HomeMy WebLinkAboutNCC201161_Notice of Termination_20200324Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/24/2020 9:28:18 AM (NOT Submittal)
Approve by Georgoulias, Bethany 3/24/2020 9:50:17 AM (NOT Request Review- NCC201161)
* New COC No. NCC201191 has been issued with correct address.
• The task was assigned to Georgoulias, Bethany. The due date is: March 27, 2020 5:00 PM
3/24/2020 9:28 AM
1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC201161
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Graham Scott Oldham Property
Address
2151 US 15/501 N, Pittsboro, NC
County
Chatham
Latitude
35.7625
Longitude
-79.1626
Permittee Listed
Self
Legally Responsible
Scott Oldham
Individual
NC Reference No.
NCG01-2020-1161
E&SC Plan ID
2019-08107
Original NOI
23310
Tracking No.
Date COC Issued
3/23/2020
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
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
Add ional
We information about the basis of this request, if needed.
Explanation
I had the wrong address on the form, new
eNOI was fill and submitted NCC-CHATH-
2020-Oldham
Supporting
Upload Supporting Cbcurrentation if applicable.
Documentation
Construction Stormwater_ Notice of Intent (NOI)
73.16KB
(2).pdf
Mist be FDFfornat
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mist beFDFforrrat
Approval
Documentation
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* Scott Oldham
Title * Owner
Organization* Self
Date * 03/24/2020
Email for Scott@poultryvilla.com
Confirmation *
Contact Telephone* 919-422-9626
NOT Certification NCG01-eNOT-Certification-Form-20190508-
Form 465.04KB
DEMLR-SW.pdf
Mist be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCdonWificationErrails
Email scott@poultryvilla.com
Original Site Contact CCd on Kbtificaiton Bmils
Email scott@poultryvilla.com