HomeMy WebLinkAboutNCC210799_Notice of Termination_20230310Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/10/2023 10:53:36 AM (NOT Submittal)
Approve by Paul.Clark 3/15/2023 2:54:10 PM (NOT Request Review - NCC210799)
• The task was assigned to DEMLR NCG01 NOT Review Team. The due date is: March 15, 2023 5:00
PM 3/10/2023 10:53:36 AM
• The task was assigned to Paul.Clark by round robin distribution 3/10/2023 10:53:36 AM
E
Use this form to submit a Notice of Termination (NOT) request for a project covered under the N.C. NPDES
General Permit for Construction Activities NCG010000 (or NCG250000). If approved, the Certificate of Coverage
(COC) will be rescinded.
Certificate of NCC210799
Coverage (COC) No.* Enter the Certificate of Coverage Number
2020 Annual Fee Status 2021 Annual Fee Status 2022 Annual Fee Status
May be blank if N/A May be blank if N/A PAID
May be blank if N/A
2023 Annual Fee Status
OPEN
May be blank if N/A
This permittee has an OPEN fee. If this NOT request is acceptable, you will have the option to waive that fee, but that is
only available AFTER the Notice of Termination (NOT) has been approved (when the permit status becomes INACTIVE).
If it is appropriate to waive the OPEN fee, it may help to assign that annual fee task to yourself immediately following this
approval so you remember to resolve the outstanding fee.
Information associated with this permit:
Project Name Greensboro Summit Creek Charter Academy
Lots Covered by this This information is especially helpful when more lots were added with Modifications since the original permit
Permit COC (if issuance.
applicable) No longer visible on the initial form (data not captured from initial application)
Address 2126 Scott Road, Greensboro, NC
County Guilford
Latitude 36.1539
Longitude-79.7443
Permittee Listed Charter Development Company, LLC
Legally Responsible Jeffrey Chamberlain
Individual
NC Reference No. NCG01-2021-0799
E&SC Plan ID 3024
Original NOI Tracking 43057
No.
Date COC Issued 2/11/2021
Prior Rescission Date Date populates only if COC was already rescinded at time of submittal.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:
Erosion Control Plan 4/13/2022
Close-out Date
Erosion Control Plan Summit Creek Charter Academy close GP 41322.pdf 656.47KB
Close-out 29365 NHA Summit Creek —Summary
Documentation 681.4KB
Letter Retention Pond FINAL.pdf
D00041422-04142022133735. pdf 32.37KB
Must be PDF format
North Carolina General Statute 143-215.613 (1) 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
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Type Name* Jeff Chamberlain
Title* Director of Real Estate
Organization* Charter Development Company, LLC
Date * 03/10/2023
Email for jhamberlain@nhaschools.com
Confirmation *
Contact Telephone* (616) 717-1860
NOT Certification NOT Cert Form Signed..pdf 574.38KB
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 Emai!s
(Optional) Jsoumis@nhaschools.com
Original Permittee CC'd on Notification Emai!s
Email jchamberlain@nhaschools.com
Original Site Contact CC'd on Notificaiton Emai!s
Email Robert.Skiffington@whiting-turner.com