NCC190659_Notice of Termination_20200114

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/14/2020 11:48:29 AM (NOT Submittal)
Approve by Georgoulias, Bethany 1/14/2020 12:32:01 PM (NOT Request Review- NCC190659)
* Email confirmation of close-out uploaded by applicant is from the same local program and City
Engineer that issued the E&SC Plan. Request will be approved.
• Georgoulias, Bethany reassigned the task to Georgoulias, Bethany 1/14/2020 12:24 PM
• The task was assigned to McCoy, Suzanne by round robin distribution 1/14/2020 11:48 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 17, 2020 5:00
PM 1/14/2020 11:48 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190659
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
114 Solitaire Dr
Address
114 Solitaire Dr, Trinity, NC
County
Randolph
Latitude
35.8623
Longitude
-79.9344
Permittee Listed
Equity Trust
Legally Responsible
Bobby Earnhardt
Individual
NC Reference No.
NCG01-2019-0659
E&SC Plan ID
COA-2019-004
Original NOI
12570
Tracking No.
Date COC Issued
6/20/2019
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This field will populate only ff OOChas already been rescinded.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 1/9/2020
Inspection Approval

Project Close-out doc05062320200113150000.pdf 273.79KB
Approval Mast be RYforrrat
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
Type Name * Bobby Earnhardt
Title * Owner
Organization* Equity Trust
Date * 01 /14/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 3362153024
NOT Certification doc05037220200109161837.pdf 389.78KB
Form Mast be FDF Forrrat