NCC191235_Notice of Termination_20191230

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/30/2019 10:11:07 AM (NOT Submittal)
Approve by Clark, Paul 12/30/2019 2:05:51 PM (NOT Request Review - NCC191235)
• The task was assigned to Clark, Paul by round robin distribution 12/30/2019 10:11 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 2, 2020 5:00
PM 12/30/2019 10:11 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC191235
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Borgin Properties, LLC
Address
9504 China Grove Church Rd., Charlotte, NC
County
Mecklenburg
Latitude
35.0000
Longitude
-81.0000
Permittee Listed
Borgin Properties, LLC
Legally Responsible
James Howell
Individual
NC Reference No.
NCG01-2019-1235
E&SC Plan ID
LDGPL-2019-00155
Original NOI
14503
Tracking No.
Date COC Issued
8/22/2019
Prior Rescission
This field will populate only ff OOChas already been rescinded.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 * O Mistake or Invalid Coverage
r Other
Addional We inforrration about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Docurrentation if applicable.
Documentation Mist beFDFforrrat
Project Close-out Information:
Final Close-out 12/4/2019
Inspection Approval

Project Close-out Grading permit NOT.PDF 81KB
Approval Mast be FDFforrrat
Documentation
North Carolina General Statute 143-215.66 (1) 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 deice or method required to be operated or maintained under this Article or rules ofthe
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
0-la"&r:wC
Type Name* James M Howell
Title * Manager for Borgin Properties LLC
Organization* Borgin Properties LLC
Date * 12/30/2019
Email for jamesmhowell1 @gmail.com
Confirmation *
Contact Telephone* 7049957689
NOT Certification NCG01 Notice of Termination (NOT) Certification
Form 525.19KB
Form.pdf
Mast be PM Forrrat