HomeMy WebLinkAboutNCC190116_Notice of Termination_20191204Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/4/2019 7:24:45 AM (NOT Submittal)
Approve by Morman, Alaina 12/9/2019 11:18:45 AM (NOT Request Review- NCC190116)
• The task was assigned to Morman, Alaina by round robin distribution 12/4/2019 7:24 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 9, 2019 5:00
PM 12/4/2019 7:24 AM
1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190116
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Chick-fil-A @ 8700 University Exec Park
Drive
Address
8700 University Executive Park Drive, Charlotte, NC
County
Mecklenburg
Latitude
35.3067
Longitude
-80.7523
Permittee Listed
Chick-fil-A, Inc.
Legally Responsible
Erwin Reid
Individual
NC Reference No.
NCG01-2019-0116
E&SC Plan ID
LDGP-2019-00072
Original NOI
10439
Tracking No.
Date COC Issued
4/29/2019
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Reason for Rescission/Termination Request:
Reason for
F Project Closed -Out
Termination of
r Sale (Another Owner/Operator will apply for a new COC)
Coverage *
r Mistake or Invalid Coverage
r Other
Add Tonal IVbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting DDcunentation if applicable.
Documentation Mist beFDFformat
Project Close-out Information:
Final Close-out 11/20/2019
Inspection Approval
Project Close-out Grading PermitNoticeOfTermination_20191120_04... 80.8KB
Approval Mast be PDFforrrat
Documentation
North Carolina General Statute 143-215.613 (i) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled 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 underthis 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 guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
17 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* David Farmer
Title * Senior Vice President - Restaurant Experience
Organization* Chick-fil-A, Inc.
Date * 12/04/2019
Email for grgassoc@comcast.net
Confirmation *
Contact Telephone* 843-556-4261
NOT Certification eNOT (11.26#04278.pdf 102.3KB
Form Mast be RY Format