NCC213515_NOI Signed Certification_20210608

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DURHAM COUNTY REG OF DEEDS
201 E. MAIN STREET
DURHAM, NC 27701
[phone]
ISSUED TO: ROBINSON 8 PLANTE
RELEIPT 4 26556
DATE May 17, 2021 09:58:13 AM
TIME BOOK PAGE FEE
09:58 AM 205 1 2021024712
PLAT 21..00
09:58 AM 205 2
2021024713
PLAT
21.00
09:58 AM 205 3
2021024714
PLAT
21.00
09:58 AM 205 4
2021024715
PLAT
21.00
Total Amount Due 84.00
CASH 84.00
-------------
Total Amount Paid 84.00
THANK YOU
SHARON A. DAVIS
Deputy: DPRUETTE

NCGO1 Notice of Intent (NOI) Certification Form
Directions:
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. Salisbury Street, 6t^ 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 143-215.6E (i), any person who knowingly makes any false statement, representation, or
certification in any application, record, 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 a fine not to
exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that (check all boxes to indicate your agreement):
X 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.
X 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.
X I will abide by all conditions of the NCGO10000 General Permit and the approved Erosion and Sediment Control
Plan.
X If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCGO10000 General Permit, I will nonetheless ensure that all conditions of Part II of the
permit are met on the project at all times.
X I 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 (must match Ala): The Montage
Specific Lot Numbers (must match Alb): NSA
Legally Responsible Organizational Entity (must match B1): Meritage Homes Of the Carolinas INC
Legally Responsible Person (must match B2 & B3): Justin Heaton
Title of Legally Responsible Person (must match B3b): Director of Ladd Development
Name & Title of Signed if Authorized Individual
Differs from Legally Responsible Person:
Phone Number: 73-2• 60 QSS&-
ure of Legally Responsible Person or Authorized Individual
<�9 / 4 I
Date
IMPORTANT NOTE: This form must 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 B,
item (6) of the NCG010000 permit.