NCC200849_Notice of Termination_20220617

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/17/2022 10:16:54 AM (NOT Submittal)
Approve by Clark, Paul B 6/17/2022 11:11:10 AM (NOT Request Review - NCC200849)
• The task was assigned to Clark, Paul B by round robin distribution 6/17/2022 10:16 AM
The task was assigned to DEMLR NCG01 NOT Review Team. The due date is: June 22, 2022 5:00 PM
6/17/2022 10:16 AM

Use this form to submit a Notice of Termination (NOT) request for a project covered under the N.C. NPDES
General Permit for Construction Activities NCGO10000 (or NCG250000). If approved, the Certificate of Coverage
(COC) will be rescinded.
Certificate of NCC200849
Coverage (COC) No.* Enter the Certificate of Coverage Number
2020 Annual Fee Status 2021 Annual Fee Status 2022 Annual Fee Status
May be blank if N/A PAID WAIVED
May be blank if N/A May be blank if N/A
Information associated with this permit:
Project Name Cole Road Stockpile
Lots Covered by this This information is especially helpful when more lots were added with Modifications since the original permit
Permit COC (if
issuance.
applicable)
No longer visible on the initial form (data not captured from initial application)
Address
1492 Cole Road, Wilson's Mills, NC
County
Johnston
Latitude
35.5889
Longitude
-78.4185
Permittee Listed
Gray Wolf Development, LLC
Legally Responsible
Wade Corbett
Individual
NC Reference No.
NCG01-2020-0849
E&SC Plan ID
JC# 19-140-P
Original NOI Tracking
22657
No.
Date COC Issued
4/17/2020
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Date populates only if COC was already rescinded at time of submittal.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
New owner/operator NCC215563
COC No. Enter the COC number obtained by the new owner

New Owner Name First and last name
Starlight Homes North Carolina LLC
New Owner Phone [phone]
Number
New Owner Email
[e-mail]
Additional
More information about the basis of this request, if needed.
Explanation
We no longer owe this property (please see the attached deed). The new developer
has an active COC for the entire site that included the stockpile. The wet signature
and copy of the NOT certification form is signed by an authorized individual (please
see attached documentation).
Supporting
Upload Supporting Documentation if applicable.
Documentation
Minutes of Authority - Delegation of Officers - Land
324.25KB
Manager for GWD 110121.pdf
Cole Road- Deed Transfer.pdf 344.42KB
Must be PDF format
Project Close-out Information:
Erosion Control Plan
Close-out Date
Erosion Control Plan Must be PDF format
Close-out
Documentation
North Carolina General Statute 143-215.6113 (i) provides that:
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 NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item
(6) of that permit.
Signature
Type Name* Dennis Ray Peacock
Title* Land Manager
Organization * Gray Wolf Development, LLC
Data * 06/17/2022

Email for [e-mail]
Confirmation *
Contact Telephone* 9199347788
NOT Certification Signed NOT -Cole Road.pdf
Form 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)
[e-mail]
Original Permittee
CC'd on Notification Emails
Email
[e-mail]
Original Site Contact
CC'd on Notificaiton Emails
Email
[e-mail]
434.22KB