NCC204011_Notice of Termination_20210702

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/2/2021 10:13:59 AM (NOT Submittal)
Approve by Morman, Alaina 7/7/2021 11:12:15 AM (NOT Request Review- NCC204011)
• The task was assigned to Morman, Alaina. The due date is: July 7, 2021 5:00 PM 7/2/2021 10:14 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC204011
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
Outer Banks Dare Challenge, Inc.
Address
NC Hwy 345, Wanchese, NC
County
Dare
Latitude
35.8630
Longitude
-75.6472
Permittee Listed
Outer Banks Dare Challenge, Inc.
Legally Responsible
Dustin Daniels
Individual
NC Reference No.
NCG01-2020-4011
E&SC Plan ID
Dare-2021-004
Original NOI
31291
Tracking No.
Date COC Issued
9/15/2020
Prior Rescission
Date populates only if OOC was already rescinded at tirre of submittal.
Date
Reason for Rescission/Ternnination 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 We information about the basis of this request, if needed.
Explanation Logging Activity has concluded. A new
Erosion Control Approval was issued for
Construction Activity and a new NCGO1 will
be issued for Construction Activity

Supporting Upload Supporting Documentation if applicable.
Documentation Mist beFDFformat
Project Close-out Information:
Final Close-out 6/4/2021
Inspection Approval
Project Close-out 210604 Outer Banks Dare Challenge DARE-2021-
Approval 74.9KB
004. pdf
Documentation
Mast be RYformat
North Carolina General Statute 143-215.613 (i) 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 Artide or a rule implementing this Artide; 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 device or method required to be operated or maintained under this Artide 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).
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
e 64#r;! 6? a 4Wr _ld
Type Name* Dustin C Daniels
Title * Executive Director
Organization* Outer Banks Dare Challenge
Date * 07/02/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 2524211807
NOT Certification notice of termination 7-2-21.pdf 5.85MB
Form NUst be RY Format
Is this COCAlready Ensure this OOChas not been rescinded since subnittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
CCd on Notification Emails
[e-mail]
OCd on Notification trrails
[e-mail]

Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]