NCC192056_NOI Signed Certification_20191001

K ri
512 N. Salisbury Street, 6'�' Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 276994612
REVIEWEDATILT MY APPL1CATIUffXW=t
AND ACCEPTEDAS COMPLETE
+_ / / '. . .: ♦ ►-,.. a iR / r ►.. _ • r - s ../ ►,
rr certification 1 application,report,11 or other documentfiled or / / to b' maintained
includeunder this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may
of _ o toexceed
ten thousand dollars /i / F R
1 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 violationsof this
I
19The information► *in thiso 1. best/my knowledgeand belief,
complete based on my inquiry of the person or persons who manage the system, or those persons
directly responsiblefor / •
SedimentIR I will abide by all conditions of the NCGO10000 Genera� Perimit and the approved Erosion and
► ■
10 If the approved Erosion and Sediment Control Plan is not compliant with Part 11 (Stormwater Pollution
Prevention ofthe.NCGO10000Generalo- ensurethat all conditionsis
Part 11 of the permit are met on the project at all times.
135 1 hereby request coverage under the NCG010000 General� Permit and understand that coverage under
this permit will constitutethe permit Y for thedischarge(s)d is enforceable
same manner as an individual permit.
PleasantName of Project: 1/ !n E&S Plan
Leeallv Resvonsible Person- Michael E. Satterwhite
l.... 1;:
Date -
°Print Name and Title of Signed if Authorized
Individual D► ers fram Permittee
Phone Number: [phone]
IMPORTANT NOTE.- Thisform must be signed by cr 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.