NCC203508_Notice of Termination_20210920

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/20/2021 2:56:38 PM (NOT Submittal)
Approve by Morman, Alaina 9/27/2021 3:18:14 PM (NOT Request Review- NCC203508)
* Only the parking deck is covered under NCC203508.
• The task was assigned to Morman, Alaina. The due date is: September 23, 2021 5:00 PM
9/20/2021 2:56 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC203508
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status PAST DUE
fvby be blank (if not yet billed).
This permittee owes a fee that is PAST DUE and has a pending NOD or NOV. Do not approve this NOT request
until payment is resolved. If this NOT request is acceptable, payment may be waived if applicable, but that action must
be completed first (at the NOD or NOV Review step) to ensure records are routed to the correct folder in the
repository.
However, you can reject the NOT now if it is not acceptable.
Information associated with this permit:
Project Name
FirstHealth Cancer Center Parking Deck
Address
Page Road N., Pinehurst, NC
County
Moore
Latitude
35.0000
Longitude
-79.0000
Permittee Listed
FirstHealth of the Carolinas, Inc.
Legally Responsible
Thomas Reoch
Individual
NC Reference No.
NCG01-2020-3508
E&SC Plan ID
MOORE-2020-082
Original NOI
29765
Tracking No.
Date COC Issued
8/17/2020
Prior Rescission
Cate populates only if OOCwas already rescinded at tirre of subaittal.
Date
Reason for Rescission/Termination Request:

Reason for r Project Closed -Out
Termination of r Sale (Another Owner/Operator obtained a newCOC)
Coverage * r Mistake or Invalid Coverage
f Other
Additional We information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Ibcurrentation if applicable.
Documentation Mist beFDFformat
Project Close-out Information:
Final Close-out 9/17/2021
Inspection Approval
Project Close-out MOORE-2021-059-INSP.pdf 35.89KB
Approval MOORE-2020-082-CO.pdf 37.38KB
Documentation
DEQ Inspections MOORE-2021-059, MOORE-2020-
279.45KB
082.pdf
NoT Cert Form.pdf 70.95KB
Wst be FDFformat
North Carolina General Statute 143-215.6113 (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 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 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
c'alzd S 101-6F 1
Type Name* Thomas E. Reoch
Title * Administrative Director of Planning, Design & Construction
Organization * FirstHealth of the Carolinas, Inc.
Date * 09/20/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 910-715-1543

NOT Certification NoT Cert Form.pdf
Form Mist be Ft7F Format
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional) [e-mail]
Original Permittee 0Cd on Wification BTails
Email [e-mail]
Original Site Contact CCd on Notificaiton Emils
Email [e-mail]
70.95KB