NCC203747_Notice of Termination_20210903

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/3/2021 10:01:49 AM (NOT Submittal)
Approve by Morman, Alaina 9/8/2021 11:38:39 AM (NOT Request Review- NCC203747)
• The task was assigned to Morman, Alaina. The due date is: September 8, 2021 5:00 PM
9/3/2021 10:01 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC203747
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status OPEN
May be blank (if not yet billed).
Information associated with this permit:
Project Name
Lots 61 and 80 in The Sentinels Subdivision
Address
5136 and 5105 Thruway Road, Gray's Creek, NC
County
Cumberland
Latitude
35.0000
Longitude
-79.0000
Permittee Listed
Southern Craftsman Homes, Inc.
Legally Responsible
Joseph Perkins
Individual
NC Reference No.
NCG01-2020-3747
E&SC Plan ID
CUMBE-2021-013
Original NOI
30526
Tracking No.
Date COC Issued
9/10/2020
Prior Rescission
Date populates only if COCwas already rescinded at time of submittal.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
Additional Nbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Documentation if applicable.
Documentation NlastbeRYforrrat

Project Close-out Information:
Final Close-out 11/10/2020
Inspection Approval
Project Close-out Lots 61 & 80 in the Sentinels (2).pdf 149.64KB
Approval Mast be FDFfornat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
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 any recording or monitoring deice 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).
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* Joseph Perkins
Title * owner
Organization* Pride Homes Inc
Date * 09/03/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9107512402
NOT Certification Document _2021-09-03_095942.pdf
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional)
Original Permittee CCdonNotification Errails
Email office. [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]
2.83MB