NCC203848_Notice of Termination_20210909

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/9/2021 9:39:39 AM (NOT Submittal)
Approve by Morman, Alaina 9/15/2021 4:36:42 PM (NOT Request Review- NCC203848)
• The task was assigned to Morman, Alaina. The due date is: September 14, 2021 5:00 PM
9/9/2021 9:39 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC203848
Coverage (COC)
Enter the Certificate of Coverage Ninber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
OPEN
May be blank (if not yet billed).
Information associated
with this permit:
Project Name
Magnolia Creek Subdivision Phase 3
Address
Bent Willow Drive, Durham, NC
County
Durham
Latitude
36.0576
Longitude
-78.8844
Permittee Listed
NVR Inc. d/b/a Ryan Homes
Legally Responsible
Jordan Riley
Individual
NC Reference No.
NCG01-2020-3848
E&SC Plan ID
6168
Original NOI
30812
Tracking No.
Date COC Issued
9/11/2020
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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
Additional Mxe information about the basis of this request, if needed.
Explanation final site inspection complete, resulting in site
compliance and closure of all lots on the
COC (NCC203848)

Supporting upload Supporting Documentation if applicable.
Documentation Mist beFDFforrrat
Project Close-out Information:
Final Close-out 4/7/2021
Inspection Approval
Project Close-out Letter of Termination Magnolia Creek JCN-6168
Approval 06.pdf
Documentation
Mast be PDFformat
North Carolina General Statute 143-215.613 (i) provides that:
19.38KB
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Artide or a rule implementing this Artide; 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 device or method required to be operated or maintained under this Artide or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
17 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
jot Im/M
Type Name* JOE SCHMIDTKE
Title * VICE PRESIDENT
Organization* NVR, Inc.
Date * 09/09/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9199871930
NOT Certification MG CR- LOT 184 NOT.pdf 412.14KB
Form Mast be RY Format
Is this COCAlready Ensure this OOChas not been rescinded since subnittal!
Rescinded?
Additional Email OCd on Notification BTails
(Optional)
Original Permittee CCd on Wification BTails
Email [e-mail]

Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]