NCC200838_Notice of Termination_20210421

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/21/2021 5:10:25 PM (NOT Submittal)
Approve by Morman, Alaina 4/22/2021 4:50:51 PM (NOT Request Review- NCC200838)
• The task was assigned to Morman, Alaina. The due date is: April 26, 2021 5:00 PM
4/21 /2021 5:10 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC200838
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status PAST DUE
ivby be blank (if not yet billed).
This permittee owes a fee that is PAST DUE and has a pending NOD or NOV. Do not approve this NOT request
until payment is resolved. If this NOT request is acceptable, payment may be waived if applicable, but that action must
be completed first (at the NOD or NOV Review step) to ensure records are routed to the correct folder in the
repository.
However, you can reject the NOT now if it is not acceptable
Information associated with this permit
Project Name FIB Fort Bragg - Willow Lakes Sports Complex (PN 86271)
Address Reilly Road, Fort Bragg, NC
County Cumberland
Latitude 35.0000
Longitude-79.0000
Permittee Listed Fort Bragg Directorate of Public Works
Legally Responsible Monica Stephenson
Individual
NC Reference No. NCG01-2020-0838
E&SC Plan ID CUMBE-2020-101
Original NOI 22524
Tracking No.
Date COC Issued 3/4/2020
Prior Rescission Cate populates only if COCwas already rescinded at tirre of subrrittal.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 obtained a newCOC)
Coverage * r Mistake or Invalid Coverage
r Other Construction not started; Construciton start delayed
Add ional
Mxe information about the basis of this request, if needed.
Explanation
The project has been suspended and at this
time does not require coverage under the
NCG01. It is understood that if/when the
project is slated to start, Fort Bragg will be
required to apply for coverage under a new
NCG01.
Supporting
Upload Supporting Dxurrentation if applicable.
Documentation
Mast beFCFforrat
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mist beFDFfornat
Approval
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 under this Artcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
Commission implementing this Artcle 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
Type Name* Lee Ward
Title * Chief, DPW/Water Management Branch
Organization* Fort Bragg Directorate of Public Works
Date * 04/21 /2021
Email for [e-mail]
Confirmation *
Contact Telephone* 910-908-5286

NOT Certification NCC200838 NOT Certification-Form-21Apri12020
Form (signed).pdf
Mast be Ft7F Format
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Additional Email 0Cd on Notification Errails
(Optional)
Original Permittee 0Cd on Wification Errails
Email [e-mail]
Original Site Contact CCd on Notificaiton Emils
Email [e-mail]
326.62KB