NCC192552_NOT Signed Certification_20201202

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.: 14 C'C' t 9 -Z S
Name of Project: PC( U,r1A r',,?- ay Y- UoT
Per NC General Statute 143-215.6B (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 p alty 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: U
* Legally Responsible Person:
Title of Legally Responsibl erson: Co
Signature:
Date: I a1312 0
* 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: Sandra Linney <slinney@uprig htbuilders.com>
Sent: Thursday, December 3, 2020 8:36 AM
To: Georgoulias, Bethany
Subject: [External] RE: Construction SW Notice of Termination Request - NOT Cert Form
Missing
Attachments: MT6 NOT Signed Close Out.pdf, MT24 NOT Signed Close Out.pdf, WX20 NOT Signed
Close Out.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Submit all suspicious email using the Phish Alarm
button or as an attachment to Report Spam.
Bethany,
Attached are sign offs for Montreaux Lot 24, Montreaux Lot 6, and Wexford Reserve Lot 20. Please let me know if you
need more info.
Thanks,
Sandra Linney
Upright Builders, Inc.
[phone]
[e-mail]
From: Georgoulias, Bethany [mailto:[e-mail]]
Sent: Thursday, December 03, 2020 8:02 AM
To: [e-mail]
Subject: RE: Construction SW Notice of Termination Request - NOT Cert Form Missing
Importance: High
Good morning,
Everything looked good with this NOT request, except a signed and completed NOT Certification form was
missing. Please complete this form and email it back to me (be sure to mail in the original per the form instructions),
and I can approve the NOT request.
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

REq
Email correspondence to and from this address is subject to the
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: Tuesday, December 1, 2020 11:43 AM
To: [e-mail]
Cc: [e-mail]
Subject: Construction SW Notice of Termination Request Received
Thank you for submitting a Notice of Termination (NOT) request for Montreaux Lot 24.
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 suzanne.mccoygncdenr.gov or
[phone]. The COC no. is NCC190910.
Be sure to add laserfiche(a�ncdenr.gov to your contacts to avoid future e-mails about this application from
going into Spam falters.
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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