NCC205891_Notice of Termination_20210804

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/4/2021 7:43:16 PM (NOT Submittal)
Approve by Morman, Alaina 8/6/2021 1:11:51 PM (NOT Request Review- NCC205891)
• The task was assigned to Morman, Alaina. The due date is: August 9, 2021 5:00 PM
8/4/2021 7:43 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC205891
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
PNG - Huntersville Replacement
Address
Westmoreland Road, Cornelius, NC
County
Mecklenburg
Latitude
35.4616
Longitude
-80.8831
Permittee Listed
Piedmont Natural Gas Company, Inc.
Legally Responsible
Tim Curtis
Individual
NC Reference No.
NCG01-2020-5891
E&SC Plan ID
MECKL-2021-036
Original NOI
39505
Tracking No.
Date COC Issued
12/22/2020
Prior Rescission
Date populates only if OOC was already rescinded at tirre of submittal.
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 Docurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 7/14/2021
Inspection Approval
Project Close-out 2021 0714 - PNG Huntersville Replacement NCDEQ
Approval 74.23KB
EC Inspection.pdf
Documentation
Mast be Ft7Fforrrat
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* Corey Dillard
Title * Supervisor Field Operations
Organization* Piedmont Natural Gas Company, Inc.
Date * 08/04/2021
Email for Corey. [e-mail]
Confirmation *
Contact Telephone* 7045876941
NOT Certification NCG01-eNOT-Certification-Form-20210514-
Form DEMLR-SW.pdf
Mast be R F Fornat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional) [e-mail]
Original Permittee CCdonWificationErrails
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]
980.83KB