NCC191601_Notice of Termination_20210222

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/22/2021 4:44:50 PM (NOT Submittal)
Approve by Morman, Alaina 2/23/2021 5:07:33 PM (NOT Request Review- NCC191601)
• The task was assigned to Morman, Alaina. The due date is: February 25, 2021 5:00 PM
2/22/2021 4:44 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC191601
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status PAID
2021 Annual Fee Status Nbybeblank (if not yet billed)
Information associated with this permit:
Project Name
Independence Mall Redevelopment
Address
3500 Oleander Drive, Wilmington, NC
County
New Hanover
Latitude
34.2140
Longitude
-77.9040
Permittee Listed
EMJ Construction
Legally Responsible
Chas Torrence
Individual
NC Reference No.
NCG01-2019-1601
E&SC Plan ID
GP #54-18 Revision #1 LDNP 19-00109
Original NOI
15277
Tracking No.
Date COC Issued
8/29/2019
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
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 *
U 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 Dxurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 2/3/2021
Inspection Approval
Project Close-out Final Field Inspection Report- Independence Mall
Approval 758.83KB
Redevelopment, GP#54-18 Revision 1.pdf
Documentation
Mast be FDFforrrat
North Carolina General Statute 143-215.66 (1) provides that:
Pnyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Atide or a rule implementing this Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Prtide or rules ofthe
Commission implementing this Atcle 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
0, 1 41 -d W,W
Type Name* Joey Barbeauld
Title * Director of Construction
Organization * EMJ Construction
Date * 02/22/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 423-240-4738
NOT Certification NCG01 NOT Certification Form - Independence
Form 64.44KB
Mall.pdf
Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
CCd on Notification Erails
CCd on Notification Erails
[e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]