NCC205188_Notice of Termination_20220323

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/23/2022 8:43:38 AM (NOT Submittal)
Approve by Morman, Alaina 3/28/2022 10:29:24 PM (NOT Request Review - NCC205188)
• The task was assigned to Morman, Alaina. The due date is: March 28, 2022 5:00 PM
3/23/2022 8:43 AM

NORTH CAROLINA
Rrf OmFkm&tral Qualrly
Certificate of NCC205188
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
Establishment at Tyvola
Address
1001 Tyvola Road, Charlotte, NC
County
Mecklenburg
Latitude
35.1659
Longitude
-80.8798
Permittee Listed
Tyvola Station Partners, LLC
Legally Responsible
Joseph Fielden, Jr
Individual
NC Reference No.
NCG01-2020-5188
E&SC Plan ID
LDGP-2020-00236
Original NOI Tracking
35832
No.
Date COC Issued
11/13/2020
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Date populates only if COC was already rescinded at time of submittal.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
New ownerloperator NCC211956
COC No. Enter the COC number obtained by the new owner

New Owner Name First and last name
William Morris
New Owner Phone [phone]
Number
New Owner Email [e-mail]
Additional More information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Documentation if applicable.
Documentation Certificate of Coverage - Tapestry Tyvola LLC.pdf 36.29KB
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 (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 NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item
(6) of that permit.
Signature
A104 Q C!7t
Type Name* Joseph Fielden Jr
Title * President
Organization * Tyvola Station Partners, LLC
Date * 03/23/2022
Email for [e-mail]
Confirmation *
Contact Telephone* 865-523-0508
NOT Certification Notice of Termination Certification Form 3-23-22.pdf 415.34KB
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 joejr@jaf!elden.com
Original Site Contact CC'd on Notificaiton Emails
Email [e-mail]