NCC201624_Notice of Termination_20220211

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/11/2022 2:27:34 PM (NOT Submittal)
Approve by Morman, Alaina 2/17/2022 11:54:44 AM (NOT Request Review - NCC201624)
• The task was assigned to EADS\amorman1. The due date is: February 16, 2022 5:00 PM
2/11/2022 2:27 PM

NORTH CAROLINA
Rrf OmFkm&tral Qualrly
Certificate of NCC201624
Coverage (COC) No.* Enter the Certificate of Coverage Number
2020 Annual Fee Status
2021 Annual Fee Status PAID
May be blank (if not yet billed).
2022 Annual Fee May be blank (if not yet billed).
Status
Information associated with this permit:
Project Name
Willoughby lot 41
Address
524 Adkins Ridge Road, Rolesville, NC
County
Wake
Latitude
35.9290
Longitude
-78.4720
Permittee Listed
The Drees Company
Legally Responsible
Jerry Dean
Individual
NC Reference No.
NCG01-2020-1624
E&SC Plan ID
SEC-035645-2020
Original NOI Tracking
24654
No.
Date COC Issued
4/23/2020
Prior Rescission Date
Date populates only if COC was already rescinded at time of submittal.
Reason for Rescission/Termination Request:
Reason for • Project Closed -Out
Termination of Sale (Another Owner/Operator obtained new COC)
Coverage* Mistake or Invalid Coverage
Other
Additional More information about the basis of this request, if needed.
Explanation I am attaching the COCs for Willoughby lot
41,02, 73, 75, 86. also attaching the NOT
Certification Forms for the same lots.

Supporting Upload Supporting Documentation if applicable.
Documentation Must be PDF format
Project Close-out Information:
Final Close-out 2/11/2022
Inspection Approval
Project Close-out WBY 41, WBY 02, WBY 73, WBY 75, WBY 86
Approval COCs.pdf
Documentation
Must be PDF format
North Carolina General Statute 143-215.613 (i) provides that:
1.15MB
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other document
filed 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 device or method required to be operated or maintained under this Article or rules of the Commission implementing this Article shall
be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
* 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 NCGO10000 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* 02/11 /2022
Email for [e-mail]
Confirmation *
Contact Telephone* 919.256.5432
NOT Certification WBY 41, WBY 02, WBY 73, WBY 75, WBY 86 - NOT
Form 4.55MB
Certification Forms.pdf
Must be PDF Format
Is this COC Already Ensure this COC has not been rescinded since submittal!
Rescinded?
Additional Email CC'd on Notification Emails
(Optional)
Original Permittee CC'd on Notification Emails
Email [e-mail]

Original Site Contact cc'd on Notificaiton Emails
Email [e-mail]