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 If approved, the Certificate of Coverage (COC) will be rescinded.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 Coverage (COC) No.*field type single line
Enter the Certificate of Coverage Number (Use capital letters)
Input blocked. Maximum character limit of 9 characters reached.
Information associated with this permit:
Project Namefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Lots Covered by this Permit COC (if applicable)field type multi line
This information is especially helpful when more lots were added with Modifications since the original permit issuance.
Addressfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Street Addressfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Cityfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Statefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Countyfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Latitudefield type number
Longitudefield type number
Permittee Listedfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Legally Responsible Individualfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
First Namefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Last Namefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
NC Reference No.field type single line
This field is hidden from initial request form to prevent confusion
Input blocked. Maximum character limit of 4000 characters reached.
E&SC Plan IDfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Original NOI Tracking No.*field type number
Date COC Originally Issuedfield type date
Most Recent Issuance/Renewal Date*field type date
Prior Rescission Date? (If Applicable)field type date
DO NOT PROCEED with this Notice of Termination. This Certificate of Coverage is no longer active.
*field type radio button
Unable to submit at this time
Reason for Rescission/Termination Request:
Reason for Termination of Coverage*field type radio button
Reason for Termination of CoverageProject Closed-OutSale (Another Owner/Operator obtained new COC)Mistake or Invalid CoverageOther
New owner/operator COC No.field type single line
Enter the COC number obtained by the new owner
Input blocked. Maximum character limit of 4000 characters reached.
New Owner Namefield type single line
First and last name
Input blocked. Maximum character limit of 4000 characters reached.
New Owner Phone Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
New Owner Emailfield type email
Additional Explanationfield type multi line
More information about the basis of this request, if needed.
In the case of a sale, you must upload supporting documentation of the transfer or close-out of the Erosion and Sediment Control (E&SC) Plan. The new owner or operator must obtain a new COC to cover construction activities.
Supporting Documentationfield type file upload
Upload Supporting Documentation if applicable.
Drop files here
You have reached the maximum file limit: .
Must be PDF format
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 Close-out Date*field type date
Erosion Control Plan Close-out Documentation*field type file upload
Drop files here
You have reached the maximum file limit: .
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).
*field type checkbox
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*field type signature
Type Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Title*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Organization*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Date*field type date
Date will be captured on form submission
Email for Confirmation*field type email
Contact Telephone*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
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 Form*field type file upload
Drop files here
You have reached the maximum file limit: .
Must be PDF Format
Additional Email (Optional)field type email
Original Permittee Emailfield type email
Original Site Contact Emailfield type email