NCC191597_NOI Signed Certification_20190827

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U1 nergl,,, Tuneraii torrrr"7'i
512 N. Salisbury Strelet, 6 1h Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
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W,
or certification in any application, record, report, plan, or other documentfiled 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 afine not to exceed ten thousand dollars ($10,00%,
Under penalty of law, I certify that (check all boxes to indicate your agreement):
Yd 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.
E9 The information submitted in this N01 is, to the best of my knoMedge 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.
P9 I will abide by all conditions of the NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
LM if the approved Erosion and Sediment Control Plan is not compliant with Part 11 (S,tormwater PoRution
Prevention Plan) of the NCGO10000 General Pl rm�t I will nonetheless ensure that all conditions of
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Part 11 of the permit are met on the project at all times.
I hereby request coverage under the NCG010000 General Permit and understand that coverage under
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-this Permit will constitute the permit requirements for the discharge(s) and is enforceable in the
same manner as an individual plermit,
Name of Project: T`)�v, f � V _ . .. . . . . . . ........
Legally Responsible Organizational Entity: We'u 9"'Jlrgi -1 - �"s t'!
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Legally Responsible Person: . . . .....
'Title of Legally Responsible Person: Zp — — - - -------
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Date:'
IMPORTANT NOTE. Thisform 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, 5ection B, Item (6) of the NCGO1 0000 permit,