NCC202114_Notice of Termination_20210525

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/25/2021 10:23:53 AM (NOT Submittal)
Approve by Morman, Alaina 5/28/2021 5:23:12 PM (NOT Request Review- NCC202114)
• The task was assigned to Morman, Alaina. The due date is: May 28, 2021 5:00 PM
5/25/2021 10:23 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC202114
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status OPEN
fvby be blank (if not yet billed).
Information associated with this permit:
Project Name
Wegmans/SECU Driveway
Address
1810 Fordham Boulevard, Chapel Hill, NC
County
Orange
Latitude
35.9452
Longitude
-79.0098
Permittee Listed
James R Vannoy & Sons Construction Co., Inc.
Legally Responsible
Ken Sparks
Individual
NC Reference No.
NCG01-2020-2114
E&SC Plan ID
LDP20-0010
Original NOI
25715
Tracking No.
Date COC Issued
5/20/2020
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 *
r Mistake or Invalid Coverage
r Other

Add ional Mare information about the basis of this request, if needed.
Explanation Erosion and Sedimentation Control Site
Inspection Report has been updated with
correct Project name by Steve Kaltenbach;
emailed to [e-mail] on
5/25/2021
Supporting Upload Supporting DDcurrentation if applicable.
Documentation Mast beFDFformt
Project Close-out Information:
Final Close-out 3/15/2021
Inspection Approval
Project Close-out Wegmans SECU driveway 3.15.21 FInal Insp.pdf
Approval Mast be FDFfornat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
57.12KB
Anyperson who knowinglymakes anyfalse 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 knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho 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 Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine notto 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
C4;4464
Type Name* Ken Sparks
Title * Project Manager
Organization * James R Vannoy & Sons Construction Co., Inc.
Date * 05/25/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 8642618458
NOT Certification NOT Certification Form.pdf 78.16KB
Form Mast be FDF Format
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?

Additional Email GCd on Notification BTails
(Optional)
Original Permittee GCdonWificationBiails
Email [e-mail]
Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]