NCC193060_Notice of Termination_20201209

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/9/2020 9:57:31 AM (NOT Submittal)
Approve by Georgoulias, Bethany 12/9/2020 1:27:15 PM (NOT Request Review- NCC193060)
• The task was assigned to Georgoulias, Bethany. The due date is: December 14, 2020 5:00 PM
12/9/2020 9:57 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC193060
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee
OPEN
Status
Information associated
with this permit:
Project Name
MCI Business Park - Phase 3 Grading Permit
Address
2121 E. Williams St., Apex, NC
County
Wake
Latitude
36.0000
Longitude
-79.0000
Permittee Listed
Mattachione Construction, Inc.
Legally Responsible
Mike Mattachione
Individual
NC Reference No.
NCG01-2019-3060
E&SC Plan ID
19-012
Original NOI
19152
Tracking No.
Date COC Issued
12/6/2019
Prior Rescission
Cute populates only if CCCwas already rescinded at tirre of subnittal.
Date
Reason for Rescission/Termination Request:
Reason for
r Project Closed -Out
Termination of
r Sale (Another Owner/Operator will apply for a new COC)
Coverage *
r Mistake or Invalid Coverage
F Other Owner will apply for a new COC due to a new construction plan

Add ional We information about the basis of this request, if needed.
Explanation As the intent of this project was to
clear/grade for a possible future site plan, we
are closing this COC out because that
possible site plan has now materialized as a
newly approved construction plan from the
Town of Apex. The project area has
expanded, and the sediment basin will be
moved. A new COC will be applied for given
the new details of the project.
Supporting upload Supporting Docurreentation if applicable.
Documentation 04-Grading & Erosion Control.pdf 1.2MB
07-Grading.pdf 1.89MB
Mast be FDFforr at
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mast beFDFforrat
Approval
Documentation
North Carolina General Statute 143-215.613 (i) 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 Artide 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 device or method required to be operated or maintained under this Artide or rules of the
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
O�O 41W7A,-WI�V0
Type Name* Mike Mattachione
Title * President
Organization* Mattachione Construction, Inc.
Date * 12/09/2020
Email for [e-mail]
Confirmation *
Contact Telephone* [phone]

NOT Certification Notice of Termination Form.pdf 59.11 KB
Form Mast be PDF For -rat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee OCdonNlotificationErrails
Email [e-mail]
Original Site Contact CCd on Kbtificaiton Bmils
Email [e-mail]