NCC190887_NOT Closeout Documents_20230822

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(NOTDIGITAL) [40 CFR 122.22]
General Permit Certificate of Coverage (COC) No.: NCel 0 807
Name of Project: West and East Salisbury Improvements
Per NC General Statute 143-215.66(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(must match eNOT): Town of Wrightsville Beach
*Legally Responsible Person (must match eNOT): Timothy W. Owens
*Title of Legally Responsible Person: Town Manager
Print Name&Title of Signed if Authorized Individual Differs from Legally Responsible Person:
*Signature: Date: 8/22/23
gnature: �'4�'�? �
* 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.

Sedimentation/Construction Stormwater Inspection Report
North Carolina Department of Environmental Quality
Land Resources: 127 Cardinal Drive Extension, Wilmington,NC 28405 [phone]
County: New Hanover Project: West and East Salisbury Street River basin: Cape Fear
Person financially responsible:Town of Wrightsville Beach-Tim Owens,Town Project#: NEWHA-2019-027
Manager
Address: 321 Causeway Drive,PO Box 626,Wrightsville Beach,
1. Project Location: Salisbury Street,Wrightsville Beach
Pictures: No
2. Weather and soil conditions: 80s clear dry Initial inspection: No
3. Is site currently under notice of violation? No
4. Is the site in compliance with S.P.C.A.and rules? Yes If no,check violations below:
5. Violations:
6. Is the site in compliance with the NPDES Permit? 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): Title:
Inspection report: Sent Report Date given/sent: October 09,2020
9. Corrective action needed:
10. Comments: File closed
[e-mail]
Reported by: Brian Lambe Others present:
Date of inspection: October 08,2020 Time arriving on site: 9:30 AM Time leaving site: 9:45 AM
CC: