HomeMy WebLinkAboutNCC216303_NOT Signed Certification_20221025NCGO1 Notice of Termination (NOT) Certification Form
Directions:
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, 6th Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM UNTIL YOUR NOT REQUEST HAS BEEN REVIEWED AND APPROVED.
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.22]
General Permit Certificate of Coverage (COC) No.: NGc Y. i to 303
Name of Project: L-vac
Per NC General Statute 143-215.6E (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: ffoa-t,Es -61 -JJ1"1 T oMPsar t z Xa-c .
*Legally Responsible Person: -Jim 77-1 crr pson/
Title of Legally Responsible Person: ,PCe-.51Pr- t
*Signature: � D.—
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 NCGO10000 permit.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCGO10000 permit.
WAKE
COUNTY
NORI-II (:AR01_INA
Wake County Sediment and Erosion Control Section, Water Quality Division
336 Fayetteville Street - PO Box 550 - Raleigh, NC 27602
Phone: 919-856-7400; Fax: 919-856-2747
CERTIFICATE OF COMPLETION
SEDIMENTATION AND EROSION CONTROL
PROJECT:
Creedmoor Manor
LOT NUMBERS:
15
ADDRESS:
1225 Explorer Trl. Wake Forest, NC
27587
SEC PERMIT NUMBER:
SEC-069312-2021
DATE:
9/2/22
This document certifies that grading for the above reference lot is
complete; all temporary erosion control devices removed, all
permanent erosion control measures installed, and final stabilization
achieved as directed by the approved Sedimentation and Erosion
Control plan.
As of the above date, the Water Quality Division of Wake County
Department of Environmental Services, deems this project to be
complete and the Land Disturbance (Grading) permit closed. Continue
to self -monitor this project until you have ended coverage under your
NPDES Permit (NCG01) through the electronic Notice of Termination
(eNOT) process with NCDEQ.
Environmental Consultant: Scott Reams
Phone: 919-868-4986