NCC202294_NOT Closeout Documents_20220829

North Carolina Department of Environmental Quality
Land Resources: 450 W. Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
[phone]
County: Rockingham Project: Carolina Marina Drystack Addition
Person financially responsible: Carolina Marina Properties, LLC - Peter Reichard, Managing
Member
Address: 548 Shelton Rd., Stokesdale, NC 27357
1. Project Location: 548 Shelton Rd., Stokesdale
Pictures: Yes - Digital
2. Weather and soil conditions: Sunny, 50s, workable soils
3. Is site currently under notice of violation? No
4. Is the site in compliance with S.P.C.A. and rules? Yes
5. Violations:
River basin: Roanoke
Project #: ROCKI-2020-001
Initial inspection:No
If no, check violations below:
6. Is the site in compliance with NPDES Permit NCGO10000 Construction Stormwater requirements? Yes
Describe:
7. Has sedimentation damage occurred since last inspection? No If Yes, where? (check all that apply)
Degree of damage:
8. Contact made with (name): Frank Sizemore Title: Director of Operations
Inspection report: Sent Report Date given/sent: December 16, 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 (NCGO 1) must be requested by the permittee via a Notice of
Termination (NOT). The NOT is available at:
https://edoes.deq.ne.gov/Fonns/NCGOI-Termination. Please note that this correspondence
must be uploaded as part of completing the NOT process.
Reported by: Brett Bell Others present: N/A
Date of inspection: December 15, 2021 Time arriving on site: 1:30 PM Time leaving site: 2:30 PM

CertificationWG01 Notice of Termination (NOT)
Form -
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, 61h Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
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General Permit Certificate of Coverage (COC) No.:
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Name of Project: (a tp 1 g A G,. ('qq t-I
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: �Ct / ti
*Legally Responsible Person: re
Title of Legally
*Signature:
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Date: . Z f 20 Z-�-
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.