NCC190670_Notice of Termination_20201030

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/30/2020 12:55:05 PM (NOT Submittal)
Approve by Georgoulias, Bethany 10/30/2020 2:52:11 PM (NOT Request Review- NCC190670)
• The task was assigned to Georgoulias, Bethany. The due date is: November 4, 2020 5:00 PM
10/30/2020 12:55 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190670
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Storage Bliss Boat and RV
Address
SR1010, Cleveland Township, NC
County
Johnston
Latitude
35.5843
Longitude
-78.5527
Permittee Listed
Spec Con, Inc.
Legally Responsible
Douglas Watson
Individual
NC Reference No.
NCG01-2019-0670
E&SC Plan ID
JC# 18-123-P
Original NOI
12635
Tracking No.
Date COC Issued
6/20/2019
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 10/30/2020
Inspection Approval

Project Close-out 10-30-20.pdf
Approval Mast be FDFforrrat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
185.16KB
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* Douglas G. Watson
Title * President
Organization* Spec Con, Inc.
Date * 10/30/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 9192665992
NOT Certification NOT Certification Form.pdf 65.92KB
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 [e-mail]
Original Site Contact CCd on Kbtificaiton Bmils
Email [e-mail]