NCC203212_Notice of Termination_20210908

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/8/2021 1:24:04 PM (NOT Submittal)
Approve by Morman, Alaina 9/14/2021 11:08:29 AM (NOT Request Review- NCC203212)
• The task was assigned to Morman, Alaina. The due date is: September 13, 2021 5:00 PM
9/8/2021 1:24 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC203212
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status PAID
K/hy be blank (if not yet billed).
Information associated with this permit:
Project Name
Clovelly Solar, LLC
Address
Neills Creek Road, Lillington, NC
County
Harnett
Latitude
35.4163
Longitude
-78.7694
Permittee Listed
Pine Gate Renewables, LLC
Legally Responsible
Ben Catt
Individual
NC Reference No.
NCG01-2020-3212
E&SC Plan ID
HARNE-2018-014
Original NOI
28866
Tracking No.
Date COC Issued
7/29/2020
Prior Rescission
Cate populates only if COCwas already rescinded at time of submittal.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 *
r Mistake or Invalid Coverage
r Other
Additional IVbre information about the basis of this request, if needed.
Explanation
Supporting upload Supporting Documentation if applicable.
Documentation Mist beRYforrrat

Project Close-out Information:
Final Close-out 8/31/2021
Inspection Approval
Project Close-out Clovelly Solar LLC_HARNE-2018-014_8-31-
Approval 24.65KB
2021.pdf
Documentation
Mist be FDFforrrat
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
r4 e 16
Type Name* Ben Catt
Title * Authorized Person
Organization* Pine Gate Renewables, LLC
Date * 09/08/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 828-820-2917
NOT Certification NCG01-eNOT-Certification-Form-20210514-
Form DEMLR-SW.pdf
Mist be FDF Forrrat
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]
992.16KB