NCC232468_Notice of Termination_20240409

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 4/9/2024 11:50:49 AM(NOT Submittal)
Approve by Kieu Tran 4/11/2024 1:16:27 PM (NOT Request Review-NCC232468)
0 This termination request is to close NCC232468 because of a change in the legally responsible entity.
NCC240859(A.R.CHesson Construction Company Inc)has been approved and is active for this
project.
• The task was assigned to DEMLR NCG01 NOT Review Team.The due date is:April 12,2024 5:00 PM
4/9/2024 11:50:53 AM
• The task was assigned to Kieu Tran by round robin distribution 4/9/2024 11:50:53 AM

Q� Notice of Termination (NOT) Request - 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(COC)will be rescinded.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 NCC232468
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 May be blank if N/A
2023 Annual Fee Status 2024 Annual Fee Status COC Expiration Date
May be blank if N/A May be blank if N/A 3/31/2029
Information associated with this permit:
Project Name Wawa Halstead and Ehringhaus
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 406 Halstead Blvd, Elizabeth City, NC
County Pasquotank
Latitude 36.2936
Longitude -76.2453
Permittee Listed Halstead Elizabeth LLC
Legally Responsible James Leach
Individual
NC Reference No. NCG01-2023-2468
E&SC Plan ID Pasqu-2023-007
Original NOI Tracking 155020
No.
Date COC Issued 4/1/2024
Prior Rescission Date Date populates only if COC was already rescinded at time of submittal.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 Q Sale(Another Owner/Operator obtained new COC)
Coverage* Q Mistake or Invalid Coverage
O Other CHANGE OF OPERATOR

Additional More information about the basis of this request,if needed.
Explanation TRANSFER FINANCIAL RESPONSIBILTIY TO A.R.CHESSON CONSTRUCTION
COMPANY COC NCC240859
Supporting Upload Supporting Documentation if applicable.
Documentation 2024-03-27 Certificate of Coverage A.R. CHESSON
313.14KB
CONSTRUCTION PROJECT PASQU-2023-007.pdf
2138-Transfer Authorization Letter of eNO1-FRO-
139.31 KB
02292024.pdf
2138 NCDEQ Sedimentation-Stormwater Inspection
80.16KB
Compliance letter 112923.pdf
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(1)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* JAMES LEACH
Title* MEMBER
Organization* HALSTEAD ELIZABETH LLC
Date* 04/09/2024
Email for [e-mail]
Confirmation*
Contact Telephone* 3056929992

NOT Certification FX-2024-04-09 COMPLETE NCG01-eNOT-
Form 66.6KB
Certification-Form-20230601-DEMLR-SW.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) [e-mail]
Original Permittee CC'd on Notification Emalls
Email [e-mail]
Original Site Contact CC'd on Notificaiton Emai!s
Email [e-mail]