NCC191514_NOI Signed Certification_20190826

New Submission
Page 1 of 2
fJORTH CA13ClLINA
Envlranmrntut Quality
Construction Stormwater: Notice of
Intent (NOI)
National Pollutant Discharge Elimination System (NPDES) application for coverage
under North Carolina's General Permit NCG010000: STORMWATER DISCHARGES
associated with construction activities (or NCG250000)
A. Project Information B. Permittee Information I C. Site Contact information
D. E&SC Plan E. Certification
North Carolina General Statute 143-215.66 (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in iany application, record, report,
plan, or other document filed or required to be maintained under this Article or a rule implementing this Article; or who
knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Article; or
who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring ;device or method required to be
operated or maintained under this Article or rules of the Commission implementing this Article shall be guilty of a Class 2
misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000): ',
Under penalty of law, I certify that:
* ❑./ 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.
* Q I will abide by all conditions of the NCG010000 General Permit and
the approved Erosion and Sediment Control Plan.
* ❑./ I hereby request coverage under the NCG010000 General Permit
and understand that'coverage under this permit will constitute the
permit requirements for the discharges) and is enforceable in the
same manner as an individual permit.
Specify if you O The Responsible Person named on this Notice of Intent
are:* Q Authorized Responsible Person*
https://edocs.deq.nc. gov/Forms/NCGOl-NOI
8/21/2019

New Submission
Page 2 of 2
Important: The person who
should be the same person
in Section B (Permittee Inf
corporate officer who owns
treasurer, or vice president,
Item (6) of the NCG010000
x
signs this Certification above and signs the NOI Certification Form
(or authorized responsible person within the same organization) as listed
mation) of this form. *An authorized individual is a responsible
or operates the construction activity, such as a president, secretary,
or a manager that is authorized in accordance with Part IV; Section B,
General Permit. For more information on signatory requirements,
see Part Iv, Section B, Item (6) of that permit.
Signature* x
Ar .. C. c�
Type Name* Kevin Caison
Title* Facilities Project Manager
Organization* New Hanover County
Date* Date captured on form submission
Previous Next
I'm not a robot
reCAPTCHA
Privacy -Terms
Submit Save as Draft
https://edocs.deq.nc.gov/Forms/NCGO1-NOI 8/21/2019