NCC204583_Notice of Termination_20211011

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/11/2021 10:13:33 AM (NOT Submittal)
Approve by Morman, Alaina 10/12/2021 12:08:42 PM (NOT Request Review- NCC204583)
• The task was assigned to Morman, Alaina. The due date is: October 14, 2021 5:00 PM
10/11 /2021 10:13 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC204583
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
Ashton Glen lot 33
Address
1101 Maduro Ct, Zebulon, NC
County
Wake
Latitude
35.7944
Longitude
-78.3317
Permittee Listed
The Drees Homes Company
Legally Responsible
Jerry Dean
Individual
NC Reference No.
NCG01-2020-4583
E&SC Plan ID
SEC-045671-2020
Original NOI
32877
Tracking No.
Date COC Issued
10/12/2020
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Cate populates only if COCwas already rescinded at time of submittal.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 6/23/2021
Inspection Approval
Project Close-out RGA 286 SEC-045671-2021 Certificate of
Approval 134.48KB
Completion_ 6-23-21.pdf
Documentation
Mast be Ft7Fforrrat
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 anyrecording or monitoring deice or method required to be operated or maintained under this Article or rules ofthe
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* Jerry Dean
Title * Division President
Organization* The Drees Homes Company
Date * 10/11 /2021
Email for [e-mail]
Confirmation *
Contact Telephone* 919.256.5432
NOT Certification RGA 286 NOT Certification form.pdf
Form Mast be PDF Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Erails
(Optional)
Original Permittee CCdonWificationBmils
Email [e-mail]
Original Site Contact 0Cd on Notificaiton Errails
Email [e-mail]
350.79KB