NCC191665_NOI Signed Certification_20190830

112111URVE1110 Ill :1 Ell
512 N. Salisbury Street, 6 th Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
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 aftne not to exceed ten thousand dollars ($10,000).
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 inthis N0is, to the best ofmyknowledge 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.
/ will abide byall conditions ofthe NCG010000 General Permit and the approved Erosion and
Sediment Control Plan,
|fthe approved Erosion and Sediment Control Plan isnot compliant with Part U(StormwaterPollution
Prevention Plan) ofthe | will nonetheless ensure that all conditions cJ
Part Uofthe permit are met mnthe project a1all times.
| hereby request coverage under the NCGO10000 General Permit and understand that coverage under
this permit will constitute the permit requirements for the dischar8e(s)and isenforceable inthe
same manner asaoindividual permit.
* Legally Responsible Person: Tim Curtis
Title of Legally Responsible Person: Supervisor - Field Services
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, Section B, Item (6) of the NCGO10000 permit.