NCC190724_NOI Signed Certification_20190625

NCGUJ Notice of Intern {I401) certification Form
olrettions:
Primm this farm: complete, SUA a -id rrplaad to tkw elcrtrcink HOs,
'hen. mail the orilitM0 form to Ow NC dEM4R Starrnwater Pr$gram at:
r&wslt m of Fne?kil, M.rreraI & ILand Resources S:tarni waler Pmsram
532 H. &akillwry 54wt, V Poor
1612 Mail service cilrrter
v 90IM it, NC 279.1612
PirNCGeneral4hi:rate]*r3•�?�.¢9(J�,onyWsonv.+hokr.p,, do'gfym4rkesnrsyfa&eirefemrnf rcprescMtrt�&
ar rtr r`fi[dtdPrl in a" dp0kTVn, retard, report. pfwt kr ortarr dorlrMEAt)7kd rar r"en'reO 10 be mairrpinrd
rn�dra rhrs a4n!icPt tx a Pule �rrqui'ementvr,g ehfs:irtkle ... srra lr be guilty a) d Class 2 Ml%derntrpw,• WM'ch ,mmy
ixh.rdt a f�r•••e rise #� txeeed tea thotasnnddcJlafrs :[S]�,axral•
voider raicy c�flaw, Icertifythat [ch, kall bocestoindicarteypvcapeement}:
I am the person responslble for theccn5lnictian attivitiescf this pr6Jeet,fafsatlsNng the
requirern t:s of this permit. and dot an v ciwil or criminal penallees Irrc+arr el due to +Violations of this
peranit.
The snforma:tkrn submitted in this 1401 1s, to the best of my kra~wiedge and Wirif, true, mcurate, and
eYirn to based on rrq Inquiry of the pose or persons who Manage the syrstem, ar thcsc r`rTwn5
f directly rz:pansible For gathering Ow Information.
Yet` F vrlfl abide by III ea:rditrcins of the NSGO#Oll7 Goneral PRPf rl and the apprgved Ern an
Sediment Content place.
Zv/ 1! the a pproved Erosion and Sediment Control Plan Is nWt Q;hnplksnt witty Part II [Storinwater Pollution
PrevRntinn xanjeat the NCrit 1JtaCJf2(5Gener.0 Permit.I will nonetheless ensure that all s[trrctd400sof
Part I I of V e perrrait are met an the protect at all tirws.
I hereby request coverage undcr the N€€o0 92kSaerteral Prrrn 1 and uri4;iersiand that cuvcrarge vnov
this Permit will rwigltufe the permit requiem cntS for The d isOArkAs) and is erifoN4C4b1e! in the
sarn,: mairtrterasa11n�� IndMdual perrnil.
Marie- cif ProjW: .1Jr Ck�- u o Y
�sga�y�ts�vrtslble S7rganlaatlonat entity-, p
t,ePPYRessionslhlekrson_ Jam,€sh a �9 Liec.
Tt§eofLeg;illfFW,4pansi'alQ'Parson:CA, Lt Y3 y''v�h � k (xIY14CP ', 6ACP tug
$<$rtiidurc: �^•.'(�'��� Raze• ':�"�
`Ib4 TAhi W7F. iN hrm mime be S4nrd by a rest ms.Ibie corpvrote of crr #,v ow,n€ or operati s the.
ronstrrxtkarl ottfvPty,.srrcb ors o preshlc tr 3gYrttgry, Irraslirrr., orwk-tPrvSWnr, ora monager tfaat fs
v4itharked.n rardeanee wrtrh ,Pert N, StCtiOA 8, lttrM (6) Qf TFW MCGQ100W,prrm(t,
For rrweMforntcritar?ons0nataryreQuiremepts, see Parr IV, SectionP,frears(6)ofthe JICegiP permit.