NCC204649_Notice of Termination_20211008

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/8/2021 2:24:04 PM (NOT Submittal)
Approve by Morman, Alaina 10/11/2021 6:17:10 PM (NOT Request Review- NCC204649)
• The task was assigned to Morman, Alaina. The due date is: October 13, 2021 5:00 PM
10/8/2021 2:24 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC204649
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
Windfall Lot 56
Address
343 Ocoee Falls Dr, Chapel Hill, NC
County
Chatham
Latitude
35.7420
Longitude
-79.0640
Permittee Listed
Triple A Homes, Inc
Legally Responsible
Gerry Felton
Individual
NC Reference No.
NCG01-2020-4649
E&SC Plan ID
2020-06742
Original NOI
33036
Tracking No.
Date COC Issued
10/16/2020
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 Nbre inforrration about the basis of this request, if needed.
Explanation construction is complete
Supporting upload Supporting Qbcurrentation if applicable.
Documentation Mast beRYforrrat

Project Close-out Information:
Final Close-out 10/6/2021
Inspection Approval
Project Close-out WF 56 Certificate of Completion.pdf 289.23KB
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* Gerry Felton
Title * VP
Organization * Triple A Homes
Date * 10/08/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9498120991
NOT Certification WF 56 NCG01-eNOTermination-Certification-Form-
Form 1.04MB
20190508-DEMLR-SW. pdf
Mist be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
OCd on Notification Errails
[e-mail]
CCd on Notification Er ails
[e-mail]
Original Site Contact 0Cd on Notificaiton Errails
Email [e-mail]