NCC200099_NOT Signed Certification with Email_20201026

NCG01 Notice of Termination (NOT) Certification Form
Directions:
Print this form, complete, scan and upload to the electronic NOT (Rescission) form.
Then, mail the original 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
General Permit Certificate of Coverage (COC) No.. NCC200099
Name of Project:
HF Lee 1982 Ash Basin Haul Road
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 natty 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:
Duke Energy Progress, LLC
* Legally Responsible Person: Issa J. Zarzar
Title of Legally Responsible Person:
Signature:
GM CCP Project Management
Date: 2 2 04 O
* 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 8, Item (6) of the NCGO10000 permit.
For more information on signatory requirements, see Part IV, Section 8, Item (6) of the NCGO10000 permit.

Georgoulias, Bethany
From: Niemann, Holly <[e-mail]>
Sent: Monday, October 26, 2020 12:31 PM
To: Georgoulias, Bethany
Cc: Zarzar, Issa J; Dishmon, Joyce Martin; Forster, Bill; Niemann, Holly
Subject: RE: [EXTERNAL] RE: Construction SW Notice of Termination Request Received
Attachments: NOT - NCC200099 - DUKE ENERGY - SIGNED - ZARZAR.pdf
External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
[e-mail]
Good afternoon, Bethany.
Please see attached for the requested signed form. I will have the original document in the mail this afternoon.
Please let us know if anything else is needed.
Have a wonderful day!
Thanks!
Holly Niemann
CCP Sr. Administrative Specialist, Duke Energy
410 South Wilmington St. Raleigh, NC 27601
[e-mail]
Mail Code: NC10
(W) [phone]
DUKE
is ENERGY.,
From: Georgoulias, Bethany <[e-mail]>
Sent: Monday, October 26, 2020 8:51 AM
To: Zarzar, Issa J <[e-mail]>
Cc: Forster, Bill <[e-mail]>
Subject: [EXTERNAL] RE: Construction SW Notice of Termination Request Received
Importance: High
Good morning,
Instead of the NOT Certification form, the COC was uploaded with this request. The NOT Certification form is required
for us to approve this request (and the original signed form must be mailed in, per instructions on the form). Please
complete the form attached and email me a copy; I can then approve the request and also waive the annual fee.
Thank you,
Bethany Georgoulias

Environmental Engineer
Stormwater Program, Division of Energy, Mineral, and Land Resources
N.C. Department of Environmental Quality
919 707 3641 office
[e-mail]
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
Website: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
E Q
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North Carolina Public Records Law and may be disclosed to third parties
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your
requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.
From: [e-mail] [mailto:[e-mail]]
Sent: Monday, October 26, 2020 7:17 AM
To: [e-mail]
Cc: [e-mail]; [e-mail]
Subject: Construction SW Notice of Termination Request Received
Thank you for submitting a Notice of Termination (NOT) request for HF Lee 1982 Ash Basin Haul Road
Improvements.
If your application is approved, you will receive e-mail confirmation when coverage under the Construction
Stormwater permit COC is terminated. You will also be notified if additional information is needed or if the
request cannot be approved.
If you have any questions, please contact the Stormwater Program Assistant at [e-mail] or
[phone]. The COC no. is NCC200099.
Be sure to add [e-mail] to your contacts to avoid future e-mails about this application from
going into Spam filters.
The NC DEMLR Stormwater Program
512 N. Salisbury Street, Archdale Building 6th Floor, 1612 Mail Service Center, Raleigh, NC 27699-1612

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