NCC202231_Notice of Termination_20201120

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/20/2020 12:00:18 PM (NOT Submittal)
Approve by Georgoulias, Bethany 11/20/2020 12:02:42 PM (NOT Request Review- NCC202231)
• The task was assigned to Georgoulias, Bethany. The due date is: November 25, 2020 5:00 PM
11/20/2020 12:00 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC202231
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
ESA Buies Creek Solar, LLC
Address
Leslie Campbell Road, Buies Creek, NC
County
Harnett
Latitude
35.4148
Longitude
-78.7145
Permittee Listed
Pure power Contractors, Inc.
Legally Responsible
Justin Taylor
Individual
NC Reference No.
NCG01-2020-2231
E&SC Plan ID
HARNE-2020-018
Original NOI
26134
Tracking No.
Date COC Issued
5/29/2020
Prior Rescission
Date populates only if OOCwas already rescinded at tirre of subaittal.
Date
Reason for Rescission/Termination Request:
Reason for F Project Closed -Out
Termination of r Sale (Another Owner/Operator will apply for a new COC)
Coverage * O Mistake or Invalid Coverage
r Other
Addional We inforrration about the basis of this request, if needed.
Explanation
Supporting upload Supporting Docurrentation if applicable.
Documentation Mist beFDFforrrat
Project Close-out Information:
Final Close-out 11/18/2020
Inspection Approval

Project Close-out ESA Buies Creek Solar LLC_HARNE-2020-018 11-
Approval — 31.97KB
18-2020.pdf
Documentation
Mast be FDFforrrat
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).
17 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
'T031'w ro loj-
Type Name* Justin Taylor
Title * President
Organization* Pure Power Contractors Inc.
Date * 11 /20/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 704-840-6798
NOT Certification Scan Nov 19 2020 at 2.58 PM.pdf
Form Mast be PDF Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee 0Cd on Wification BTails
Email [e-mail]
Original Site Contact CCd on Kbtificaiton Bmils
Email [e-mail]
724.02KB