NCC191093_Notice of Termination_20190802

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/2/2019 9:08:15 AM (NOT Submittal)
Approve by Lucas, Annette 8/2/2019 5:04:31 PM (NOT Request Review- NCC191093)
• The task was assigned to Lucas, Annette by round robin distribution 8/2/2019 9:08 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 7, 2019 5:00
PM 8/2/2019 9:08 AM

3111`1 a1LUUFF1 id1
NORTH CAROLINA
Ernvlronmental Qualily
Certificate of
NCC191093
Coverage (COC)
Enter the Certificate of Coverage Nunber
No. *
Information associated
with this permit:
Project Name
FB-PN79443 Human Performance Training
Center
Address
Eagle Talon Drive, Fort Bragg, NC
County
Cumberland
Latitude
35.0811
Longitude
-79.0304
Permittee Listed
ACC Construction Company, Inc.
Legally Responsible
Mason McKnight, IV
Individual
NC Reference No.
NCG01-2019-1093
E&SC Plan ID
CUMBE-2020-009
Original NOI
13918
Tracking No.
Date COC Issued
7/26/2019
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Reason for Rescission/Termination Request:
Reason for r Project Closed -Out
Termination of r Sale (Another Owner/Operator will apply for a new COC)
Coverage * F Mistake or Invalid Coverage
r Other
Addional Nbre infornation about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Docurrentation if applicable.
Documentation Must beFCFforrrat
Project Close-out Information

Final Close-out
Inspection Approval
Project Close-out Mist beFDFforrrat
Approval
Documentation
North Carolina General Statute 143-215.613 (1) provides that:
Any person who knowingly makes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained underthis Article or a rule implementing this Article; orwho knowinglymakes 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 deiceor method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyof a Class 2 misdemeanor which mayinclude a fine not to e)ceed 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 * Mason H McKnight IV
Title * VP
Organization* ACC Construction
Date * 08/02/2019
Email for [e-mail]
Confirmation *
Contact Telephone* 706-564-4206
NOT Certification 190802 NOT HPTC FT BRAGG NC.pdf 54.87KB
Form Mast be FDF Format