HomeMy WebLinkAboutNCC190150_Notice of Termination_20210521Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/21/2021 2:13:17 PM (NOT Submittal)
Approve by Morman, Alaina 5/23/2021 12:59:53 PM (NOT Request Review- NCC190150)
• The task was assigned to Morman, Alaina. The due date is: May 26, 2021 5:00 PM 5/21/2021 2:13 PM
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NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190150
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status PAID
2021 Annual Fee Status OPEN
K/hy be blank (if not yet billed).
Information associated with this permit:
Project Name
Tioga Auto Repair
Address
Commerce Ct, Pittsboro, NC
County
Chatham
Latitude
36.0000
Longitude
-79.0000
Permittee Listed
TiHo LLC
Legally Responsible
Tioga Honigmann
Individual
NC Reference No.
NCG01-2019-0150
E&SC Plan ID
2019-03020
Original NOI
10549
Tracking No.
Date COC Issued
5/1/2019
Prior Rescission
Cate populates only if COCwas already rescinded at time of submittal.
Date
Reason for Rescission/Termination Request:
Reason for
r Project Closed -Out
Termination of
r Sale (Another Owner/Operator obtained a new COC)
Coverage *
r Mistake or Invalid Coverage
r Other
Addional IVbre information about the basis of this request, if needed.
Explanation
Supporting upload Supporting Documentation if applicable.
Documentation Mist beRYforrrat
Project Close-out Information:
Final Close-out 4/1/2021
Inspection Approval
Project Close-out CERTIFICATE OF COMPLETION.pdf 34.26KB
Approval Mast be FDFforrrat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson 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 Article; orwho 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 of the
Commission implementing this Article 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
TOY<2 11oa4,�,Wc?a411
Type Name* Tioga Honigmann
Title * President
Organization* Tiho IIc.
Date * 05/21 /2021
Email for tioga.hh@gmail.com
Confirmation *
Contact Telephone* 919-260-4628
NOT Certification NOT Form.pdf
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email OCd on Notification Errails
(Optional) aefrost@gmail.com
Original Permittee CCdonWificationErrails
Email tiogahonigmann@bellsouth.net
Original Site Contact 0Cd on Notificaiton Errails
Email tiogahonigmann@bellsouth.net
957.73KB