NCC191350_Notice of Termination_20190826

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/26/2019 5:22:16 PM (NOT Submittal)
Approve by Georgoulias, Bethany 8/27/2019 8:51:19 AM (NOT Request Review- NCC191350)
In This permittee did obtain anew COC for this project: no. NCC191414
• The task was assigned to Georgoulias, Bethany by round robin distribution 8/26/2019 5:22 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 29, 2019 5:00
PM 8/26/2019 5:22 PM

STME
NORTH CAROLINA
Ernvlronmental Qualily
Certificate of NCC191350
Coverage (COC) Enter the Certificate of Coverage Nlurrber
No. *
Information associated with this permit
Project Name
Lot #24 - Narrow Passage Subdivision
(#398989)
Address
14328 Ryker Way, Davidson, NC
County
Mecklenburg
Latitude
35.4750
Longitude
-80.4750
Permittee Listed
Plattner Custom Builder
Legally Responsible
Christopher Plattner
Individual
NC Reference No.
NCG01-2019-1350
E&SC Plan ID
398989
Original NOI
14734
Tracking No.
Date COC Issued
8/14/2019
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This field will populate only if COChas already been rescinded.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 information about the basis of this request, if needed.
Explanation Longitute was incorrect so had to redo the
form
Supporting Upload Supporting Docurrentation if applicable.
Documentation Mast beFEFformat
Project Close-out Information:
Jn a1LUUFF1Widl1

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 * Christopher K Plattner
Title * Memeber
Organization * Plattner Custom Builders, LLC
Date * 08/26/2019
Email for [e-mail]
Confirmation *
Contact Telephone* [e-mail]
NOT Certification Lot24NOT.pdf 463.94KB
Form lutist be FDF Format