NCC202002_NOI Signed Certification_20200701

NORTH CAROLINA
6tvironmental Quality
Construction Stormwater: Notice of
Intent (NOI)
National Pollutant Discharge Elimination System (NPDES) application for coverage
under North Carolina's General Permit NCGO10000: STORMWATER DISCHARGES
associated with construction activities (or NCG250000)
A. Project Information B. Permittee Information I C. Site Contact information
D. E&SC Plan I E. Certification
North Carolina General Statute 143-215.613 (i) provides that:
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; or who
knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Article; or
who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be
operated or maintained under this Article or rules of the Commission 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:
* a 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.
* Cj 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 will abide by all conditions of the NCGO10000 General Permit and
the approved Erosion and Sediment Control Plan.
* [Z If the Erosion and Sediment Control Plan approved by the
delegated program is not compliant with Part II (Stormwater
Pollution Prevention Plan) of the NCGO10000 General Permit, I will
nonetheless ensure that all conditions of Part 11 of the permit are
met on the project at all times.

* Q I hereby 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 an individual permit.
Specify if you �ii The Responsible Person named on this Notice of Intent
are: * Q Authorized Responsible Person*
Important: The person who electronically signs this Certification above must be the same person
who signs the NOI Certification Form. If that person is signing on behalf of the Permittee, that
individual must be an authorized responsible person within the same organization as the Permittee.
*An authorized individual is a responsible corporate officer who 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 NCG010000 General Permit. For more
information on signatory requirements, see Part IV, Section B, Item (6) of that permit.
Signature*
Type Name* Thomas D. Pearson
Title * Manager -Member
Organization* Legally Responsible Entity
J. P. Development Group, LLC
Date Date /3 �U Date captured on form submission
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