NCC230246_NOI Signed Certification_20230127

NCGO1 Notice of Intent (NOI) Certification Form
Directions:
Print Lhis form, complete,scan and upload to the electronic NOI.
Then, mail the original form to the NC DCMLR Stormwater Program (with $100 check if paying by check) at:
Division of Lnergy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, Fi', Floor {Office W10
1612 Mail Service Center
Raleigh, NC 27G99 1612
DO NOT MAIL THIS FORM OR PAYMENT UNTIL YOUR APPLICATION HAS BEEN ACCEPTED AS COMPLETE.
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) (40 CFR 122.221
Per NC General Statute 143-215.15E N, any person who knowingly makes any false statement, representation, or
rFrtificolion in any application, rerord, repot[, plan, or other document filed or required to be mointained under this
Article or a ruse implementing this Article ... shoil be guilty of a class 2 misdemeanor which may include a fine not (o
exrppd ten thousand dollars ($10,000).
Linder penalty of law, I certify that (check all boxes to indicate your agreement):
Q I am the person responsible for the constructio0 activities of this project, for satisfying the rQquiremenLs of this
permit, and for any civil or criminal penalties incurred due to violations of this permit.
The information submitted in this NOI is, to the best of my knowledge and belief, true-, accurate, and complete
based on my inquiry of Lhe person or persons who manage the system, or those persons directly responsible tc+r
gathering the information.
�✓ 1 will abide by all conditions of the NCGQJQIJW Gieneral_PtgEit and liie approved Frosion and Sediment Con:ral
Plan.
✓n if the approved Lrosion and Sediment Control Plan i5 not compliant with Part 11 (Stormwater Pollution
Pri-►reniion Plan) of thef 0 Gen4rral Permit. I will nonetheless ensure that all conditions of Part 11 of the
permit are met on the project at all times.
1 hereby toques[ coverage under the fyCQ41QQQQ General Perrlilt: and understand that coverage under this
permit will constitute the permit requifernents for the discharge(s) and is entorce-ahle in the same manner as an
individuaal permit.
Project Name (must match Ala): 5689 Cedarmere Drive -SFD Construction
SpeCific Lot Numbers (mint match A1b1,,�
PPrmittee (must match ffi):
5316
Aher Builders inc
Legally Responsible Person (must match 82 & R.3): Sanjay Aher
Title of Legally Responsible Person (must rrratch 03b); President
Name. & Title ❑f Signed if Authorized individual
Differs frorn Legally Responsible Person: Sanjay Aher
Phone Number' 336'75-034 _
SanjayAher ri [ Q A&II-l"
Signature of Legally Respdn�ible Person or Authorized Individual
1126/20
Date
* IMPORTANT NOTE, This form must Gee signed by o reWrioblr. corpo rare officer t?ipr owns or opercfes the tom truif60 acbviry,
such as a presrdent,-rC.'retary, treasurer, or Trice prrsidont, or a errcroger that is uurhor►zrd in accordance with Pert N, W-tion S.
item (6i of 0& NC6010000 perrnil