NCC191158_Notice of Termination_20210729

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/29/2021 9:18:47 AM (NOT Submittal)
Approve by Morman, Alaina 7/29/2021 3:09:20 PM (NOT Request Review- NCC191158)
• The task was assigned to Morman, Alaina. The due date is: August 3, 2021 5:00 PM
7/29/2021 9:18 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC191158
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
PAID
2021 Annual Fee Status
OPEN
Nby be blank (if not yet billed).
Information associated
with this permit:
Project Name
Front Street Greenway
Address
SR 1323 (W. Front St), Burlington, NC
County
Alamance
Latitude
36.0980
Longitude
-79.4961
Permittee Listed
City of Burlington
Legally Responsible
Hardin Watkins
Individual
NC Reference No.
NCG01-2019-1158
E&SC Plan ID
ALAMA-2019-037
Original NOI
14237
Tracking No.
Date COC Issued
7/31/2019
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Cate populates only if COCwas already rescinded at time of submittal.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 6/29/2021
Inspection Approval
Project Close-out 6-29-2021 Inspection Report ALAMA-2019-037
Approval 132.36KB
Front Street Greenway_.pdf
Documentation
Mast be FDFforrrat
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
Type Name* Hardin Watkins
Title * City Manager
Organization * City of Burlington
Date * 07/29/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 3362293188
NOT Certification front street greenway NOT.pdf
Form Mast be PDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional) [e-mail]
Original Permittee CCdonNotificationErrails
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]
30.31 KB