NCC205773_NOI Signed Certification_20201216

NCG01 Notice of intent (NOI) Certification Form
..._.... _ ._ .... plrectivns:
Print thla form, complete, gran and tipload to thr electtonic N01,
Them, mail the original form to tht NC DLMI R 5torrriwatr•r Program (with $100 chock If paying by check) at:
Olvixion of f oergy, Mineral & t-md Resources Storrnwater Program
') I) N. Salisbury Street, 6" Floor (Offirr 440X)
1612 Mad Service center
Ralrlgh, NC 2 7699.1612
DO NOT MAIL THIS FORM OR PAYMENT UNTIL YOUR APPLICATION HAS BEEN
REVIEWED AND ACCEPTED AS COMPLETE
Per NC General Statute 143-215.69 (i), any person who knowingly makes any false statement, representation,
arcertification in any application, record, report, plan, or other document filed orrequired to be maintained
under this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may
include a fine not to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that (check all boxes to Indicate your agreement):
D!4 I am the person responsible for the construction activities of this project, for satisfying the
requirements of this permit, and for any civil or criminal penalties incurred due to violations of this
permit.
1 The information submitted In this NOI is, to the best of my knowledge and belief, true, accurate, and
complete based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information.
i$l I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and
Sediment Control Plan.
If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCG01Q000 General Permit, I will nonetheless ensure that all conditions of
Part iI of the permit are met on the project at all times.
hereby request coverage under the NCGO10000 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: Harris Plant -Wake 230 kV (01_146) NCDOT 1-540 Triangle Expressway Conflict (R-2828;
Legally Responsible Organizational Entity: Duke Energy Progress, LLC
Legally Responsible Person: Randy Veltri
Title of Legally Responsible person: Director of Transmission Permitting
*Signature: Date:
*Print Name and Tit of Signed if Authorized
Individual Differs from Permittee:
Phone Number: 704-382-2741
*IMPORTANT NOTE. This form must be signed by a responsible corporate officer that owns or operates the
construction activity, such as a president, secretory, treasurer, or vice president, or a manager that is
authorized in accordance with Part IV, Section 0, item (6) of the NCG010000 permit.
For more information an signatory requirements, see Part IV, Section 8, Item (6) of the NCG01000b permit