NCC191597_Notice of Termination_20201201

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/1/2020 1:21:47 PM (NOT Submittal)
Approve by Georgoulias, Bethany 12/3/2020 8:36:16 AM (NOT Request Review- NCC191597)
p Person who submitted/signed the NOT request listed a different organization than the permittee entity,
but it's the same individual (may have been oversight in original NOI review or mistake by applicant). Will
accept.
• The task was assigned to Georgoulias, Bethany. The due date is: December 4, 2020 5:00 PM
12/1/20201:21 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC191597
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
The Bellamy at WCU
Address
South Painter road, Cullowhee, NC
County
Jackson
Latitude
35.3180
Longitude
-83.1830
Permittee Listed
WCU Student Housing, LLC
Legally Responsible
Twd Hudgins
Individual
NC Reference No.
NCG01-2019-1597
E&SC Plan ID
19-110
Original NOI
15264
Tracking No.
Date COC Issued
8/27/2019
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 We 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 11/24/2020
Inspection Approval

Project Close-out 2020 Sediment Report with COC Bellamy 2029-
Approval 1.29MB
14197 11-25-2020. pdf
Documentation
Mast be FL7Fforrrat
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other
document filed 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 under this 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 of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which may include 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
9C71 �` Z K�71*1/
Type Name* Ted Hudgins
Title * VP
Organization* M&E Dev. LLC
Date * 12/01 /2020
Email for [e-mail]
Confirmation *
Contact Telephone* 404-379-6738
NOT Certification NOT Form 12-1-20.pdf 743.4KB
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 Kbtificaiton Errails
Email [e-mail]