NCC242324_NOI Signed Certification_20240731

C 1 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 the k if p yi rg by check)
I i at:
Division of Energy, Mineral & Land Resources Stormwater Progr..m
512 N. Salisbury Street,6th Floor(Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
Per NC General Sta to 143-215.68(i), any person who knowingly makes any false stateme t,re res:ntation, 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 incl de a fine not to
exceed ten thousand dollars($10,000).
Under penalty of la , I certify that(check all boxes to indicate your agreement):
❑✓ I am the pe son responsible fo(the construction activities of this project,for satisfying the r:quirements of this
permit, and for any civil or criminal penalties incurred due to violations of this per it.
2The inform tion submitted in this NOI is,to the best of my knowledge and belief,t ue, accurate, and complete
based on m inquiry of the person or persons who manage the system, or those pe sons dir:ctly responsible for
gathering the information.
Q✓ I will abide by all conditions of the N4G010000 General Permit and the approved E osion,an' Sediment Control
Plan.
Q✓ If the approlved Erosion and Sediment Control Plan is not compliant with Part II (St rmwater Pollution
Prevention Plan)of the NCG01b000 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 FCG010000 General Permit and understand that coverage under this
permit will (constitute the pe-mit requirements for the discharge(s)and is enforceable in the same manner as an
individual plermit.
Project Name(must match Ala): Harvest Fields
Specific Lot Nun-,bers(must matcn Alb):
Permittee (must match 81): DR Horton, Inc.
Legally Responsible Person (must match B2&83): Neil Uldrick
Title of Legally Responsible Person (must match B3b): Division Stormwater Compliance Specialist III
Print Name&Title of Signed if Authorized
Individual Differs f m Legally onsible Person:
Phone Numb . 6899 40
7/�1A1f
Y Signatur of Legally Responsible Person or Authorized Individual Date
* 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 NCG910000 permit.