HomeMy WebLinkAboutNCC190053_Notice of Termination_20210126Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/26/2021 8:29:48 AM (NOT Submittal)
Approve by Morman, Alaina 1/28/2021 9:09:51 AM (NOT Request Review- NCC190053)
• The task was assigned to Morman, Alaina. The due date is: January 29, 2021 5:00 PM
1 /26/2021 8:30 AM
1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC190053
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
PAID
2021 Annual Fee Status
Nbybeblank (if not yet billed).
Information associated
with this permit:
Project Name
Project Cure
Address
Startown Road, Hickory, NC
County
Catawba
Latitude
35.6842
Longitude
-81.2871
Permittee Listed
City of Hickory -Assistant City Manager
Legally Responsible
Lloyd B. Beasley
Individual
NC Reference No.
NCG01-2019-0053
E&SC Plan ID
CATAW-2019-018
Original NOI
10192
Tracking No.
Date COC Issued
4/17/2019
Prior Rescission
Date populates only if COCwas already rescinded at tirre of submittal.
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 *
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 4/17/2020
Inspection Approval
Project Close-out Erosion control permit closeout.pdf 1.06MB
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
rJPrk'� r�'7�ll�clf�Y�
Type Name* Lloyd B. Beasley
Title * City of Hickory -Assistant City Manager
Organization * City of Hickory
Date * 01 /26/2021
Email for swalters@cecinc.com
Confirmation *
Contact Telephone* 980-260-2127
NOT Certification NCG01-Erosion Control NOT Certification Form -
Form 34.12KB
Signed.pdf
Mist be FDF Fornat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
CCd on Notification Errails
mrjohnson@cecinc.com
CCd on Notification Bmils
rbeasley@hickorync.gov
Original Site Contact CCd on Notificaiton Errnils
Email spennell@hickorync.gov