NCC193188_Notice of Termination_20211201

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/1/2021 2:30:51 PM (NOT Submittal)
Approve by Morman, Alaina 12/3/2021 1:56:54 PM (NOT Request Review - NCC193188)
• The task was assigned to Morman, Alaina. The due date is: December 6, 2021 5:00 PM
12/1/2021 2:30 PM

NORTH CAROLINA
Rrf OmFkm&tral Qualrly
Certificate of NCC193188
Coverage (COC) No.* Enter the Certificate of Coverage Number
2020 Annual Fee Status PAID
2021 Annual Fee Status OPEN
May be blank (if not yet billed).
Information associated with this permit:
Project Name
Durham Technical Community College - New Applied Technology Building
Address
1604 East Lawson Street, Durham, NC
County
Durham
Latitude
35.9727
Longitude
-78.8821
Permittee Listed
Bordeaux Construction
Legally Responsible
Matthew Woodlief
Individual
NC Reference No.
NCG01-2019-3188
E&SC Plan ID
DURHA-2020-001
Original NOI Tracking
19515
No.
Date COC Issued
12/16/2019
Prior Rescission Date
Date populates only if COC was already rescinded at time of submittal.
Reason for Rescission/Termination Request:
Reason for Project Closed -Out
Termination of Sale (Another Owner/Operator obtained a new COC)
Coverage* Mistake or Invalid Coverage
• Other Duplicate COC for same job. Other COC # (#NCC191487)
Additional More information about the basis of this request, if needed.
Explanation This job has already been closed out.
Bordeaux apparently had 2 COCs for the
same job. The COC that was closed out
earlier in the year was COC #NCC191487

Supporting Upload Supporting Documentation if applicable.
Documentation DENR Applied Tech Inspection Report.pdf
Must be PDF format
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Must be PDF format
Approval
Documentation
North Carolina General Statute 143-215.6113 (i) provides that:
196.65KB
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other document
filed 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 under this 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 Article or rules of the Commission implementing this Article shall
be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
* 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item
(6) of that permit.
Signature
Type Name* Matthew Woodlief
Title* Project Manager
Organization* Bordeaux Construction Co., Inc. - Raleigh, NC
Date * 12/01 /2021
Email for [e-mail]
Confirmation*
Contact Telephone* 9192201141
NOT Certification NCG01 - NOT - DTCC - NCC 193188 - 12-1-
Form 2021.pdf
Must be PDF Format
Is this COC Already Ensure this COC has not been rescinded since submittal!
Rescinded?
Additional Email CC'd on Notification Emails
(Optional) [e-mail]
Original Permittee CC'd on Notification Emails
Email [e-mail]
733.29KB

Original Site Contact cc'd on Notificaiton Emails
Email [e-mail]