NCC201555_Notice of Termination_20210606

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/6/2021 8:53:42 AM (NOT Submittal)
Approve by Morman, Alaina 6/9/2021 2:55:47 PM (NOT Request Review- NCC201555)
• The task was assigned to Morman, Alaina. The due date is: June 10, 2021 5:00 PM 6/6/2021 8:53 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC201555
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
PAID
fvby be blank (if not yet billed).
Information associated
with this permit:
Project Name
Holiday Inn Express & Suites and Future Hotel
Address
Legend Avebue, Fayetteville, NC
County
Cumberland
Latitude
35.0000
Longitude
-79.0000
Permittee Listed
True North Hospitality, LLC
Legally Responsible
Akash Patel
Individual
NC Reference No.
NCG01-2020-1555
E&SC Plan ID
CUMBE-2020-088
Original NOI
24462
Tracking No.
Date COC Issued
4/20/2020
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 new COC)
Coverage *
r Mistake or Invalid Coverage
r Other Project never got started and we are not moving forward .
Addional
MDre information about the basis of this request, if needed.
Explanation
Due to COVID , We had to hold on the
project and given current circumstances
project is not feasible.

Supporting Upload Supporting Documentation if applicable.
Documentation Holiday Inn Express & Suites and Future Hotel off
Legend Ave.pdf
NUst be FDFformat
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mist beFDFformat
Approval
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
29.63KB
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 Amide; 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 of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
I7 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 * Akash D. Patel, MD
Title * President
Organization* True North Hospitality
Date * 06/06/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 919-500-9326
NOT Certification Scan05202021.pdf 564.66KB
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional) dr—[e-mail]

Original Permittee CCdonNotificationBmils
Email dr—[e-mail]
Original Site Contact GCd on Notificaiton BTails
Email dr—[e-mail]