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HomeMy WebLinkAboutNCC231272_NOT Signed Certification_20241028 NCGO1 Notice of Termination (NOT) Certification Form
Directions:
Print this form, complete, scan and upload to the electronic NOT(Rescission)form.
Then, mail the original signed form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6th Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM UNTIL YOUR NOT REQUEST HAS BEEN REVIEWED AND APPROVED.
THE FORM_YOU_MAIL MUST.BE COMPLETED_WITH-AN_ORIGINAL-SIGNATURE(NOT DIGITAL) [40-CFR-1.22.221
General Permit Certificate of Coverage (COC) No.: NCC231272
Name of Project: Spare Space Self Storage LLC
Per NC General Statute 143-215.68(i), 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. . . shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
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.
Legally Responsible Organizational Entity(must match eNOT): Spare Space Self Storage LLC
*Legally Responsible Person (must match eNOT): Steve Stafford
*Title of Legally Responsible Person: Owner
Print Name &Title of Signed if Authorized Individual Differs from Legally Responsible Person:
*Signature: Date: /D a
(71
* IMPORTANT NOTE: 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 permit.
For more information on signatory requirements,see Part IV, Section B, Item (6)of the NCG010000 permit.
Sedimentation/Construction Stormwater Inspection Report
North Carolina Department of Environmental Quality
Land Resources: 450 W. Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
(336) 776-9800
County: Randolph Project: Spare Space Self Storage LLC River basin: Yadkin-PeeDee
Person financially responsible:Spare Space Self Storage LLC-Stephen Project#: RANDO-2023-025
Stafford,Owner
Address: 3836 Trinity Church Road,Seagrove,NC 27341
1. Project Location: US Hwy 220 S,Asheboro
Pictures: Yes-Digital
2. Weather and soil conditions: 70s,Clear,Windy,Workable soils Initial inspection: No
3. Is site currently under notice of violation? No
4. Is the site in compliance with S.P.C.A.and rules? Yes If no,check violations below:
5. Violations:
6. Is the site in compliance with NPDES Permit NCG010000 Construction Stormwater requirements? Yes
Describe:
7. Has sedimentation damage occurred since last inspection? No If Yes,where? (check all that apply)
Degree of damage:
8. Contact made with(name): Steve Stafford Title: Owner
Inspection report: Sent Report Date given/sent: October 25,2024
9. Corrective action needed:
10. Comments: A routine inspection was conducted for closeout. Permanent ground cover sufficient to restrain
erosion has been established. No additional self-monitoring or self-inspections are required.
Project is in compliance and released under the SPCA. Termination of coverage under the
NPDES General Stormwater Permit for Construction Activities (NCG01) must be requested
by the permittee via a Notice of Termination (NOT). The NOT is available at:
https://edocs.deq.nc.gov/Forms/NCGO1-Termination. Please note that this correspondence
must be uploaded as part of completing the NOT process. If you have any questions, feel free
to contact me at Jason.moffitt@deq.nc.gov or by phone at(336)776-9723.
Reported by: Jason Moffitt Others present:
Date of inspection: October 22,2024 Time arriving on site: 4:05 PM Time leaving site: 4:30 PM
CC: