NCC190170_Notice of Termination_20200304

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/4/2020 11:18:04 AM (NOT Submittal)
Approve by Georgoulias, Bethany 3/5/2020 1:40:14 PM (NOT Request Review- NCC190170)
p Applicant neglected to upload the NOT Certification form but e-mailed it separately. It will be added to
the permit records.
• Georgoulias, Bethany reassigned the task to Georgoulias, Bethany 3/4/2020 1:32 PM
• The task was assigned to McCoy, Suzanne by round robin distribution 3/4/2020 11:18 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 9, 2020 5:00 PM
3/4/2020 11:18 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC190170
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
Information associated
with this permit:
Project Name
Snows Cut RV Park Ph -I
Address
9617 River Rd., Wilmington, NC
County
New Hanover
Latitude
34.0570
Longitude
-77.9000
Permittee Listed
CWEST, LLC
Legally Responsible
Curtis Westbrook, Sr.
Individual
NC Reference No.
NCG01-2019-0170
E&SC Plan ID
1-19
Original NOI
10643
Tracking No.
Date COC Issued
5/3/2019
Prior Rescission
Cate populates only if OOCwas already rescinded at tirre of subaittal.
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 3/3/2020
Inspection Approval

Project Close-out Field Inspection Report 01-19-03.02.20.pdf 267.82KB
Approval Mist be FDFforrrat
Documentation
North Carolina General Statute 143-215.6E (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 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* CURTIS WESTBROOK SR.
Title * MANAGER
Organization* CWEST, LLC
Date * 03/04/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 9194676166
NOT Certification Field Inspection Report 01-19-03.02.20.pdf 267.82KB
Form Mist be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?