HomeMy WebLinkAboutNCC190411_Notice of Termination_20201123Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/23/2020 1:52:54 PM (NOT Submittal)
Approve by Georgoulias, Bethany 11/23/2020 1:57:36 PM (NOT Request Review- NCC190411)
• The task was assigned to Georgoulias, Bethany. The due date is: November 26, 2020 5:00 PM
11/23/2020 1:53 PM
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NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190411
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Lake Wheeler Creamery Cafe and Education Center
Address
100 Dairy Lane, Raleigh, NC
County
Wake
Latitude
35.7242
Longitude
-78.6831
Permittee Listed
NC State University
Legally Responsible
Mary Peloquin-Dodd
Individual
NC Reference No.
NCG01-2019-0411
E&SC Plan ID
WAKE-2019-092
Original NOI
11540
Tracking No.
Date COC Issued
5/31/2019
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Date populates only if OOCwas already rescinded at tirre of subaittal.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
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 11/5/2020
Inspection Approval
Project Close-out Lake Wheeler Creamery_WAKE 2019 092.pdf 116.05KB
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* Charles Maimone
Title * Vice Chancellor for Fianance and Administration
Organization* NC State University
Date * 11 /23/2020
Email for kcgreen@ncsu.edu
Confirmation *
Contact Telephone* 919-368-0949
NOT Certification Lake Wheeler Creamery Certification.pdf 419.81 KB
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on Nbtification Errails
Email vc-finadmin@ncsu.edu
Original Site Contact CCd on Kbtificaiton Bmils
Email jmterrel@ncsu.edu