NCC203860_Notice of Termination_20210908

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/8/2021 1:35:40 PM (NOT Submittal)
Approve by Morman, Alaina 9/14/2021 11:12:28 AM (NOT Request Review- NCC203860)
• The task was assigned to Morman, Alaina. The due date is: September 13, 2021 5:00 PM
9/8/2021 1:35 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC203860
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
OPEN
Nby be blank (if not yet billed).
Information associated
with this permit:
Project Name
Lot 11 Sunset Grove
Address
509 Sunset Grove Dr, Pittsboro, NC
County
Chatham
Latitude
35.7569
Longitude
-79.0830
Permittee Listed
WMLR, Inc
Legally Responsible
Wes Walker
Individual
NC Reference No.
NCG01-2020-3860
E&SC Plan ID
2020-05133
Original NOI
30852
Tracking No.
Date COC Issued
9/4/2020
Prior Rescission
Cate populates only if COCwas already rescinded at time of submittal.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 IVbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Documentation if applicable.
Documentation MstbeRYforrrat

Project Close-out Information:
Final Close-out 9/7/2021
Inspection Approval
Project Close-out E&SC COC (SUNSET GROVE LOT 11) 9-7-21.pdf 290.5KB
Approval Must be FDFforrrat
Documentation
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 under this 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 of the
Commission implementing this Artcle 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
Type Name* Wes Walker
Title * Vice President
Organization* WMLR, Inc.
Date * 09/08/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9192344284
NOT Certification NCG01 NOT FORM (LOT 11 SUNSET GROVE) 9-7-
Form 21.pdf 630.96KB
Mist be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
CCd on Notification En -ails
CCd on Kbtification Bmils
[e-mail]
Original Site Contact CCd on Notificaiton BTails
Email [e-mail]