HomeMy WebLinkAboutNCC211867_Notice of Termination_20220301Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/1/2022 10:15:43 AM (NOT Submittal)
Approve by Morman, Alaina 3/2/2022 1:07:54 PM (NOT Request Review - NCC211867)
• The task was assigned to EADS\amorman1. The due date is: March 4, 2022 5:00 PM
3/1/2022 10:15 AM
NORTH CAROLINA
Rrf OmFkm&tral Qualrly
Certificate of
NCC211867
Coverage (COC) No.*
Enter the Certificate of Coverage Number
2020 Annual Fee Status
2021 Annual Fee Status May be blank (if not yet billed).
2022 Annual Fee
OPEN
Status
May be blank (if not yet billed).
Information associated with this permit:
Project Name
Dollar General- Hertford
Address
1609 Ocean Hwy N, Hertford, NC
County
Perquimans
Latitude
36.2303
Longitude
-76.3494
Permittee Listed
Glandon Forest Equity
Legally Responsible
George Barnes
Individual
NC Reference No.
NCG01-2021-1867
E&SC Plan ID
PERQU-2021-003
Original NOI Tracking
48532
No.
Date COC Issued
3/31/2021
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Date populates only if COC was already rescinded at time of submittal.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 2/17/2022
Inspection Approval
Project Close-out Final Erosion Control Inspection.pdf 32.31 KB
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
rt; PAM/4
Type Name* George Barnes
Title* Manager
Organization* Glandon Forest Equity, LLC
Date * 03/01 /2022
Email for gbarnes@vanguardpg.com
Confirmation*
Contact Telephone* 919-459-2601
NOT Certification NOT Hertford NC.pdf
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) gbarnes@vanguardpg.com
Original Permittee CC'd on Notification Emails
Email gbarnes@vanguardpg.com
Original Site Contact CC'd on Notificaiton Emails
Email adavis@vanguradpg.com
32.96KB