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HomeMy WebLinkAboutNCC210571_Notice of Termination_20211215Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 12/15/2021 2:03:54 PM (NOT Submittal) Approve by Morman, Alaina 12/29/2021 3:42:33 PM (NOT Request Review - NCC210571) • The task was assigned to Morman, Alaina. The due date is: December 20, 2021 5:00 PM 12/15/2021 2:03 PM NORTH CAROLINA Rrf OmFkm&tral Qualrly Certificate of NCC210571 Coverage (COC) No.* Enter the Certificate of Coverage Number 2020 Annual Fee Status 2021 Annual Fee Status May be blank (if not yet billed). Information associated with this permit: Project Name Quiktrip #1036 Address 4270 Trailer Drive, Charlotte, NC County Mecklenburg Latitude 35.2790 Longitude -80.8100 Permittee Listed Carmel Contractors Legally Responsible Clay Knight Individual NC Reference No. NCG01-2021-0571 E&SC Plan ID LDGP-2021-00014 Original NOI Tracking 41956 No. Date COC Issued 2/1/2021 Prior Rescission Date Date populates only if COC was already rescinded at time of submittal.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 new COC) Coverage* Mistake or Invalid Coverage Other Additional More information about the basis of this request, if needed. Explanation Supporting Upload Supporting Documentation if applicable. Documentation Must be PDF format Project Close-out Information: Final Close-out 11/12/2021 Inspection Approval Project Close-out Grad ingPermitNoticeOfTermination_20211112_07... 83.4KB Approval Must be PDF format 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 ?lr1� ' ` A, 01_ Type Name* Clay Knight Title* Project Manager Organization * Carmel Contractors Date * 12/15/2021 Email for cknight@carmelcontractors.com Confirmation * Contact Telephone* 7049754795 NOT Certification NCG01-eNOT-Certification-Form-20210514-DEMLR- Form 1.07MB SW-SIGNED.pdf Must be PDF Format Is this CDC Already Ensure this COC has not been rescinded since submittal! Rescinded? Additional Email CC'd on Notification Emails (Optional) Original Permittee CC'd on Notification Emails Email cknight@carmelcontractors.com Original Site Contact CC'd on Notificaiton Emails Email cknight@carmelcontractors.com