NCC202467_NOI Signed Certification_20200612

NC0 Notice of I n te-n t W".411 C &" t H1,,.-, afl o n F c,1i r ti t„
DlrecUons-
Print this form, complete, scan and upload -to theelectronic NOI.
Then, mail the original form to the NC; DE:Mt k Storrnvir. er Program (with $100 chc.-ck if paying b�� cher?) at. -
Division of Energy, Nlineral & Land Rr•3;ources s torrnwate-qr Program,
512 N. Salisbury Stree,; , V' Floor (Office 640K)
1612 Mail Service! Center
Raleigh, NC 2' 699-1.6:t2
00 NOT MAIL THIS OR PAY11A. N ' €P.'i'rK,. YOUR APPUCAT�IOIN 'HA.,.!i,
Per NC General Statute 143-215.69 (1), any faerson who knowingly makes any.•fcalse statement, representation,
or c:ertiflcation in any application, record, report; pion, or, crtlr€>r docurnent filed or required to be rnaintained
under this Article or a rule implementing this Article .. , shall .he quilty of a Class 2 rnisdemocynor which rncx1
include a fine not to exceed ten thousand dollars ( 1t1,Ci[iC7).
Under penalty of law, I certify that (check all boxes to indicate your
Ck� I am the person responsible -for the c o nstrk.iction acaJvities of this pr•ojecl, for 5ati;aftijing ti o
requirements of this permit, and for any civil or criminal pl-ffl- i s Eiacurr'ed clue to vialati�jras ca'='tl,is
per 'nit.
The information submitted in this NOI is, to the best of nay knowledge and belief, true:, accurate, and
complete based or) my inquiry of this parson or per-,ons who roanage the system, o thos'�! per*, ins
directly responsible for gathering the inform.'.)'! ion.
Cl I will abide by all conditions of the NG,O1C7000 eGg ix_-jieaC Parts€t, and the approved Erosion and
Sediment Control Plana
iXl If the approved Erosion and Sediment Controi Plan s not compliant with Part 11 {Storrnw�;'(--xr PcalluE:i,;ar.
Prevention Plan) of the NQG010000 General Permit, I will nonetheless ensure•that: all conditions of
Part 11 of -the permit are met on the project at all times.
N] I hereby request coverage under the NQ-.-'010Q' 0 _Permit. and understand that co ier•age under
this permit will constitute the permit regrrirerrre nts for the discharge(s) and is enforce able in the
s`earne rnaanner as an Individual permit,
Name of Project: Sycamore Cove Subdivision
Legally Responsible Organizational Entity: !CV Ventures, I..I..:M
Legally Etesponsible Person: David Day
Title of Legally Respo;asible Person: Owner
*Signature?: f [p
- t3 atc� •
*Print Name and Title of Signed if Autho °.ed
Individual Differs from Permittee:
Phone dumber: [phone]
*IMPORTANT NOTE. This form must be signed by a responsible corporate officer brat owns or oprCate. th,,
construction activity, such as a president, secretary, treasurer, or vice president, or a manager that is
authorized in accordance with Part IV, Section 8, Item (6) of the NCG010000 permit.
For more information on signatory requirements, see Part. -IV, .section 8, Iaern (6) of the i1.r(:GO1(000 permit.