NCC216883_Notice of Termination_20230214

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/14/2023 11:34:52 AM (NOT Submittal)
Approve by Paul.Clark 2/16/2023 9:56:40 PM (NOT Request Review - NCC216883)
• The task was assigned to Paul.Clark by round robin distribution 2/14/2023 11:34 AM
The task was assigned to DEMLR NCG01 NOT Review Team. The due date is: February 17, 2023 5:00
PM 2/14/2023 11:34 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(COC) will be rescinded.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 NCC216883
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 May be blank if N/A WAIVED
May be blank if N/A
2023 Annual Fee Status
May be blank if N/A
Information associated with this permit:
Project Name Norris Road Tract
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
Norris Road, Clayton, NC
County
Johnston
Latitude
36.0000
Longitude
-78.0000
Permittee Listed
Gray Wolf Development, LLC
Legally Responsible
Ben Mathis
Individual
NC Reference No.
NCG01-2021-6883
E&SC Plan ID
JC# 21-013-P
Original NOI Tracking
75443
No.
Date COC Issued
12/13/2021
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Date populates only if COC was already rescinded at time of submittal.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 NCC223372
COC No. Enter the COC number obtained by the new owner
New Owner Name First and last name
DR Horton, Inc.
New Owner Phone [phone]
Number
New Owner Email [e-mail]
Additional More information about the basis of this request, if needed.
Explanation Project sold
Supporting Upload Supporting Documentation if applicable.
Documentation 21-013-1.PDF
Certificate of Coverage phase1.pdf
Must be PDF format
Project Close-out Information:
Erosion Control Plan
Close-out Date
Erosion Control Plan Must be PDF format
Close-out
Documentation
508.58KB
83.51 KB
North Carolina General Statute 143-215.6B (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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item
(6) of that permit.
Signature
Type Name* Ben Mathis
Title* Chief Operating Officer
Organization* Gray Wolf Homes
Date * 02/14/2023
Email for [e-mail]
Confirmation*

Contact Telephone* 9199347788
NOT Certification Norris Rd Tract Notice of Termination.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]
429.01 KB