NCC190257_Notice of Termination_20210128

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/28/2021 6:19:36 PM (NOT Submittal)
Approve by Morman, Alaina 1/29/2021 3:32:49 PM (NOT Request Review- NCC190257)
• The task was assigned to Morman, Alaina. The due date is: February 2, 2021 5:00 PM
1 /28/2021 6:19 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190257
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
The Riveter
Address
701 Old Fanning Bridge Road, Mills River, NC
County
Henderson
Latitude
35.4289
Longitude
-82.5457
Permittee Listed
Riveter Property Holdings LLC
Legally Responsible
Elizabeth Jackson
Individual
NC Reference No.
NCG01-2019-0257
E&SC Plan ID
HENDE2019-012
Original NOI
10933
Tracking No.
Date COC Issued
5/13/2019
Prior Rescission
Date populates only if OOC was already rescinded at tirre of submittal.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 *
U 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 Docurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 12/15/2020
Inspection Approval
Project Close-out Inspection Report _Riveter.pdf 311.7KB
Approval Mist be FDFfornat
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
Type Name* Elizabeth Jackson
Title * Owner/GM
Organization* Riveter Property Holdings, LLC
Date * 01 /28/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 828-577-2263
NOT Certification Inspection Report_Riveter.pdf
Form permit complete & signed .pdf
Mist be FDF Fornat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Erails
(Optional)
Original Permittee CCd on Wification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]
311.7KB
758.77KB