NCC190728_Notice of Termination_20201028

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/28/2020 4:22:14 PM (NOT Submittal)
Approve by Georgoulias, Bethany 10/29/2020 8:01:01 AM (NOT Request Review- NCC190728)
• The task was assigned to Georgoulias, Bethany. The due date is: November 2, 2020 5:00 PM
10/28/2020 4:22 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190728
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Washington Terrace - Phase 3
Address
401 N. Fisher St. & 1901 Oakwood Ave., Raleigh, NC
County
Wake
Latitude
35.7851
Longitude
-78.6142
Permittee Listed
College Park Collaborative, LLC
Legally Responsible
Natalie Britt
Individual
NC Reference No.
NCG01-2019-0728
E&SC Plan ID
119038
Original NOI
12780
Tracking No.
Date COC Issued
6/25/2019
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 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 5/18/2020
Inspection Approval

Project Close-out 20-05-18 SL CERTIFICATE OF COMPLETION
Approval 38.16KB
Washington Terrace.pdf
Documentation
Mast be FL7Fforrrat
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
0&rr
Name* Natalie Britt
Title * Vice President
Organization* College Park Collaborative, LLC
Date * 10/28/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 9196005364
NOT Certification Washington Terrace Phase 3 -NOT Form.pdf 237.25KB
Form Mast be PDF Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on Wification BTails
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]