NCC200110_NOT Signed Certification_20210916

NCG01 Notice of Termination (NOT) Certification Form
Directions:
Print this form, complete, scan and upload to the electronic NOT (Rescission) form.
Then, mail the original signed form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 611 Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM UNTIL YOUR NOT REQUEST HAS BEEN REVIEWED AND APPROVED.
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.22]
General Permit Certificate of Coverage (COC) No.: = A _- • , 62—
Name of Project: kfi W
Per NC General Statute 143-215.6B (i), any person who knowingly makes any false statement, representation, or
certification in any application, record, report, plan, or other document filed or required to be maintained under this
Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
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.
Legally Responsible Organizational Entity:
*Legally Responsible Person: - —
Title of Legally j sponsible Per,%gn: ..A .
*Signature:
ate: (56�/1542
Print Name and Title of Signed (only if authorized individual signing differs from Legally Responsible Person):
* IMPORTANT NOTE: 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 NCGO10000 permit.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCGO10000 permit.

North Carolina Department of Environmental Quality
Land Resources: 610 East Center Avenue, Suite 301, Mooresville, NC 28115 [phone]
County: Catawba Project: Maiden Creek Solar Project
Person financially responsible: Martenson - Tom Schmall, Vice President,
Operations
Address: 700 Meadow Lanc North, Minneapolis, MN 55422
1. Project Location: Bowhunting Club Road, Maiden
Pictures: No
2. Weather and soil conditions: Sunny, workable soil
River basin: Catawba
Project #: CATAW-2020-008
Initial inspection: No
3. Is site currently under notice of violation? No
4. Is the site in compliance with S.P.C.A. and rules? Yes If no, check violations below:
5. Violations:
6. Is the site in compliance with NPDES Permit NCGO10000 Construction Stormwater requirements?
Describe:
7. Has sedimentation damage occurred since last inspection? No If Yes, where? (check all that apply l
Degree of damage:
8. Contact made with (name): Katlyn Beebout Title: Mortenson
Inspection report: Sent Report Date giver/sent: September 20, 2021
9. Corrective action needed:
10. Comments: Overall, the site has sufficient permanent ground cover to restrain erosion, however there are
some bare areas and rills that need to be repaired and stabilized. No additional self -monitoring
or self -inspections are required. Project is in compliance and released under the SPCA.
Termination of coverage under the NPDES General Stormwater Permit for Construction
Activities (NCGO 1) must be requested by the permittee via a Notice of Termination (NOT).
The NOT is available at: https:..-.-'edocs -deq.nc.gov.:Fonns/NCGO I -Termination. Please note
that this correspondence must be uploaded as part of completing the NOT process.
All project that have been approved prior to April 01, 2019, under the old permit system, are
not required to take any additional actions. The stormwater permit is terminated at the same
time as the termination of this erosion control permit.
Reported by: Jesse McDonnell
Date of inspection: September 14, 2021
cc:
Yes
Others present:
Time arriving on site: 9:21 j AM Time leaving site: 10:45 AM