NCC190890_Notice of Termination_20201104

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/4/2020 1:13:32 PM (NOT Submittal)
Approve by Georgoulias, Bethany 11/4/2020 1:23:49 PM (NOT Request Review- NCC190890)
• The task was assigned to Georgoulias, Bethany. The due date is: November 9, 2020 5:00 PM
11/4/2020 1:13 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190890
Coverage (COC) Enter the Certificate of Coverage Ninber
No.*
Information associated with this permit
Project Name
Riverbend Grading and E&SC Plan for Final Closure - Additional
Area
Address
473 Horseshoe Bend Beach Road, Mount Holly, NC
County
Gaston
Latitude
35.3600
Longitude
-80.9691
Permittee Listed
Duke Energy Carolinas, LLC
Legally Responsible
Christopher Varner
Individual
NC Reference No.
NCG01-2019-0890
E&SC Plan ID
GASTO-2019-023
Original NOI
13138
Tracking No.
Date COC Issued
7/9/2019
Prior Rescission
Date populates only if COCwas already rescinded at tirre of submttal.
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 *
r Mistake or Invalid Coverage
r Other
Add final We inforrration about the basis of this request, if needed.
Explanation Project is complete
Supporting Upload Supporting DDcunentation if applicable.
Documentation Mist beFDFfornat
Project Close-out Information:

Final Close-out 10/21/2020
Inspection Approval
Project Close-out 10-21-2020 Closure Inspection Report (GASTO-
Approval 245.66KB
2019-023).pdf
Documentation
Mast be FDFforrrat
North Carolina General Statute 143-215.613 (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 device or method required to be operated or maintained under this Article or rules of the
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
W. vw'ew
Type Name* Christoper Varner
Title * Senior Project Manager
Organization* Duke Energy -Coal Combustion Products
Date * 11/04/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 8284787104
NOT Certification NCG01-eNOT-Certification-Form-20190508-
Form 282.7KB
DEMLR-SW.pdf
Mast be FDF Forrrat
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCdonKlotificationErrails
Email [e-mail]
Original Site Contact 0Cd on Wificaiton Errails
Email Brad. [e-mail]