HomeMy WebLinkAboutNCC191732_Notice of Termination_20210603Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/3/2021 3:07:33 PM (NOT Submittal)
Approve by Morman, Alaina 6/9/2021 11:44:16 AM (NOT Request Review- NCC191732)
• The task was assigned to Morman, Alaina. The due date is: June 8, 2021 5:00 PM 6/3/2021 3:07 PM
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NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC191732
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
Gastonia FUSE Complex
Address
Franklin Blvd., Gastonia, NC
County
Gaston
Latitude
35.0000
Longitude
-81.0000
Permittee Listed
City of Gastonia
Legally Responsible
V. Todd Carpenter
Individual
NC Reference No.
NCG01-2019-1732
E&SC Plan ID
GASTO-2019-018
Original NOI
15583
Tracking No.
Date COC Issued
9/12/2019
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 *
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 Dxurrentation if applicable.
Documentation Mist beFDFformat
Project Close-out Information:
Final Close-out 3/23/2021
Inspection Approval
Project Close-out 20210401-145241.pdf
Approval Mast be FDFforrrat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
47.13KB
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* V. Todd Carpenter
Title * Deputy City Manager
Organization * City of Gastonia
Date * 06/03/2021
Email for flib@cityofgastonia.com
Confirmation *
Contact Telephone* 7048546641
NOT Certification NCG01 Notice of Termination Certification Form.pdf 273.56KB
Form Mast be FDF Fornat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional) keithl@cityofgastonia.com
Original Permittee CCdonWificationErrails
Email toddc@cityofgastonia.com
Original Site Contact CCd on Notificaiton Errails
Email flipb@cityofgastonia.com