NCC201500_Notice of Termination_20210201

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/1/2021 3:05:20 PM (NOT Submittal)
Approve by Morman, Alaina 2/2/2021 9:15:00 AM (NOT Request Review- NCC201500)
• The task was assigned to Morman, Alaina. The due date is: February 4, 2021 5:00 PM
2/1/2021 3:05 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC201500
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status May be blank (if not yet billed)
Information associated with this permit:
Project Name
Davis Drive Middle School Track Repair
Address
Davis Drive, Cary, NC
County
Wake
Latitude
35.7775
Longitude
-78.8524
Permittee Listed
Wake County Board of Education
Legally Responsible
David Neter
Individual
NC Reference No.
NCG01-2020-1500
E&SC Plan ID
WAKE-2019-075
Original NOI
24257
Tracking No.
Date COC Issued
4/17/2020
Prior Rescission
Date populates only if COCwas already rescinded at tirre of submittal.
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 *
O Mistake or Invalid Coverage
r Other
Ad d i o n a I Nbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Docurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 10/22/2020
Inspection Approval
Project Close-out WAKE-2019-075_20201022_InspRpt.pdf 112.07KB
Approval Mist be FDFfornat
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
o"(41A0k
Type Name* David Neter
Title * Chief Business Officer
Organization * Wake County Board of Education
Date * 02/01 /2021
Email for [e-mail]
Confirmation *
Contact Telephone* (919) 6940232
NOT Certification NCG01-eNOT-Certification Form_DDMS Track
Form 329.95KB
signed.pdf
Mist be FDF Fornat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
CCd on Notification Errails
[e-mail]
CCd on Notification Erails
[e-mail]
Original Site Contact CCd on Notificaiton BTails
Email [e-mail]