NCC204382_Notice of Termination_20210813

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 8/13/2021 9:39:16 AM(NOT Submittal)
Approve by Morman,Alaina 8/13/2021 11:14:39 AM(NOT Request Review-NCC204382)
• The task was assigned to Morman,Alaina.The due date is:August 18,2021 5:00 PM
8/13/2021 9:39 AM

" RequestNOT • Construction Stormwater
1 i
�a•aThis formto request Notice of • • for •co\erage under •
NORTH CAROLINA General - for • i i• Activities Qr�arrry
Certificate of NCC204382
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 Ventura Solar, LLC
Address County Home Road,Taylorsville, NC
County Alexander
Latitude 36.0000
Longitude -81.0000
Permittee Listed Pure Power Contractors, Inc.
Legally Responsible Justin Taylor
Individual
NC Reference No. NCG01-2020-4382
E&SC Plan ID ALEXA-2019-003
Original NOI 32369
Tracking No.
Date COC Issued 10/2/2020
Prior Rescission Cate populates only if COC was already rescinded at tine of subrrittal.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 inforrration about the basis of this request,if needed.
Explanation
Supporting Upload Supporting Dxurrentation if applicable.
Documentation Mist beFDFforrrat

Project Close-out Information:
Final Close-out 8/5/2021
Inspection Approval
Project Close-out NCDEQ Close Out Inspection.pdf 115.19KB
Approval Mast be FDFfornat
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* Justin Coffey
Title* CFO
Organization* Pure Power Contractors, LLC.
Date* 08/13/2021
Email for [e-mail]
Confirmation
Contact Telephone* 7049893451
NOT Certification NCDEQ Notice of Termination Certification Form.pdf 383.49KB
Form Mast be FDF Format
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 57ails
Email [e-mail]

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