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HomeMy WebLinkAboutNCC190047_NOI Signed Certification_20190416 NCGO1 Notice of Intent (NOI) Certification Form Directions: Print this form,complete,scan and upload to the electronic NOL Then, mail the original form to the NC DEMLR Stormwater Program at: Division of Energy, Mineral &Land Resources Stormwater Program 512 N. Salisbury Street,61"Floor 1612 Mail Service Center Raleigh, NC 27699-1612 Per NC General Statute 143-215.6B(1), any person who knowingly makes any 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 aftne not to exceed ten thousand dollars($10,000). Under penalty of law, i certify that(check all four boxes to indicate your agreement): 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 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. i/ I will abide by all conditions of the NCGO10000,General Permit and the approved Erosion and Sediment Control Plan. If the approved Erosion and Sediment Control Plan is not compliant with Part 11 (Stormwater Pollution Prevention Plan) of the NCG0110000 General perDit´┐Ż, I will nonetheless ensure that all conditions of Part II of the permit are met on the project at all times. I hereby request coverage under the NCGO,10000 General Permit and understand that coverage under this permit will constitute the permit requirements for the discharg,e(s) and is enforceable in the same manner as an individual permit. Legally Responsible Organizational Entity: Steel Bridge Crossing, LLC Legally Responsible Person: Harold G. Carroll Signature: Date: * 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 authorized in accordonce,with Part IV, Section B, Item (6)of the NCG010000 permit, For more information on signatory requirements,see Part IV, Section B, Item (6)of the NCGO10000 permit.