NCC210291_NOT Signed Certification_20211130

North Carolina Department of Environmental Quality
Land Resources: 1628 Mail Service Center, Raleigh, NC 27699 [phone]
County: Wake Project: Fiesta -Featherstone -Whittler Sidewalk River basin: Neuse
Person financially responsible: City of Raleigh -Richard Kelly, Engineering Project #: WAKE-2020-055
Services Director
Address: P.O. Box 590, Raleigh, NC 27602
1. Project Location: Fiesta, Featherstone, Whittier, Raleigh
Pictures: No
2. Weather and soil conditions: sunny, dry, workable 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 NCG010000 Construction Stormwater requirements? Yes
Describe:
7. Has sedimentation damage occurred since last inspection? No IfYes, where? (check all that apply)
Degree of damage:
8. Contact made with (name): no one on site Title:
Inspection report: Sent Report Date given/sent: November 15, 2021
9. Corrective action needed:
10. Comments: Permanent ground cover sufficient to restrain erosion has been established. 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 (NCGO1) must be requested by the permittee via a Notice of
Termination (NOT). The NOT is available at:
https://edoes.deq.nc.gov/Forms/NCG0I-Termination. Please note that this correspondence
must be uploaded as part of completing the NOT process.
Reported by: Kimberly Summers Others present: Dylan Kirk
Date of inspection: November 02, 2021 Time arriving on site: 10:15 AM Time leaving site: 11:05 AM
cc:

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, 6th Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
General Permit Certificate of Coverage (COC) No.: NCC210291
Name of Project: Fiesta -Featherstone -Whittier Sidewalk Improvement Project
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: City of Raleigh
*Legally Responsible Person: Richard Kelly
Title of Legally Respoi ib e Person: ztngineering Services Director
*Signature:
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 NCG010000 permit.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCGO10000 permit.