HomeMy WebLinkAboutNCC191611_Notice of Termination_20200421Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/21/2020 9:13:36 AM (NOT Submittal)
Approve by Georgoulias, Bethany 4/21/2020 2:21:12 PM (NOT Request Review- NCC191611)
p The original submittal yesterday was lacking the NOT Certification form. This form was uploaded
today, but Charlotte's Termination of the Grading Permit correspondence was not (only the Building Permit
was included). The reviewer will move that record into the final permit file from the original copies stored
from the submittal on 4120 so this NOT request can be approved.
• The task was assigned to Georgoulias, Bethany. The due date is: April 24, 2020 5:00 PM
4/21/2020 9:13 AM
1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC191611
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
Information associated
with this permit:
Project Name
CHARLOTTE BOYS AND GIRLS CLUB
Address
2901 MILTON ROAD, CHARLOTTE, GA
County
Mecklenburg
Latitude
35.2470
Longitude
-80.7410
Permittee Listed
SPORTS FIELDS, INC
Legally Responsible
GREG KERBOW
Individual
NC Reference No.
NCG01-2019-1611
E&SC Plan ID
LDGP-2019-00166
Original NOI
15324
Tracking No.
Date COC Issued
8/28/2019
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
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 4/20/2020
Inspection Approval
Project Close-out Mecklenburg WebPermit Permit Status.pdf 919.44KB
Approval Mast be FDFfornat
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
?" owe
Type Name* Andrew Doster
Title * Project Engineer
Organization* Sports Fields, Inc.
Date * 04/21 /2020
Email for adoster@fields-inc.com
Confirmation *
Contact Telephone* 7706584628
NOT Certification Charlotte NOT Certification Form.pdf
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on Wification BTails
Email GKERBOW@FIELDS-INC.COM
Original Site Contact CCd on Notificaiton Bmils
Email GKERBOW@FIELDS-INC.COM
482.1 KB