NCC190844_Notice of Termination_20210111

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/11/2021 4:19:08 PM (NOT Submittal)
Approve by Morman, Alaina 1/12/2021 3:51:51 PM (NOT Request Review- NCC190844)
• The task was assigned to Morman, Alaina. The due date is: January 14, 2021 5:00 PM
1/11/2021 4:19 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190844
Coverage (COC) Enter the Certificate of Coverage Ninber
No.*
2020 Annual Fee Status PAST DUE
2021 Annual Fee Status Nbybeblank (if not yet billed).
This permittee owes a fee that is PAST DUE and has a pending NOD or NOV. Do not approve this NOT request
until payment is resolved. If this NOT request is acceptable, payment may be waived if applicable, but that action must
be completed first (at the NOD or NOV Reviewstep) to ensure records are routed to the correct folder in the
repository.
However, you can reject the NOT now if it is not acceptable.
Information associated with this permit:
Project Name
Highland Elementary School Access Improvements
Address
3720 Bonnar Bridge Parkway, Burlington, NC
County
Alamance
Latitude
36.0000
Longitude
-80.0000
Permittee Listed
ZP No. 331, LLC
Legally Responsible
Jeffrey Zimmer
Individual
NC Reference No.
NCG01-2019-0844
E&SC Plan ID
649
Original NOI
13079
Tracking No.
Date COC Issued
7/3/2019
Prior Rescission
Cate populates only if CDC was already rescinded at tirre of submittal.
Date
Reason for Rescission/Termination Request:
Reason for
C Project Closed -Out
Termination of
Q Sale (Another Owner/Operator will apply for a new COC)
Coverage *
a Mistake or Invalid Coverage
0 Other

Add ional Nbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Documentation if applicable.
Documentation Mist beFDFfornat
Project Close-out Information:
Final Close-out 12/23/2019
Inspection Approval
Project Close-out Scanned from a Xerox Multifunction Printer.pdf 29.87KB
Approval Mist be FDFformat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Pnyperson 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 Atcle; orwho falsifies, tampers with, or knowinglyrenders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Atcle shall be guiltyofa Class 2 misdemeanor which mayinclude a fine notto 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
OA1`#c2i_"&'Wel�
Type Name* Jeffrey L. Zimmer
Title * Manager
Organization * ZP NO. 331, LLC
Date * 01 /11 /2021
Email for [e-mail]
Confirmation *
Contact Telephone* 910-619-2795
NOT Certification Scanned from a Xerox Multifunction Printer.pdf 35.61 KB
Form Mist be FDF Format
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional) wescottbutler@( zdc.com

Original Permittee CCdonNotificationBmils
Email [e-mail]
Original Site Contact GCd on Notificaiton Blails
Email \tvescottbutler@_zdc.com