NCC190295_NOI Signed Certification_20190516

NCGO1 Nticeoof Ientnt (NO
Directions:
Certification Form
Print this farm, complete, scan and upload to the electronic NO
Then
mail t
he original form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 61h Floor
1612 Ma
Raleigh,
Per NC
or certificatton in any application, record, report, plan, or other document filed or required ro ve maintained
II Service Center
NC 27699-1612
eneral Statute 143-215. 6B (i),, any person who knowingly makes any false statemen
under this Article or o rule implemen
his Article ... shall
nclude a fine not to exceed ten thousand dollars ($10,000).
ting t
representation,
be guilty of a Class 2 misdemeanor which may
Under penalty of law, I certify that (check all boxes to indicate your agreement):
Ae
am the person responsible
requirements of this permit,
permit.
Theinformation submitted in this N01 is, to the best of my knowledge and belief, true, accurate, and
complete based on myinquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information.
will abide by all conditions of the NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCGO10000 General Permit, I will nonetheless ensure that all conditions of
Part II of the permit are met on the project at all times,,,
I hereby request coverage under the NCG010000 General Pe6 rmit and understand that coverage under
this permit will constitute the permitrequirements for the discharge(s) and is enforceable in the
same manner as an individual permit.
for the construction activities of this project, for satisfying the
'�' rrea due to violations OT this
criminaland for any civil or penalties incu
Name of Project: Barr ington Subdivision Phase 2
Legally Responsible Organizational Entity,., Barrington Development, LLC
* Legally Responsible Person: John W'I&Ilia s
Title of Legally Respond
Signature:
Person: Senior Partner
Date:
lee
":)
* IMPORTANT NOTE:Th'Is 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 8, Item (6) of the NCGO10000 permit.
For more information on signatory requirements, see Part 1V, Section B,, Item (6) of the NCGO10000 permit.