NCC202745_Notice of Termination_20210907

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/7/2021 2:10:15 PM (NOT Submittal)
Approve by Morman, Alaina 9/8/2021 2:03:26 PM (NOT Request Review- NCC202745)
• The task was assigned to Morman, Alaina. The due date is: September 10, 2021 5:00 PM
9/7/2021 2:10 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC202745
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status PAST DUE
fvby be blank (if not yet billed).
This permittee owes a fee that is PAST DUE and has a pending NOD or NOV. Do not approve this NOT request
until payment is resolved. If this NOT request is acceptable, payment may be waived if applicable, but that action must
be completed first (at the NOD or NOV Review step) to ensure records are routed to the correct folder in the
repository.
However, you can reject the NOT now if it is not acceptable.
Information associated with this permit:
Project Name
Lot 50 Rosemont Subdivision
Address
386 Blue Violet Way, Williams, NC
County
Chatham
Latitude
35.8528
Longitude
-78.9161
Permittee Listed
Loyd Builders, LLC
Legally Responsible
Frank Loyd
Individual
NC Reference No.
NCG01-2020-2745
E&SC Plan ID
2020-03938
Original NOI
27506
Tracking No.
Date COC Issued
7/1/2020
Prior Rescission
Cate populates only if OOC was already rescinded at tirre of submittal.
Date
Reason for Rescission/Termination Request:

Reason for r Project Closed -Out
Termination of r Sale (Another Owner/Operator obtained a newCOC)
Coverage * r Mistake or Invalid Coverage
f Other
Additional
Mxe information about the basis of this request, if needed.
Explanation
This project wa actually closed out 6/16/2021
(CO attached) however I was unaware of this
inspection. I have attached the Final
Inspection dated 8/26/2021. If we should still
pay the fee please advise and 1 will take care
of it immediately.
Supporting
Upload Supporting Dxurrentation if applicable.
Documentation
Mist beFDFformat
Project Close-out Information:
Final Close-out 8/26/2021
Inspection Approval
Project Close-out NCC202745 Final Inspection & CO (2).pdf 656.21 KB
Approval Wst be FDFformat
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 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).
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* Frank R. Loyd, III
Title * Member Manager
Organization* Loyd Builders, LLC
Date * 09/07/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 919-387-1455

NOT Certification NCG01 NOT Cert Form.pdf
Form Mist be FDF Forrrat
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional)
Original Permittee 0Cd on Wification BTails
Email [e-mail]
Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]
421.83KB