HomeMy WebLinkAboutNCC212348_NOI Signed Certification_20210426SICe of Intent (NOI) Cert
ficationE
Directions:
Print this form, complete, scan and upload to the
electronic NOI.
Then, mail the original form to the NC DEMLR Stormwater Program (w
th $100 check if paying by check) at:
Division of Energy, Mineral & Land Resources Stor
water Program
512 N. Salisbury Street, 61h Floor (Office
40K)
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM OR PAYMENT UNTIL YOUR
APPLICATION HAS BEEN
REVIEWED ACCEPTED AS COMPLETE
Per NC General Statute 143-215.6B (i), any person who knowingly makes
any false statement, representation,
or certification in any application, record, report, plan, or other documen
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 a fine not to exceed ten thousand dollars ($10,000).
Under 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 penaly
s incurred due to violations of this
permit.
19 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 mz
nage the system, or those persons
directly responsible for gathering the information.
® I will abide by all conditions of the NCGO10000 General Permit z
nd the approved Erosion and
Sediment Control Plan.
IN If the approved Erosion and Sediment Control Plan is not compl
ant with Part II (Stormwater Pollution
Prevention Plan) of the NCG010000 General Permit I will nonetheless
ensure that all conditions of
Part II of the permit are met on the project at all times.
IN I hereby request coverage under the NCGO10000 General Permit
and understand that coverage under
this permit will constitute the permit requirements for the disc
arge(s) and is enforceable in the
same manner as an individual permit.
Name of Project: Cha el Rid e Lot 748
Legally Responsible Organizational Entity: Prewitt Custom Homes Inc.
Legally Responsible Person: Jim Prewitt
Title of Legally Responsible Person: President
*Signature:
Date: 4/15/2021
*Print Name and itle of Signed if Autho zed
Individual Differs from Permittee:
Phone Number: 919-669-1969
IMPORTANT NOTE: This form must be signed by a responsible corporate
qfficer 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 B, Item (6) of the NCGO10
00 permit.
For more information on signatory requirements, see Part IV, Section B, Item
(6) of the NCGO10000 permit.