NCC214584_Notice of Termination_20230906

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 9/6/2023 1:38:56 PM(NOT Submittal)
Approve by Kieu Tran 9/11/2023 2:17:30 PM (NOT Request Review-NCC214584)
• The task was assigned to DEMLR NCG01 NOT Review Team.The due date is:September 11,2023 5:00
PM 9/6/2023 1:38:58 PM
• The task was assigned to Kieu Tran by round robin distribution 9/6/2023 1:38:58 PM

NPDE,�tz-
Stormwater Permit for . •
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(COC)will be rescinded.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 NCC214584
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 Home2 Suites-Boone, NC
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 252 E KING ST BOONE, NC 28607, Boone, NC
County Watauga
Latitude 36.2159
Longitude -81.6711
Permittee Listed NSV Boone, LLC
Legally Responsible Dan Norman
Individual
NC Reference No. NCG01-2021-4584
E&SC Plan ID Z03796-051920
Original NOI Tracking 61876
No.
Date COC Issued 8/12/2021
Prior Rescission Date Date populates only if COC was already rescinded at time of submittal.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
New owner/operator NCC232496
COC No. Enter the COC number obtained by the new owner
New Owner Name First and last name
Narsi Development Boone LLC-Deven Patel
New Owner Phone [phone]
Number
New Owner Email [e-mail]
Additional More information about the basis of this request,if needed.
Explanation on 08/02/2023 Property and entitlements sold by Mountaineer Hospitality LLC a
Delaware limited liability company to Narsi Development Boone LLC. Uploaded is
the Watauga County Register of Deeds filed General Warranty Deed to support&
document the closing event.
Supporting Upload Supporting Documentation if applicable.
Documentation 2345-1 GW Deed.pdf 116.11 KB
Must be PDF format
Project Close-out Information:
Erosion Control Plan
Close-out Date
Erosion Control Plan Must be PDF format
Close-out
Documentation
North Carolina General Statute 143-215.613(i)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
Type Name* Dan Norman
Title* Managing Member

Organization* NSV BOONE LLC
Date* 09/06/2023
Email for [e-mail]
Confirmation*
Contact Telephone* 7049759867
NOT Certification NCG01 Notice of Termination(NOT)Certification
Form 865KB
Form 09062023.pdf
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)
Original Permittee CC'd on Notification Emai!s
Email [e-mail]
Original Site Contact CC'd on Notificaiton Emai!s
Email [e-mail]