NCC204347_Notice of Termination_20220112

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/12/2022 2:18:56 PM (NOT Submittal)
Approve by Morman, Alaina 1/12/2022 7:01:56 PM (NOT Request Review - NCC204347)
• The task was assigned to Morman, Alaina. The due date is: January 17, 2022 5:00 PM
1/12/2022 2:18 PM

NORTH CAROLINA
Rrf OmFkm&tral Qualrly
Certificate of NCC204347
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).
2022 Annual Fee May be blank (if not yet billed).
Status
Information associated with this permit
Project Name
Piedmont Natural Gas Havelock Station
Address
McCotter Blvd, Havelock, NC
County
Craven
Latitude
34.8593
Longitude
-76.8909
Permittee Listed
Piedmont Natural Gas Company, Inc.
Legally Responsible
Dave Vena
Individual
NC Reference No.
NCG01-2020-4347
E&SC Plan ID
Crave-2021-013
Original NOI Tracking
32228
No.
Date COC Issued
10/1/2020
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Date populates only if COC was already rescinded at time of submittal.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 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 12/6/2021
Inspection Approval
Project Close-out 11206 PNG SUBSTATION CRAVE-2021-013.pdf 36.68KB
Approval Must be PDF format
Documentation
North Carolina General Statute 143-215.613 (i) 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
Ai4-t411E VWA
Type Name* Dave Vena
Title* Senior Project Manager
Organization* Piedmont Natural Gas
Date * 01 /12/2022
Email for [e-mail]
Confirmation*
Contact Telephone* 7047314496
NOT Certification NCG01-eNOT-Certification-Form-20210514-DEMLR-
Form 62.18KB
SW NCC204347.pdf
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 Ennails
Email [e-mail]