HomeMy WebLinkAboutNCC191166_Notice of Termination_20200110Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/10/2020 8:54:00 AM (NOT Submittal)
Approve by Morman, Alaina 1/10/2020 3:51:10 PM (NOT Request Review- NCC191166)
• The task was assigned to Morman, Alaina by round robin distribution 1/10/2020 8:54 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 15, 2020 5:00
PM 1/10/2020 8:54 AM
1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC191166
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Blackbridge Subdivision Phase Two Lot 11
Address
Low Oak Ct, Rockfish, NC
County
Cumberland
Latitude
35.0000
Longitude
-79.0000
Permittee Listed
Caviness Land Development, Inc.
Legally Responsible
Watson Caviness
Individual
NC Reference No.
NCG01-2019-1166
E&SC Plan ID
CUMBE-2019-159
Original NOI
14213
Tracking No.
Date COC Issued
7/31/2019
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This field will populate only ff OOChas already been rescinded.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 Mxe 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 10/28/2019
Inspection Approval
Project Close-out BV11 Release.pdf 59.46KB
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
K"Al n n! 6 0-*V/;Jo5.s
Type Name* Watson G Caviness
Title * President
Organization* Caviness Land Development, Inc
Date * 01 /10/2020
Email for pj@cavinessland.com
Confirmation *
Contact Telephone* 910-339-6330
NOT Certification BV11 NOTCertForm.pdf 24.3KB
Form Mast be FDF Forrrat