NCC191627_NOI Signed Certification_20190903

Print this form, complete, scan and upload to the electronic NOI,
Then, mail the original form to the NC DEMLR S,tormwater Program at:
.177777
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512 N. Salisbury Street, 6 th Floor
1612 Mail Service Ce-tter
or certification in oopplicotion, 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).
I am the person responsible for the construction activities of this project, for satisfying the
requirements of this permit, and for any civil or crimiinal penalties incurred due to violations of this
permit.
-rhe 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.
PQ I will abide by all conditions of the NCGOI.0000 General Permit and the approved Erosion and
Sediment Control Plan.,
X If the approved Erosion and Sediment Control' Plan is not compliant with Part H (Stormwater Pollution
Prevention Plani) of the.NCGO1QOOO General Permit I will nonetheless ensure that all conditions o
Part 11 of the permit are met on the project at all times.
I hereby request coverage under the NCGO1OQOO 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..
Name of Project: Adams Vineyards Subdivision
Legally Responsible Organizational EntityStand Vineyards, LLC
Legally Responsible Person: _Er-ed2-6
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ate: 8 N1
*IMPORTANTNOTE. 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
outhoirized in accordance with Part IV, Section 8, Item (6) of the NCGO10000 permit.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCGO10000 permit.