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HomeMy WebLinkAboutNCC191347_Notice of Termination_20201214Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 12/14/2020 1:00:22 PM (NOT Submittal) Approve by Georgoulias, Bethany 12/15/2020 8:07:40 AM (NOT Request Review- NCC191347) • The task was assigned to Georgoulias, Bethany. The due date is: December 17, 2020 5:00 PM 12/14/2020 1:00 PM 1 � NORTH CAROLINA Enrlronmenral Quallly Certificate of NCC191347 Coverage (COC) Enter the Certificate of Coverage Nimber No.* 2020 Annual Fee Status OPEN 2021 Annual Fee Status N/A Information associated with this permit Project Name Heritage Vet Clinic Address 3240 Rogers Rd, Wake Forest, NC County Wake Latitude 35.9490 Longitude -78.5170 Permittee Listed G&G Builders Legally Responsible Amos Greene Individual NC Reference No. NCG01-2019-1347 E&SC Plan ID 2019-00000910 Original NOI 14749 Tracking No. Date COC Issued 8/13/2019 Prior Rescission Cate populates only if COCwas already rescinded at tirre of subrrittal.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 Ad d i o n a I Nbre information about the basis of this request, if needed. Explanation Supporting Upload Supporting Dxurrentation if applicable. Documentation Mist beFDFformat Project Close-out Information: Final Close-out 12/11/2020 Inspection Approval Project Close-out Heritage Vet_ Certificate of Completion_12.11.20.pdf 155.11 KB 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). rJ 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 K_-Avev 6F?ag._ Type Name* Amos Greene Title * Vice President Organization* G&G Builders, Inc Date * 12/14/2020 Email for amos@ggbuildersnc.com Confirmation * Contact Telephone* 9194279652 NOT Certification NCG01-eNOT-Certification-Form-20190508- Form DEMLR-SW.pdf Mist be FDF Format Is this COC Already Ensure this CCChas not been rescinded since subrrittal! Rescinded? Additional Email OCd on Notification Errails (Optional) amos@ggbuildersnc.com Original Permittee CCdonWificationErrails Email amos@ggbuildersnc.com Original Site Contact CCd on Notificaiton Errails Email amos@ggbuildersnc.com 323.67KB