NCC202761_Notice of Termination_20210526

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/26/2021 4:13:53 PM (NOT Submittal)
Approve by Morman, Alaina 5/28/2021 9:45:50 AM (NOT Request Review- NCC202761)
• The task was assigned to Morman, Alaina. The due date is: May 31, 2021 5:00 PM 5/26/2021 4:13 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC202761
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
Maiden Creek Solar Project - Overhead Line
Address
Bowbunting Club Road, Maiden, NC
County
Catawba
Latitude
35.6120
Longitude
-81.1850
Permittee Listed
M. A. Mortenson Company
Legally Responsible
Tom Schmall
Individual
NC Reference No.
NCG01-2020-2761
E&SC Plan ID
CATAW-2020-013
Original NOI
27648
Tracking No.
Date COC Issued
6/30/2020
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 obtained 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 5/19/2021
Inspection Approval
Project Close-out CATAW-2020-013_5.19.2021.pdf 59.12KB
Approval Mist be FDFforrrat
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
Type Name* Katlyn Beebout
Title * Associate Environmental Specialist
Organization* M. A. Mortenson Company
Date * 05/26/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 5078293848
NOT Certification 2025.05.26 - NCG01 Notice of Termination - Maiden
Form 42.06KB
Creek Solar Project-Overhead.pdf
Mist be FDF Format
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Erails
(Optional)
Original Permittee CCd on Wification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]