NCC210616_NOT Closeout Documents (2)_20230424

Notice of Termination (NOT) Request - NPDES
Stormwater Permit for Construction Activities
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 NCG010000(or NCG250000).If approved,the Certificate of Coverage
(COC)will be rescinded.
Certificate of NCC210616
Coverage(COC)No.* Enter the Certificate of Coverage Number(Use capital letters)
Information associated with this permit:
Project Name Oak Park Phase 2
Address 176 Belleforte Park 172 Belleforte Park 175 Belleforte Park 171 Belleforte Park 167
Belleforte Park 163 Belleforte Park 159 B,Garner, NC
County Wake
Latitude 35.6538
Longitude -78.5930
Permittee Listed Mattamy Homes, LLC
Legally Responsible George Young
Individual
E&SC Plan ID SEC-047200-2020
Original NOI Tracking 42097
No.*
Date COC Issued* 02/01/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.
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
For Project Close-out, you must provide documentation below. Please note, a Certificate of Occupancy
is not sufficient close-out documentation. You must provide a final inspection report or correspondence
from the authority that approved the Erosion and Sediment Control (E&SC) Plan.
Erosion Control Plan 3/31/2023
Close-out Date*

Erosion Control Plan Signed Inspection Report(Fri Mar 31,2023 at 834
Close-out 23.88KB
PM)Close out of Oak Park Ph 2.pdf
Documentation*
Must be PDF format
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.
Important:The person who electronically signs this Certification must be the same person who signs the paper NOT
Certification Form(uploaded below). If that person is signing on behalf of the Permittee,that individual must be an
authorized responsible person within the same organization as the Permittee.
*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* George Young
Title* Vice President Land Acquisition
Organization* Mattamy Homes
Date* 04/03/2023
Email for [e-mail]
Confirmation*
Contact Telephone* 919-625-9546
YOU MUST MAIL THE ORIGINAL SIGNED NOT CERTIFICATION FORM(click on this link)to The Stormwater
Program at the address on the form for the application to fulfill federal requirements.You must also upload a copy of that
completed below:
NOT Certification Signed Inspection Report(Fri Mar 31,2023 at 834
Form* 23.88KB
PM)Close out of Oak Park Ph 2.pdf
Must be PDF Format
Additional Email
(Optional)