HomeMy WebLinkAboutNCC191702_Notice of Termination_20201201Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/1/2020 5:05:11 PM (NOT Submittal)
Approve by Georgoulias, Bethany 12/3/2020 8:40:06 AM (NOT Request Review- NCC191702)
• The task was assigned to Georgoulias, Bethany. The due date is: December 4, 2020 5:00 PM
12/1/2020 5:05 PM
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NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC191702
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Taylor Residence
Address
2541 Devine Road, Iron Station, NC
County
Lincoln
Latitude
35.4170
Longitude
-81.1570
Permittee Listed
Dayle L. Taylor
Legally Responsible
Dayle Taylor
Individual
NC Reference No.
NCG01-2019-1702
E&SC Plan ID
19-OTH-04
Original NOI
15525
Tracking No.
Date COC Issued
9/4/2019
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Date populates only if OOCwas already rescinded at tirre of subaittal.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 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 Soil and Erosion Post Construction Letter.pdf 424.74KB
Approval Mist 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* Dayle Taylor
Title * Owner
Organization* Dayle Taylor
Date * 12/01 /2020
Email for mrlymie@outlook.com
Confirmation *
Contact Telephone* 18284094001
NOT Certification NCG01 Noice of Termination Certification Form.pdf 339.77KB
Form Mast be FDF Format
Is this COC Already Ensure this CCChas not been rescinded since submttal!
Rescinded?
Original Permittee CCd on Wification Errails
Email mrlymie@outlook.com
Original Site Contact CCd on Kbtificaiton Errails
Email mrlymie@outlook.com