NCC191009_Notice of Termination_20210716

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 7/16/2021 10:45:38 AM(NOT Submittal)
Approve by Morman,Alaina 7/19/2021 9:31:58 AM(NOT Request Review-NCC191009)
• The task was assigned to Morman,Alaina.The due date is:July 21,2021 5:00 PM
7/16/2021 10:45 AM

" RequestNOT • Construction Stormwater
1 i
�a•aThis formto request Notice of • • for •co\erage under •
NORTH CAROLINA General - for • i i• Activities Qr�arrry
Certificate of NCC191009
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status PAID
2021 Annual Fee Status OPEN
May be blank(if not yet billed).
Information associated with this permit:
Project Name Westpoint Lot 6
Address 7810 NC 751 Highway, Durham, NC
County Durham
Latitude 35.9021
Longitude -78.9613
Permittee Listed Brasfield&Gorrie LLC
Legally Responsible Maggie Weeks
Individual
NC Reference No. NCG01-2019-1009
E&SC Plan ID 6011-14
Original NOI 13586
Tracking No.
Date COC Issued 7/18/2019
Prior Rescission Cate populates only if COC was already rescinded at time of submittal.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 7/15/2021
Inspection Approval
Project Close-out Letter of Termination JCN 6011-14 Lot 6 M.O.B
Approval 55.25KB
(Westpoint Lot 6).pdf
Documentation
Mast be FDFforrrat
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 anyrecording 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 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
Type Name* Andrew Carroll
Title* Project Manager
Organization* Brasfield&Gorrie, LLC
Date* 07/16/2021
Email for [e-mail]
Confirmation
Contact Telephone* 8126301183
NOT Certification 16_07_2021-09_43_34.pdf 884.89KB
Form Mast be PDF Format
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]

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