NCC190225_Notice of Termination_20201201

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/1/2020 8:57:45 AM (NOT Submittal)
Approve by Georgoulias, Bethany 12/3/2020 11:53:21 AM (NOT Request Review- NCC190225)
* Permittee provided NOT certification via e-mail on 1213.
• The task was assigned to Georgoulias, Bethany. The due date is: December 4, 2020 5:00 PM
12/1/2020 8:58 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC190225
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
Information associated
with this permit:
Project Name
Grove Solar
Address
1090 Washington Post Road, New Bern, NC
County
Craven
Latitude
35.1658
Longitude
-77.1207
Permittee Listed
Cypress Creek EPC, LLC
Legally Responsible
Geoff Fallon
Individual
NC Reference No.
NCG01-2019-0225
E&SC Plan ID
Crave-2019-032
Original NOI
10834
Tracking No.
Date COC Issued
5/9/2019
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Date populates only if OOCwas already rescinded at tirre of subaittal.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 5/15/2020
Inspection Approval

Project Close-out 200515 GROVE SOLAR CRAVE-2019-032.pdf 36.14KB
Approval Mast be FDFfornil
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes anyfalse 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 knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho falsifies, tampers with, or knowingly renders
inaccurate anyrecording 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 notto 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* KAYTI CURTIS
Title * AUTHORIZED PERSON
Organization* CYPRESS CREEK RENEWABLES, LCC
Date * 12/01 /2020
Email for [e-mail]
Confirmation *
Contact Telephone* 732-485-8285
NOT Certification NCG010000_Final _ Permit _2019_04_01.pdf 10.74MB
Form Grove-NCDEQ NPDES Certificate of Coverage (5-9-
36.05KB
19).pdf
Mast be FDF Format
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on Wification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton BTails
Email [e-mail]