NCC223488_NOI Signed Certification_20221007

Print this form, complete, scan and upload tothe electronic NOi
Then, mail the original form to the NC DEMLR Stormwater Program (with $100 check if paying by check) at:
Division ofEnergy, Mineral & Land Resources StormvvuterProgram
S1ZN.Salisbury Street, 6~Floor (Office 64OK)
1G12Mail Service Center
Raleigh NC27G991G12
Per NC General Statute143-215.6B (i), any person who knowingly makes anyfalse statement, representation, or
certification in any application, record, report, plan, or other documentfiled or required to be maintained under this
Article orurule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten thousand dollars ($20,000).
Under penaltyoflaw, | certifythat (check all boxes toindicate your a8reemnent):
[v] |amthepersonosponsib|efortheconstruciionactivbiesofthis project, for satisfying the requirements ofthis
permit, and for any civil or criminal penalties incurred due to violations of this permit.
0TheinfnrmadonsubmittedinthisN0|ir,tothebey1ofmyknovv/edgeandbe|ief,t/ue,accumte,andcomp|ete
based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information.
u� | will abide byall conditions ofthe NCGO10000 General Permit and the approved Erosion and Sediment Control
���
�� If the approved Erosion and Sediment Control Plan is not compliant with Part 11 (Stormwater Pollution
Prevention Plan) ofthe NCGO10000 General Permit, | will nonetheless ensure that all conditions ofPart Uofthe
permit are met onthe project atall times.
k3 |henyby/equestcoveraQeunderthe NCGO10000 General Permit and understand that coverage under this
permit will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
Chapel Crossing Major SUbdkjSioO
—Project Name (must match Ala):
—Specific Lot Numbers (must match Alb):
Permittee (must match Bl): Alarka Properties LLC
TDddBleVins
—Legally Responsible Person (must match B2 & B3): —Title of Legally Responsible Person (must match B3b): Om08[
Name & Title ofSigned ifAuthorized Individual
Differs from LeRallv Rewonsible Person:
—Phone Number: 28-45G-9038
Signature ofLegally Responsible Person orAuthorized Individual
106Z -
Date
IMPORTANTNOTE. This/ormmust be signed byoresponsible corporate officer that owns moperates the construction activity,
such uoopresident, secretary, treasurer, o/vice president, oromanager that isauthorized /naccordance with Part IV, SecbonE,