NCC230556_NOI Signed Certification_20230302

NCG01 Notice of Intent (N01) Certification Form
Then, mail the original form to the NC DEMLR Stormwater Program (with $100 check if paying by check) all:
l� Print this form, complete, scan and upload tothe electronic NQi
Division of Energy, Mineral & Land Resources StonmeaterProgram
5I2N.Salisbury Street, 6=Floor (Office 64OK)
1612Mail Service Center
Raleigh, NC 27699-1612
DO NOT hAAlLTH1S F0RIM ORHWIV ENT UNDLYOUR APPUCCAIFION BEEN ACCERTEL' AS0D1'W"N ETE.
Per NC General Statute243-2-15.6B (i), any person who knowingly makes anyfolse statement, r.-Presentation,or
certification in any application, record, report, plan, or other documentfiled or required to be rraintained under this
Article ororule implementing this Article...shall beguilty oƒoClass 2misdemeanor which may include ofine not to
exceed ten thousand dollars /$1(I0DU/.
Under penalty of law, I certify that (check aH boxes to indicate your agreernent):
R1 iamthepemonnesponsibhe/ord`eoonstructionactivitiesofthisproject,forsutisfyingdoenequ{nementsofthis
permit, and for any civil or criminal penalties incurred due to violations cf this perillit.
[7l The infonnadonsubmitted in this NO] is, tothe best ofmyknowledge and belief, true' sccurate and ozmp|ete
based on my inquiry of the person or persons who manage the system, or those persons 6rectly responsible for
gathering the information.
[�l ! will abide byall -conditions ofthe and the approved Erosion and Sediment [on1rn!
[71 Ifthe approved Erosion and Sediment Control Plan |snot compliant vvbhPart U(S1wrmwalerPoi|ut�n
PrevendonPlan) ofthe |mjUnonetheless ensure that aUcond�t|onsofPart 0ofthe
permit are met onthe project atail times.
[7l ihereby request coverage under the NCG010000 General Permit and Understand that coverage under this
permit will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as ;-n
individual permit.
MahOO'VVhiteViUe115hVLine, Replace Switch 544�&544-1-EXPRES"
Prolect Name (must match Ala):
Specific Lot Numbers (must match Alb):
---
Permittee (must match Bl): Duke Energy Progress, LLC
Legally Responsible Person (must match 32 & B3):
NUVV8DVV'8SUhVa
Title of Legally Responsible Person (must match B3b): Lead Transmission Permitting lVGnGger
Name & Title ofSigned ifAuthorized individual
Differs from UResponsible
Phone Number: 9188315655
Signature of Legally Resp
ible Pers(Vor Authorized Individual[
* IMPORTANT NOTE. This form must besigned byoresponsible corporate officer that owns oroperates 'Checons.,ructionoctivit>
such osopresident, secretary, treasurer, o/vice president, oromonrge/that isauthorized hvaccordance vvithPart IV, Section 6,