NCC191883_NOI Signed Certification_20190924

Print this form, complete, scan and upload to the electronic NOL
Then, mail the original form to the NC DEMLR Sto,rmwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6 th Floor
1612 Mail Service Center
Ralleigh, NC 27699-1612
Per NC General Statute 143-215.6B (i), any person who knowingly makes ony 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 four boxes to indicate your agreemenfl:
FX-] 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 iincurred due to violations of this
permit.
The information submitted in this NO11 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.
LJ I will abide by all conditions of the NCG010000 General Permit and the aipproved Erosion and
Sediment Control Plan.
KJ if the approved Erosion and Sediment Control Plan is not compliant with Part fl (Stormwater Pollution
Prevention Plan) of the NCC0100010 General Permit, I will) nonetheless ensure that all conditions of
Part 1:1 of the permit are met on the project at all times.
EX I hereby request coverage under the NCGO10000 General Permit and understand that coverage under
this, perm,it will constitute the permit requirements for the discharge(s) and is enforceable in the
same manner as an individual permit.
Legally Responsible Organizational Entity:
* Legally Respopible Person:
Signature
D.R. Horton, Inc.
Elizabeth Shelton - D,R. Horton - Wilmington City Manager
MM
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 B, Item (6) of the NCGO10000 permit.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCGO10000 permit.