HomeMy WebLinkAboutNCC190502_Notice of Termination_20201027Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/27/2020 8:13:43 AM (NOT Submittal)
Approve by Georgoulias, Bethany 10/27/2020 11:26:39 AM (NOT Request Review- NCC190502)
• The task was assigned to Georgoulias, Bethany. The due date is: October 30, 2020 5:00 PM
10/27/2020 8:13 AM
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NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190502
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
WakeMed Medical Office Park of Cary
Address
210 & 220 Ashville Avenue, Cary, NC
County
Wake
Latitude
35.7404
Longitude
-78.7839
Permittee Listed
Brasfield & Gorrie, LLC
Legally Responsible
Drew Stokley
Individual
NC Reference No.
NCG01-2019-0502
E&SC Plan ID
19-DP-0047
Original NOI
11785
Tracking No.
Date COC Issued
6/6/2019
Prior Rescission
Date populates only if OOCwas already rescinded at tirre of subaittal.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
Add ional Nbre inforrration about the basis of this request, if needed.
Explanation project is complete.
Supporting upload Supporting Docurrentation if applicable.
Documentation Mist beFDFforrrat
Project Close-out Information:
Final Close-out 8/5/2020
Inspection Approval
Project Close-out 8-5-20 permit closed.pdf 192.4KB
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
Type Name* Drew Stokley
Title * Project Manage
Organization* Brasfield & Gorrie, LLC
Date * 10/27/2020
Email for dstokley@brasfieldgorrie.com
Confirmation *
Contact Telephone* 9198775835
NOT Certification NCG01-eNOT-Certification-Form-20190508-
Form DEMLR-SW.pdf
Mast be PM Fornat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on Wification Errails
Email dstokley@brasfieldgorrie.com
Original Site Contact CCd on Kbtificaiton Bmils
Email dstokley@brasfieldgorrie.com
647.63KB