NCC191514_Notice of Termination_20201204

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/4/2020 12:30:38 PM (NOT Submittal)
Approve by Georgoulias, Bethany 12/7/2020 7:50:48 AM (NOT Request Review- NCC191514)
• The task was assigned to Georgoulias, Bethany. The due date is: December 9, 2020 5:00 PM
12/4/2020 12:30 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC191514
Coverage (COC) Enter the Certificate of Coverage Ninber
No.*
Information associated with this permit
Project Name
New Hanover County Health & Human Services Facility
Address
1650 Greenfield Street, Wilmington, NC
County
New Hanover
Latitude
34.2200
Longitude
-77.9300
Permittee Listed
New Hanover County
Legally Responsible
Kevin Caison
Individual
NC Reference No.
NCG01-2019-1514
E&SC Plan ID
NEWHA-2018-029
Original NOI
15111
Tracking No.
Date COC Issued
8/26/2019
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 10/6/2020
Inspection Approval

Project Close-out NEWHA-2018-029 20201006 FINAL.pdf 114.16KB
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* Kevin Caison
Title * NHC Facilities Project Manager
Organization* New Hanover County
Date * 12/04/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 910-798-4338
NOT Certification NOT cert.pdf 38.82KB
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on Wification Errails
Email [e-mail]
Original Site Contact CCd on %tificaiton Bmils
Email [e-mail]