NCC191612_NOI Signed Certification_20190827

Print this form, complete, scan and upload to the electronic NOI.
Then, mail the original form to the NC DEMLR Stormwater Program (with $100 check if paying by check) at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 61" Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
Per NC General Statute 143-215.68 (i), any person who knowingly makes any false statement, representation,
or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule 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 (check all boxes to indicate your agreement):
VI am the person responsible for the construction activities of this project, for satisfying the
T7 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
direc
e for
ng the information.
II will abide by all bconditionsloflthe NCCC1. 209 .ner lI P..gr.mjl and the approved Erosion and
/ Sediment Control Plan.
+/1J If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the.N.CC.0 .0.209_C.g.nnr lI P..grrn%t, I will nonetheless ensure that all conditions of
Part l of the permit are
II hereby request coveragesunder the NCCC C209 G.2.2eral_I 21..mil 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: Parking Lot Expansion
Legally Responsible Organizational Entity: GE Aviation
* Legally Responsible Person:
Shane Pope
Title of Legally Responsible Person: Facilities Engineering Specialist
Signature: �� a&'W-L Date: 8-27-2019
IV
* IMPORTANT NOTE: This 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 IV, Section 8, Item (6) of the NCGO10000 permit.