NCC191349_Notice of Termination_20210708

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/8/2021 3:49:11 PM (NOT Submittal)
Approve by Morman, Alaina 7/9/2021 10:43:09 AM (NOT Request Review- NCC191349)
• The task was assigned to Morman, Alaina. The due date is: July 13, 2021 5:00 PM 7/8/2021 3:49 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC191349
Coverage (COC)
Enter the Certificate of Coverage Number
No.*
2020 Annual Fee Status
PAID
2021 Annual Fee Status
Nbybeblank (if not yet billed).
Information associated
with this permit:
Project Name
Marvin Gardens
Address
Providence Road South / New Town Road, Marvin, NC
County
Union
Latitude
34.9890
Longitude
-80.7770
Permittee Listed
WIMCO Corp
Legally Responsible
Brad Makepeace
Individual
NC Reference No.
NCG01-2019-1349
E&SC Plan ID
UNION-2019-052
Original NOI
14729
Tracking No.
Date COC Issued
8/13/2019
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 7/2/2021
Inspection Approval
Project Close-out UNION-2019-052_Marvin Gardens Publix
Approval 115.77KB
CO_7.1.2021.pdf
Documentation
Mast be FOFforrrat
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
�frr.7`lr��r� rl�
Type Name* Matthew Hill
Title * Vice President
Organization* WIMCO Corp
Date * 07/08/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 25234106533
NOT Certification NOT cert Marvin Gardens.pdf 80.72KB
Form Mast be WF Forrrat
Is this COC Already Ensure this OCChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
CCd on Notification Errails
[e-mail]
CCd on Notification Errails
[e-mail]
Original Site Contact OCd on Notificaiton Errails
Email [e-mail]