NCC192471_Notice of Termination_20211004

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/4/2021 8:22:25 AM (NOT Submittal)
Approve by Morman, Alaina 10/7/2021 9:44:40 AM (NOT Request Review- NCC192471)
• The task was assigned to Morman, Alaina. The due date is: October 7, 2021 5:00 PM
10/4/2021 8:22 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC192471
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
PAID
2021 Annual Fee Status
OPEN
Nby be blank (if not yet billed).
Information associated
with this permit:
Project Name
NCDOT US 70 Havelock Bypass E)asting Line Improvements (Areas 1-9)
Address
US 70, Township 6, NC
County
Craven
Latitude
34.9334
Longitude
-76.9547
Permittee Listed
Duke Energy Progress, LLC
Legally Responsible
Thomas Williarms
Individual
NC Reference No.
NCG01-2019-2471
E&SC Plan ID
CRAVE-2019-023
Original NOI
17462
Tracking No.
Date COC Issued
10/25/2019
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Cate populates only if COCwas already rescinded at time of submittal.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 10/1/2021
Inspection Approval
Project Close-out 210927 NCDOT US 70 HAVELOCK CRAVE-2019-
Approval 37.22KB
023.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* Nuwan Wijesuriya
Title * Sr Transmission Permitting Manager
Organization* Duke Energy Progress, LLC
Date * 10/04/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 19199316655
NOT Certification NCG01-eNOT-Certification-Form-20210514-
Form DEMLR-SW (1).pdf
Mist be FDF Fbrrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Erails
(Optional)
Original Permittee CCd on Wification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton BTails
Email [e-mail]
935.01 KB