NCC203435_NOI Signed Certification_20200811

NCG01 Notice of Intent ( c 0) Certification Farm
Directions..
Print this crr►a,.COM fete, scan and upload to the electronic N01:
Their, mail the Original form to the NC DEMLR Storrs water Program (with $100 check if Paging by check) at -
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6' Floor (Office 640K)
1612 Mail Service Center
Raleigh, .NC 27699-1.612
DO NOT MAIL TEAS FORK OR PAYMENT UNTIL YOUR. Appt.1CATION HAS BEEN
REVIEWED ► ND AccEPTED AS COMPLETE
Per NC General Statute 143-215,69 01, any person who knowingly makes any false statement, representation,
or certification in any application, recx7rd, 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 Q fine not to exceed ten .thousand dollars ($10,000}:
Linder penalty of law, 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 information submitted in this N01 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.
1 will abide by all conditions of the NCC010000 General Permit and the approved Erosion and
Sed-iment Control Plan,
if the approved Erosion and Sediment Control Plan is not compliant with Part 11 (Stormwater Pollution
Prevention Plan) of the NCG010M General hermit ! will nonetheless ensure that all conditions of
Part It .of the permit are met on the project at all times.
1 hereby request coverage under the NCGG 0000 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.
Name of Project: Camden Solar Pr `fit
Legally Responsible organizational Entity: The Ft►io�e. Groh , Inc.
Legally Responsible Person: Ailfred H. Wills Cll re
Title of
Of
*Print Name and Title of.Signe if Authorized V
Individual Differs from Permittee.
Phone Number- 704-904-9097
* IMPORTANT NOi6: This form mast 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 accordance with Part IV, Section 8, item (j of the NCG010000 permit.
For more information an signatory requirements, see Part IV, Section 6, Item (6) of the NC6010000 permit_