NCC210189_NOI Signed Certification_20210112

NCGO1 Notice of Intent (NUI) Certification Farm
Directions:
i
Print this form, complete, scan and upload to the electronic NOI.
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. Satisbury Street. 61 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
Per NC General Statute 143-215.69 (i), any person who knowingly makes any false statement, representation,
or certification in any application, record, report; pion, or other document filed or required to be maintained
under this Article or a rule implementing this Article, .. shaft be guilty of a Class 2 misdemeanor which may
include a fine not to exceed ten thousand dollars ($10,000).
Under penalty of law, 1 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.
Ir 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.
I will abide by all conditKwmof the NCG0100W General Pe — it and the approved Erosion and
Sediment Control Plan.
tf the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCGfl1c"klt"k1 General Permit, I will nonetheless ensure that all conditions of
Part 11 of the permit are met on the project at all times.
I hereby request coverage under the NCGO12M General Permit and understand that coverage under
this permit wilt constitute 'he permit requirements for the discharges) and is enforceable to the
same manner as an individual permit.
Name of Project: Duke Energy Sraw4ey School - Nesbit 100kV Tap
Legalty Responsible Qrganirati+onat Entity: Dune Energy Carolinas, LLC -
Legally Rewnsible Person: Randy Vettri
Title of
Person: Ma
Date: ta.- t"• W20
`Print Name ana Title
if Authorimd
Indrinduaf 0f ifs from Perrrtttee
Phone Number J-.-1 - 741 ..__
tAWOd Mff NOTE. T#wfixm must &t sifd by o respoewbk cokpgxate a; fc e - t awns or operates the
cvgwtn,cbon a t wfy. souls as a prini kilt soartlxwy, trec;surer, tar vice pre-9de,- . :manager that. is
authorzed in ar K *Rth Pori IV, Sft-& r► 8, htwn (6) 4 thr WW1 t71t7Ci12 permt.
for ffsvre afo► yxib ar oe tenor ry frgweerwnts;, see Purl 16; Sectim A Rein (6) of the WW1(7[i "Ott