NCC203447_Notice of Termination_20210920

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/20/2021 2:58:37 PM (NOT Submittal)
Approve by Morman, Alaina 9/27/2021 3:21:23 PM (NOT Request Review- NCC203447)
• The task was assigned to Morman, Alaina. The due date is: September 23, 2021 5:00 PM
9/20/2021 2:59 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC203447
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
PAID
Nby be blank (if not yet billed).
Information associated
with this permit:
Project Name
Falling Creek 115 kV Transmission Line Phase 2
Address
US 70, Kinston, NC
County
Lenoir
Latitude
35.2730
Longitude
-77.6660
Permittee Listed
City of Kinston
Legally Responsible
Rhonda Barwick
Individual
NC Reference No.
NCG01-2020-3447
E&SC Plan ID
Lenoi-2021-001
Original NOI
29689
Tracking No.
Date COC Issued
9/1/2020
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Cate populates only if COCwas already rescinded at time of submittal.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 MstbeRYforrrat

Project Close-out Information:
Final Close-out 9/16/2021
Inspection Approval
Project Close-out 20210916 sed insp report LENOI-2021-001
Approval 166.86KB
Fallingcreek 115kv ph2.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
Type Name* Rhonda Barwick
Title * City Manager
Organization * City of Kinston NC
Date * 09/20/2021
Email for Rhonda. [e-mail]. us
Confirmation *
Contact Telephone* 252-939-3111
NOT Certification NCC203447_Falling Creek 115 kV Transmission
Form Line Phase 2 Signed.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 Rhonda. [e-mail]. us
Original Site Contact CCd on Notificaiton Firnils
Email [e-mail]
312.18KB