NCC190362_NOI Signed Certification_20190523

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Print this form, complete, scan and upload to the electronic NOI.
Then, mail the original form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6t" Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
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Under penalty of law, I certify that (check all boxes to indicate your agreement):
X1 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.
X I will abide by all conditions of the INCGOI.0000._ eimeir�Il....lPenrnii�and the approved Erosion and
Sediment Control Plan.
X If the approved Erosion and Sediment Control Plan is not compliant with Part 11 (Stormwater Pollution
Prevention Plan) of the INCGOI.0G�G 0 Geimeiral.l{ -irirniit, I will nonetheless ensure that all conditions of
Part 11 of the permit are met on the project at all times.
( I hereby request coverage under the INCGOI.0000.._ eimeirA lPenrnii�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.
Name of Project: Lee Ct Duplex
Legally Responsible Organizational Entity: MJ Commercial Inc.
John Palczuk
* Legally Responsible Person: _
Tit Legally R s o I Person: Manager
SigWatu re: Date:
5/23/19
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