HomeMy WebLinkAboutNCC230166_NOI Signed Certification_20230123NCGO1 Notice of Intent (NON) Certification Form
Oirecfions:
Print this 110M Complete. scan and upload to the electronic M.
Lu itiv NC
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Division of Energy, Mineral & Land Resources Stormwater Program
512 N. SaWbufy Siteet, W Fks4A (Ciffitv 64101(i
1612 Mail Service Center
Raleigh, NC 21W'9� 1612
f%O 1407 �AAII THK FORM Ctrr i3,AYt0!:NT t,04711, YOUR A"!!(AT1f%4 4*5 PffR ArfFPTF t, rnP't 1) Ar . I"FTF
TKF 60kii^ V CKI h0k", #MOST illif CiWPt,VT'F0 W11TW AW ORIGWAi GWATUQF 9407 DIGII'AIJ 148 c',;* 122,;;
r Per NcGeneioi statute 143-21,5.66 (ij, any person who knOwifig"Yrnakes anyJarse stuiefftent, repneseniation, or
r Oka. ertf,
Article or a rule implem en ring this Article . . -shQUbCgu#tYOf a Class 2 Mdemeonor whkh may include aline not to
exceed ten thousand dallats (,SIOVW;.
I Inelor nona4v c ivo nt law I r—t�vv t#Az4t Orhow*;60 twt nri-
I . 11 - — - , - - - - to i. -w;o" Yneor arre!--t!
I am titre Pe rs o r re s,-,i n s i b!e f -re r tide. C-011!t!"Uct;241 actiOt im- s C4 thn P, m-'i - ct, f c r s-,trsfrift the mquir --me nts of this
permit, and for any' civil or criminal penalties incurred due to violations of this permit.
The infutmation submitted on this NOI is, to the best of my knowledge and belief, true, accurate, and complete
based on my inquirV of the person or persons who manage the system, or those persons directly responsible for
I will abide by all conditions of and the approved Erosion and Sediment Control
Plan.
If tMapprMed Erosion and Sediment Con!rcl Plain is nt:tcomPllant with, P3rt!l (StOrMWaterPolIt;t:--.n
PmVention Plata) of the N=j 20pr
I wit ne"theleSs ensure that all candltians of Part I! of the
permit are met on the project at al throes.
Lj 1 CLjurit COOeAa&c Lie —aka -Ule Ufit"-
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permit will constitute the zietmit reattimnents, for the discharge(sl and is enforceable in the same manner as an
individual permit.
praj,Wt Naff W (rnuA ( match Ala); MOTSU Fire Protection (Phase I
pemittP4- IMA)Vt match 81). MOTSU-Directorate of Pubfic Works
UKakv Resnonsible Person (must match W1 & &3i. Adren.ne Flogers
Title of Lega Ily Responsible Person most match 93b)- Pub4c Woirk6 Envitot imentili Ckmiphwoo Mainageir
Odalfle OL I file 01.3%U0120 It AUU10IF1,4120 InUIVICUal
Differs from Legally Responsible Person:
Phone Number: 910-457-8425
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WPORTANT NOTE, this joren must be so
a responsible cwporate officer that owns or operates the constiumon acrlvity,
—n as a preswnr, secretary, treasurer, or vice president, or a manager that is outhoirizea in ocrofoonce with Purf w, section B,
Oem IS! of Ow Wi5ol11" pefmAr.