NCC200852_Notice of Termination_20201203

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/3/2020 8:15:24 AM (NOT Submittal)
Approve by Georgoulias, Bethany 12/3/2020 10:45:37 AM (NOT Request Review- NCC200852)
• The task was assigned to Georgoulias, Bethany. The due date is: December 8, 2020 5:00 PM
12/3/2020 8:15 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC200852
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
Buck Station, Beneficial Ash Project - Plan Amendment
Address
1555 Dukeville Road, Salisbury, NC
County
Rowan
Latitude
35.7018
Longitude
-80.3745
Permittee Listed
Duke Energy Carolinas, LLC
Legally Responsible
John Smith
Individual
NC Reference No.
NCG01-2020-0852
E&SC Plan ID
ROWAN-2020-003
Original NOI
22650
Tracking No.
Date COC Issued
3/3/2020
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
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 11/4/2020
Inspection Approval

Project Close-out 11-04-2020 Buck Beneficial Septic Addition Closure
Approval 244.65KB
Inspection Report (ROWAN-2020-003).pdf
Documentation
Mast be FL7Fforrrat
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
�%ra r 1iarr2;0 err
Type Name* John
Title * Smith
Organization* Duke Energy Carolinas, LLC
Date * 12/03/2020
Email for [e-mail]
Confirmation *
Contact Telephone * 704 382 4738
NOT Certification NCG01-eNOT-Certification-Form buck
Form 2020003jrsjr.pdf
Mist be RY Fornat
Is this COC Already Ensure this CCChas not been rescinded since submttal!
Rescinded?
Original Permittee CCdonNotificationBTails
Email [e-mail]
Original Site Contact CCd on Notificaiton Erails
Email [e-mail]
383.26KB