Mistake or Invalid Coverage
Other
Additional More information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Documentation if applicable.
Documentation Must be PDF format
Project Close-out Information:
Erosion Control Plan 5/25/2021
Close-out Date
Erosion Control Plan Signed ESC Completion Letter.docx.pdf
Close-out Must be PDF format
Documentation
North Carolina General Statute 143-215.6113 (i) provides that:
RIR1i12.1
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed 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 under this Article; or who falsifies, tampers with, or knowingly renders inaccurate
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NOT Request Review - NCC203956
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 guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
* 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
ffz�w W11�4611-
Type Name* Brian Walker
Title * Agent
Organization * H&H Constructors of Fayetteville , LLC
Date * 09/02/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 19107782876
NOT Certification
Form
Is this COC Already
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
Original Site Contact
Email
NOT.pdf
Must be PDF Format
Ensure this COC has not been rescinded since submittal!
CC'd on Notification Emails
[e-mail]
CC'd on Notification Emails
[e-mail]
CC'd on Notificaiton Emails
[e-mail]
355.51 KB
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OEMIR-NCG01 Rescission NCC203956 CRL02AO20
Use this form to submit a Notice of Termination (NOT) request for a project covered under the N.C. NPOES
General Permit for Construction Activities NCGO1000D (or NCG2H000d. If approved, Me Certificate of Coverage
(COC) will be rescinded.
Certificate of NCC203956
Coverage(COC( No.v E^a` Me ski omwnage xumeer
2020 Annual Fee Status 2021 Annual Fee Status 2022 Annual Fee Status
May be Wank n NIA OPEN May be Wank it WA
May be Wank it NIA
2023 Annual Fee Status
May be Wank �f WA
r NOT Request Review-NCC203956
OEMIR-NCGm R......an NCC2039% CRURA020
Summary Action History
Process Completed
9132021 445 PM
92/20214:45 PM
Mormon. Alamo completed task NOTRequert n
Review -NCC2U39%
J Approve
The task was assigned to Morman. Anne on
September 2. 2021 7:51 AM. The due date is:
September ]. 2021 Onto PM
92/2021 7:51 AM
V Anonymous UsersubmRted chant