NCC202176_NOT Signed Certification_20240725

NCGO1 Notice of Termination (NOT) Certification Form
Directions:
Print this form, complete, scan and upload to the electronic NOT (Rescission) form.
Then, mail the original signed form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6th Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM UNTIL YOUR NOT REQUEST HAS BEEN REVIEWED AND APPROVED.
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.22]
General Permit Certificate of Coverage (COC) No.: NCC200979
Name of Project: Wendell Crossing
Per NC General Statute 143-215.6E (i), 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 . . . shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for
the subject facility.facilit . 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.
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Legally Responsible Organizational Entity (must match eNOT): True Homes LLC
Responsible Person (must match eNOT): Bobby Hilgoe
*Legally
*Title of Legally Responsible Person:
Market Partner
Print Na
me & Title of Signed if Authorized Individual Differs from Legally Responsible Person:
Date:
20 Zt
*Signature: �.
* IMPORTANT NOTE: This form must be signedby
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 permit.
see Part I V, Section B, Item (6) of the NCG010000 permit.
For more information on signatory requirement s,