NCC216056_NOT Closeout Documents_20230824

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 122.221
General Permit Certificate of Coverage (COC) No.: Nen\ D..t. Q
Name of Project \\ UVINO S
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: f 0---(Aa.k.A0.--
*Legally Responsible Person: kJ...N 1 NC (O(q'1�1(`a.
Title of Legally Responsible Person: O'er e C C__Y,..
SYANDti�l
*Signature: - Date: ei 14(a.
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 NCG010000 permit.

Sedimentation/Construction Stormwater Inspection Report
North Carolina Department of Environmental Quality
Land Resources: Systel Building,225 Green Street, Suite 714, Fayetteville,NC 28301-5094
[phone]
County: Cumberland Project: Front Street Stedman River basin: Cape Fear
Person financially responsible:Billy Horne,Owner Project#: CUMBE-2022-017
NCC216056
Address: PO Box 205,Fayetteville,NC 28302
I. Project Location: Front St,Stedman
Pictures: No
2. Weather and soil conditions: dry,workable soils 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 NPDES Permit NCGO10000 Construction Stormwater requirements? Yes
Describe:
7. Has sedimentation damage occurred since last inspection? No I f Ycs,where? (check all that apply)
Degree of damage:
8. Contact made with(name): No one Title:
inspection report: Sent Report Date given/sent: August 18,2023
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 must be requested by the pennittee via a Notice of Termination
(NOT). The NOT is available at:hops://cdocs.deq.nc.gov/Fonns/NCG01-Termination.
Please note that this correspondence must be uploaded as part of completing the Notice of
Termination process.
Reported by: Melissa Joyner Others present:
Date of inspection: August 04,2023 Time arriving on site: 3:05 PM 'lime leaving site: 3:20 PM
cc:

Certificate of Coverage
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY,MINERAL,AND LAND RESOURCES
GENERAL PERMIT NO.NCG010000
NC Reference No. NCG01-2021-6056
Certificate of Coverage No.NCC216056
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1,other lawful standards and regulations
promulgated and adopted by the North Carolina Environmental Management Commission,and the Federal Water
Pollution Control Act,as amended,
Kevin Correia
is hereby authorized to discharge stormwater associated with CONSTRUCTION ACTIVITIES to surface waters of North
Carolina from a site located at:
Front Street Stedman
5183-5195 Front Street
Stedman
Cumberland County
in accordance with the effluent limitations,monitoring requirements,and other conditions set forth in N.C.General Permit
No.NCG010000.
This Certificate of Coverage is affiliated with E&SC Plan Project No.CUMBE-2022-017
This Certificate of Coverage shall become effective 11/2/2021.
This Certificate of Coverage shall remain in effect until rescinded or expired.
This Certificate of Coverage will expire on the anniversary of its effective date unless it is renewed by payment of the
annual administration and compliance fee.
i/A
-
for Brian Wrenn
Director,Division of Energy,Mineral,and Land Resources
By the Authority of the Environmental Management Commission