NCC200984_NOT Signed Certification_20231102

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.: NCG010000
Name of Project: LIV North Tryon Station
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(must match eNOT): PG III/LIV UNCC Apartments, LLC
*Legally Responsible Person (must match eNOT): Robb Crumpton
*Title of Legally Responsible Person: Manager
Print Name&Title of Signed if Authorized Individual Differs from Legally Responsible Person:
*Signature: Date: dill J 23
*IMPORTAN OTE: T s f r m be signed by a responsible corporate officer that owns or operates the
construction ctivity,s ch as a pr sident,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.

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.NCG01-2020-0984
Certificate of Coverage No.NCC200984
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,
PG III/LIV UNCC Apartments, LLC
is hereby authorized to discharge stormwater associated with CONSTRUCTION ACTIVITIES to surface waters of North
Carolina from a site located at:
LIV North Tryon Station
North Tryon Street
Charlotte
Mecklenburg 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.LDGP-2020-00022
This Certificate of Coverage shall become effective 3/16/2020.
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.
for Brian Wrenn
Acting Director, Division of Energy, Mineral,and Land Resources
By the Authority of the Environmental Management Commission