NCC203587_Notice of Termination_20211025

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/25/2021 8:14:18 AM (NOT Submittal)
Approve by Morman, Alaina 10/27/2021 10:14:28 AM (NOT Request Review - NCC203587)
• The task was assigned to Morman, Alaina. The due date is: October 28, 2021 5:00 PM
10/25/2021 8:14 AM

NORTH CAROLINA
Rrf OmFkm&tral Qualrly
Certificate of NCC203587
Coverage (COC) No.* Enter the Certificate of Coverage Number
2020 Annual Fee Status
2021 Annual Fee Status PAID
May be blank (if not yet billed).
Information associated with this permit:
Project Name
PNG Line 472 Laydown Yard
Address
Cleveland Crossing Drive, Garner, NC
County
Johnston
Latitude
36.0000
Longitude
-79.0000
Permittee Listed
Piedmont Natural Gas Co. Inc.
Legally Responsible
Thomas Morris
Individual
NC Reference No.
NCG01-2020-3587
E&SC Plan ID
JOHNS-2020-036
Original NOI Tracking
30011
No.
Date COC Issued
8/19/2020
Prior Rescission Date
Date populates only if COC was already rescinded at time of submittal.
Reason for Rescission/Termination Request:
Reason for Project Closed -Out
Termination of Sale (Another Owner/Operator obtained a new COC)
Coverage* Mistake or Invalid Coverage
Other

Additional
More information about the basis of this request, if needed.
Explanation
"This project meets the NCG01 exemption as
defined in Clean Water Act (CWA) section
402(I)(2) for transmission facilities." The
project is for the construction of a
transmission pipe, as defined by PHMSA and
includes access roads and a laydown yard
exclusively servicing the construction the
PHMSA-defined transmission pipe."
Supporting
Upload Supporting Documentation if applicable.
Documentation
Must be PDF format
Project Close-out
Information:
Final Close-out
Inspection Approval
Project Close-out Must be PDF format
Approval
Documentation
North Carolina General Statute 143-215.613 (1) provides that:
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; or who knowingly makes a false statement of a material
fact in a rulemaking proceeding or contested case under this 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 Article or rules of the Commission implementing this Article shall
be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
* 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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item
(6) of that permit.
Signature
Tor/ �Aa
Type Name* Tom Morris
Title* Project Manager
Organization * Piedmont Natural Gas
Date * 10/25/2021
Email for [e-mail]
Confirmation*
Contact Telephone* 7047314245
NOT Certification Line 472 Laydown yard NOT.pdf 114.08KB
Form Must be PDF Format

Is this COC Already Ensure this COC has not been rescinded since submittal!
Rescinded?
Additional Email CC'd on Notification Emails
(Optional) [e-mail]
Original Permittee CC'd on Notification Emails
Email [e-mail]
Original Site Contact CC'd on Notificaiton Emails
Email [e-mail]