NCC201809_NOT Signed Certification_20210504

NCGO1 Notice of Termination (NOT) Certification Form
Directions:
Print this form, complete, scan and upload to the electronic NOT (Rescission) form.
Then, mail the original form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6`h Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
General Permit Certificate of Coverage (CGC) No.: t4Lczolooq
Name of Project: t)r
Per NC General Statute 143-215.6B (i), any person who knowingly makes any false statement, representation,
or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may
include a fine not to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
1, 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.
Legally Responsible Organizational Entity: '4rc,00Ltc
Legally Responsible Person:
Title of Legally Responsible Person:
r•
*Signature: — Z�9'
Date: 51AII k
Print Name and Title of Signed (only if authorized individual signing differs from Legally Responsible Person):
* IMPORTANT NOTE: 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 NCGO10000 permit.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCGO10000 permit.

North Carolina Department of Environmental Quality
Division of Energy, Mineral, and Land Resources
Stormwater Program
D� NPDES Construction Stormwater Permit
INVOICE
Annual Permit Fee
This Construction Stormwater annual fee is required by the North Carolina Administrative Code 143-
215.1)(a). The fee covers the administrative costs associated with your permit. The fee is required of
any person holding a permit for any time during the annual fee period, regardless of the facility's
operating status. Failure to pay the fee by the due date will subject the permit to revocation,
Operating without a valid permit is a violation and is subject to a $10,000 per day fine. If the permit is
revoked and you later decide a permit is needed, you must reapply, with the understanding the permit
request may be denied due to changes in environmental, regulatory, or modeling conditions.
Invoice No: NCC201809-2021
Invoice Date: 05/01/2021
Certificate of Coverage No.: NCC201809
Due Date: 06/01/2021
Effective Date: 05/11/2020
Annual Fee Period: May 2021 to May 2022
Project Name: DP Electrical - Lot 13
Annual Fee: $100
Legally Responsible Person:
E-mail: [e-mail]
David Pruitt
Telephone: [phone]
❑P Investment Properties LLC
Site Contact: David Pruitt
7116 Kasay Dee Circle
Site Contact E-mail: davidCadpelectrical.com
Garner, NC
27529
Electronic payment option is preferred. Type https:lLdeg.nc.eoy/SW-epayments into your browser. If
you select eCheck, there is no convenience fee. The convenience fee for a credit card is 2.65% and
convenience fee for debit card is $3.95.
If you must pay with paper check, please make your check payable to "DEMLR Stormwater Program"
and include the Certificate of Coverage No. in the memo field alone with a copy of this invoice.
A $25.00 processing fee will be charged for returned check in accordance with North Carolina General
Statute 25-3-512. Contact Aziza Selkane at a ziza.se I ka.ne@ ncdenr. ov or [phone] with questions.
Remit to: NCDEQ— Division of Energy, Mineral, and Land Resources
Stormwater Program
1612 Mail Service Center
Raleigh NC 27699-1612
If this project has been closed out, you must submit a Notice of Termination (NOT) request here-
http,s://edocs.deg.nc.gov/Forms/NCGOl-Termination

WAKEWake County Sediment and Erosion Control Section, Water Quality Division
COUNTY 336 Fayetteville Street - PO Box 550 - Raleigh, NC 27602
N0R-I II CAR 011XA Phone: [phone]; Fax: [phone]
CERTIFICATE OF COMPLETION
SEDIMENTATION AND EROSION CONTROL
PROJECT: DP Electrical
LOCATION: 701 Bricksteel Rd, Garner, NC
S&E PERMIT NUMBER: SEC-033345-2020
DATE: 4/21/2021
This document certifies that the land disturbance permit for the above
reference project is complete; 1) all conditions of the approved land
disturbance permit are met; 2) all disturbed areas are stabilized with
permanent ground cover, permanent armor or impervious surface; 3) all
proposed roads, utilities, permanent erosion control devices and other
infrastructure have been installed according to approved plans; 4) all
requirements of the approved stormwater plan are met; and 5) all
temporary sediment and erosion control devices have been removed or
converted to permanent stormwater devices according to the approved
stormwater plan.
As of the above date, the Water Quality Division of Wake County
Department of Environmental Services, deems this project to be complete
and the Land Disturbance (Grading) permit closed.
The NCG-010000 NPDES Construction Stormwater General Permit must be
closed by obtaining a Notice of Termination(e-NOT) from NC ❑EQ (if
applicable).
Environmental Consultant: Andrew J. Lake
Phone: [phone]