NCC190713_NOI Signed Certification_20190624

NCGO1 Notice
ofIntent (NOU) Certification Form
Print this form, complete, scan and upload to the electronic NO1.
Then mail the original form tothe NC DEMLRStonmvvaterProgram at:
Division mfEnergy, Mineral /& Land Resources StonmvvaterProgram
S12N.Salisbury Street, 6 mF|mor
1612 Mail Service Center
Per N[General Statute 243-215.68(i), any person who knowingly makes anyfalsestatement, representation,
or certification in any application, record, report, plan, Vrother document/Dedorrequired tobemaintained
under this Article ororule implementing this Article ... shall beguilty ofoClass 2misdemeanor which may
include mfinenot bnexceed ten thousand dollars ($2D,UOO).
Under penalty oflaw, | certify that (check all boxes toindicate your a0reemoenA:
[XI I am the person responsible for the construction activities of this project, for satisfying the
requirements ofthis permit, and for any civil urcriminal penalties incurred due toviolations ofthis
permit.
OD 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.
DD | will abide bvall conditions ofthe NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
DO If the approved Erosion and Sediment Control Plan is not compliant with Part 11 (Stormwater Pollution
Prevention Plan) ofthe NCGO10000 General Permit, | will nonetheless ensure that all conditions of
Part |)ofthe permit are met onthe project atall times.
QJ | 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 asanindividual permit.
NamneufProject: Middle Creek High School
Legally Responsible Organizational Entity: Wake County Board of Ed
* Legally Responsible Person: - David Neter
Title of Legally ResponsibMson: Chief Operating Officer 6 �20tk-%
*8MPORTANT0OTE. This form must besigned bxo responsible corporate officer that owns oroperates the
construction activity, such osu president, secretary, treasurer, nrvice president, ormmnonogerthot/s
authorized in accordance with Part IV, SectionB, Item (6) of the NCGOU0000permit.
For more information on signatory requirements, see Part IV, Section B, Item (6)ofthe NCGO1O00Opermit.