HomeMy WebLinkAboutNCC241977_NOI Signed Certification_20240628 NCGO1 Notice of Intent (NOI) Certification Form
Directions:
Print this form,complete,scan and upload to the electronic NOI.
Then, mail the original form to the NC DEMLR Stormwater Program (with$120 check if paying by check)
at:
Division of Energy, Mineral& Land Resources Stormwater Program
512 N.Salisbury Street,6th Floor(Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE(NOT DIGITAL) [40 CFR 122.22]
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(check all boxes to indicate your agreement):
✓❑ I am the person responsible for the construction activities of this project,for satisfying the requirements 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 the person or persons who manage the system, or those persons directly responsible for
gathering the information.
12 I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control
Plan.
Q✓ If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCG010000 General Permit, I will nonetheless ensure that all conditions of Part II of the
permit are met on the project at all times.
Q✓ I hereby request coverage under the NCG010000 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.
Project Name (must match Ala): Unmanned Data Storage Facility
Specific Lot Numbers(must match Alb): 0784111869
Permittee (must match B1): American Tower Management, LLC
Legally Responsible Person (must match 82& B3): Benjamin Caron
Title of Legally Responsible Person (must match B3b): Senior Construction Manager
Print Name&Title of Signed if Authorized
Individual Differs from Legally Responsible Person:
Phone Number: 781-926-4753 7
//
6/26/24
Signature of Lei Ily Responsible Person or Authorized Individual Date
Benjamin Caron,Senior Construction Manager,for American Tower Management,LLC
* 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 authority to sign,please see attached.
DocuSign Envelope ID:735D6F6B-0A60-46BD-8BC8-A4140C65D894
AMERICAN TOWER
CORPORATION
ASSISTANT SECRETARY'S CERTIFICATE
I, Stephen Greene, a duly elected and acting Assistant Secretary of American Tower Corporation,
a Delaware corporation(the "Company"),hereby certify that:
• American Tower Management, LLC, a Delaware limited liability company, is an indirect
but wholly owned subsidiary of the Company; and
• pursuant to the Company's Delegation of Authority Policy, Benjamon Caron, Senior
Construction Manager, has been granted the authority, to execute, on behalf of the
Company and each of its directly and indirectly held subsidiaries,including,but not limited
to American Tower Management, LLC, any contracts, certificates, agreements, or other
documents to be executed; and
• this authority includes,but is not limited to,the execution of any and all documents,to take
such steps on behalf of the Company and American Tower Management,LLC that may be
necessary and appropriate in connection with, and in support of any construction activities
in connection with the Raleigh Data Center project, specifically, he is the person
responsible for the construction activities of this project, for satisfying the requirements of
this permit,and for any civil or criminal penalties incurred due to violations of this permit.
IN WITNESS WHEREOF, I have hereunto signed my name as Assistant Secretary of the
Company,this 26th day of June 2024.
ESDocuSigned by:
~& 4 tUAL
F0B3B926F2974E3...
Stephen Greene
Assistant Secretary