NCC191400_Notice of Termination for DUPLICATE COC_20190910

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by McCoy, Suzanne 9/10/2019 11:01:59 AM (NOT Submittal)
Approve by McCoy, Suzanne 9/10/2019 11:04:37 AM (NOT Request Review- NCC191400)
• McCoy, Suzanne reassigned the task to McCoy, Suzanne 9/10/2019 11:03 AM
• The task was assigned to Garcia, Lauren V by round robin distribution 9/10/2019 11:02 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 13, 2019 5:00
PM 9/10/2019 11:02 AM

STME
NORTH CAROLINA
Ernvlronmental Qualily
Certificate of
NCC191400
Coverage (COC)
Enter the Certificate of Coverage Nurrbeer
No. *
Information associated
with this permit:
Project Name
Camberly 54
Address
7508 Dover Hills Rd, Wake Forest, NC
County
Wake
Latitude
35.9844
Longitude
-78.5721
Permittee Listed
Thayer Homes
Legally Responsible
Terry Thayer
Individual
NC Reference No.
NCG01-2019-1400
E&SC Plan ID
SEC-021350-2019
Original NOI
14890
Tracking No.
Date COC Issued
9/3/2019
Prior Rescission
lhis field will populate only if 0OChas already been rescinded.
Date
Reason for Rescission/Termination Request:
Reason for
r Project Closed -Out
Termination of
r Sale (Another Owner/Operator will apply for a new COC)
Coverage *
r Mistake or Invalid Coverage
r Other
Addional
Ivbre infornation about the basis of this request, if needed.
Explanation
Was a duplicate application. Wrong radio
button selected at payment rejection stage
by SMcCoy.
Supporting
1pload Supporting Wcunentation if applicable.
Documentation
WstbeFDFfornat
Project Close-out Information:
Jn a1LUUFF1Widl1

Final Close-out
Inspection Approval
Project Close-out Mist bePDFforrrat
Approval
Documentation
North Carolina General Statute 143-215.613 (1) provides that:
Any person who knowingly makes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained underthis Article or a rule implementing this Article; orwho knowinglymakes 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 deiceor method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyof a Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
rJ 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 * Suzanne McCoy
Title * Administrative Assistant
Organization * NCDEQ - Stormwater Program
Date * 09/10/2019
Email for [e-mail]
Confirmation *
Contact Telephone* 919-707-3640
NOT Certification Xerox Scan_ 09102019110840.PDF 33.94KB
Form Wst be PDF Forrrat