HomeMy WebLinkAboutNCC221774_NOT Signed Certification_20240701 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.: NCC221774
Name of Project: UNCW Randall Library Renovation & Expansion
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): UNC-Wilmington
*Legally Responsible Person (must match eNOT): Mark Morgan
*Title of Legally Responsible Person: Associate Vice Chancellor for Business Affairs - Facilities
Print Name&Title of Signed if Authorized Individual Differs from Legally Responsible Person:
David Holsinger, Assist. Director- Facilities ACS
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*Signature: Date: Cj S' L
*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.
SUB-DELEGATION MEMORANDUM
To: David Holsinger, Assistant Director, Architectural & Construction
Services
From: Rachel Patrick, Director, Architectural & Construction Services
Re: Sub-delegation of Signature Authority to Sign Certain Contracts and
Documents
Date: February 20, 2023
In accordance with Chancellor Rosemary DePaolo's Memorandum dated February 26,
2004, effective immediately, I hereby sub-delegate signature authority for the following
contracts and agreements in your role as Assistant Director, Architectural & Construction
Services:
Agreements including or related to: The North Carolina Division of Environmental
Quality and United States Army Corps of Engineers, construction contracts, and related
permit requests; environmental assessments, wetlands delineations, submittals to the
State Contraction Office and other state and federal agencies related to construction.
/e)a-t-72 2/20/2023
Rachel Patrick Date
CC: Mark Morgan
Miles Lackey
Chancellor Dr. Aswani Volney
Office of General Counsel