NCC200612_NOT Closeout Documents_20230417

WAKE
COUNTY
NOR-I-11 CARUI_INA
Wake County Sediment and Erosion Control Section, Water Quality Division
336 Fayetteville Street - PO Box 550 - Raleigh, NC 27602
Phone: [phone]; Fax: [phone]
CERTIFICATE OF COMPLETION
SEDIMENTATION AND EROSION CONTROL
PROJECT:
Harry & Dorothy Leete Minor
Subdivision Lot 6
LOT NUMBERS:
6
ADDRESS:
7620 Mitchell Mill Road
SEC PERMIT NUMBER:
SEC-030368-2019
DATE:
2/27/23
This document certifies that grading for the above reference lot is
completed; 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.
Remember that you must now proceed to the NCDEQ-DEMLR Portal to
submit for your electronic Notice of Termination (eNOT) to release your
coverage under the NPDES Permit (NCG01) that you received. Once you
receive the eNOT, continued self -monitoring of the project for NPDES
compliance will no longer be required.
'dj , Environmental Consultant
919-868-6414

NCGO1 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.: Nee �+�1'ZOO?i2-
c /t
Name of Project: � 4Jfr9t/ ILO/ �/��. � JxN
/©
Per NC General Statute 143-215.68(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: tcV/ 14' C L" 1
*Legally Responsible P_ • frietiV/
Title of Legally Respo •. Person: 0k"AL 4 60%0 4- 6ONT 49-off
*Signature: �*' ' t►,j Date: -/7"Z
Print Name and Title of Si -: . ly 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 NCG010000 permit.