NCC204652_Notice of Termination_20210120

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/20/2021 1:21:55 PM (NOT Submittal)
Approve by Morman, Alaina 2/5/2021 4:42:45 PM (NOT Request Review- NCC204652)
* Please see email from Candi Alexander dated 21212021 in permit file for clarifying details.
• The task was assigned to Morman, Alaina. The due date is: January 25, 2021 5:00 PM
1 /20/2021 1:22 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC204652
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
Parsons Mill
Address
Huntsman Court, Cape Fear, NC
County
New Hanover
Latitude
34.3279
Longitude
-77.8853
Permittee Listed
Dominion Land Corporation
Legally Responsible
Nathan Sanders
Individual
NC Reference No.
NCG01-2020-4652
E&SC Plan ID
GP#20-07 Revision #6
Original NOI
33048
Tracking No.
Date COC Issued
10/21/2020
Prior Rescission
Date populates only if OOC was already rescinded at tirre of submittal.
Date
Reason for Rescission/Termination Request:
Reason for
r Project Closed -Out
Termination of
F Sale (Another Owner/Operator will apply for a new COC)
Coverage *
r Mistake or Invalid Coverage
r Other
Ad d i o n a I We information about the basis of this request, if needed.
Explanation The new owner is in the process of
submitting for a new COC.

Supporting Upload Supporting Documentation if applicable.
Documentation B6374-P95 - Deed to Clayton Prop. Group (PH4-8)
382.04KB
11-02-2020.pdf
B6374-P103 - Deed to Clayton Prop. Group (PH3)
93.61 KB
(1-45-49)(1-53-84)(1-205-223) 11-02-2020.pdf
NUst be FDFformat
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mist beFDFformat
Approval
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this A tide or a rule implementing this Article; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this 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 of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which may include 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
��dt/Yr2� ��aJr2��fi't�f
Type Name* Nathan Sanders
Title * Manager
Organization* Dominion Land Corporation
Date * 01 /20/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 910-791-1196
NOT Certification NOTICE OF TERMINATION FORM.pdf 84.36KB
Form Mast be FDF Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional) [e-mail]

Original Permittee OCdonWificationErrails
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]