NCC190533_Notice of Termination_20210601

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/1/2021 10:43:03 AM (NOT Submittal)
Approve by Morman, Alaina 6/3/2021 12:32:15 PM (NOT Request Review- NCC190533)
• The task was assigned to Morman, Alaina. The due date is: June 4, 2021 5:00 PM 6/1/2021 10:43 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190533
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
East Carolina Univeristy Multipurpose Practice Fields
Address
Charles Blvd., Greenville, NC
County
Pitt
Latitude
35.5961
Longitude
-77.3690
Permittee Listed
East Carolina University Educational Foundation
Legally Responsible
Phillip Wood
Individual
NC Reference No.
NCG01-2019-0533
E&SC Plan ID
Pitt-2019-019
Original NOI
11873
Tracking No.
Date COC Issued
6/7/2019
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
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Explanation Phillip Wood has been replaced by Ryan
Robinson as the Pirate Club Interim
Executive Director

Supporting Upload Supporting Documentation if applicable.
Documentation Mist beFDFformat
Project Close-out Information:
Final Close-out 4/15/2020
Inspection Approval
Project Close-out 200402 ECU Multipurpose Practice Field PITT-2019-
Approval 019. pdf 244.37KB
Documentation
Mast be RYformat
North Carolina General Statute 143-215.613 (i) 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 Artide 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 device or method required to be operated or maintained under this Artide or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
17 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* Ryan Robinson
Title * Interim Executive Director of the Pirate Club
Organization* Pirate Club Educational Foundation
Date * 06/01 /2021
Email for [e-mail]
Confirmation *
Contact Telephone* 252-737-4669
NOT Certification NOT Request Form - Construction Stormwater
Form 44.85KB
NCG01 o.pdf
Ryan Robinson Signed NOT.pdf 360.59KB
NUst be RY Format
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional)

Original Permittee CCdonKlotificationBmils
Email [e-mail]
Original Site Contact GCd on Nlotificaiton BTails
Email [e-mail]