NCC202826_NOI Signed Certification_20200707

NCG01 Notice of Intent (NOI) Certification Form
Print this form, complete, scan and upload to the electronic NOL
Then, mail the original form to the NC DEMLR Stormwater Program (with $100 check if paying by check) at:
Division of Energy, Mineral & land Resources Stormwater Program
512 N. Salisbury Street, 611 Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM OR PAYMENT UNTIL. YOUR APPLICATION HAS BEEN
REVIEWED AND ACCEPTED AS COMPLETE
Pef NC Gerwal Statute 143-215,68 (t), any person who knowingly makes any false statement, representation,
or ceftifcation in any application, record, report, plan, or other document filed or required to be maintained
urKdrr t!►is Article or a rule irnplementing this Article .. , shall be guilty of a Class 2 misdemeanor which may
a fine root to exceed tern thousand dollars ($10,000).
Under penalty of laver, I certify that (check all 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 informaton submitted in this NOI is, to the best of my knowledge and belief, true, accurate, and
complete hased on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information.
EB I will *bide by all conditions of the !2gL010000 General Permit and the approved Erosion and
Sediment Control Pian,
F, tf the approved Erosion and Sediment Control Plan is not compliant with Part 11(Stormwater Pollution
Prevention Plan) of the NCG010M General Permit, I will nonetheless ensure that all conditions of
Part ll of the permit are met on the project at all times.
r� I hereby request coverage under the NCC701Q General Permit and understand that coverage under
this permit will constitute the pei mit requirements for the discharge(s) and is enforceable in the
same manner as an individual permit.
Name of Project Ouke Energy Cliffside to Shelby Tie OPGW
aRlt geible p anelat}onat En ' Duke Energy Carolinas
l a!I Re bit~ Person: Randy Veltri
� Y
Title of L
,..�R�f#
e Person: �M^aana"r. Transmission Pemitting
'LEma
t bate: & y^ �.
'Print Nate and 11tie of Si*d it Authmized
k,*wkvw fiwm Plt+rfrHttee � � -
Plume Number: 7fl4�382 1I#I
wpm l'ANT tYort This Pwm must be signed by a r*gponc)bk corporate officer that owns or operates the
te7s ss: �c+c trot 'W t:vsty, suwh 05 a president, srcretury. tni surer, or vire president, or a manager that is
xrvtfiovravrd in ocrorda"re watt Part W Se+ctian S. item (6) oy the Nc:GO.Et] W permit.
For more rvot'ltraow on signatory requkiments, see Port tV, Section B, item (6) of the MCGO10000 permit.