NCC230694_NOI Signed Certification_20230316

NC�|01 Not^ of Intent (N01' Certification Form
113 ?nectons:
Print this form, complete scan and upload tothe electronic N0L
Then, mail the original form to the NC DEMLR Stormwater Program (with $100 check if paying by check) at:
Division of Energy, Mineral Q Land Resources 3tonnxvaterProgram
51ZN.Salisbury Street, 6*Floor (Office 64OK)
161ZMail Service Center
Raleigh; NC 27699-1612
DO NOT MAIL THIS FORRVI OR PAYIVIIENT U N--,'l L"'OUR A?i-'U�'ATION HIAS BEEN VED AS CONIPLET'2'.
THE FORM YOU MAIL 'MUST BE COh8PLETED W[TtAUM C)RlGiNiAL SIGNATURE (NOT DIGITAL) f-40 r-FR12122]
Per NC General Statute 143-215.6B (i), anyperson who knowinglymakes any false statement, representation, or
certification in any application, record, report, plan, or other documentfiled or required to be maintained under this
Article o/orule implementing this Article ... sho8beguilty ofuClass 2misdemeanor which may include ofine not tu
exceed ten thousand dollars ($10,000.
Under penalty oflaw, | certify that (check all boxes toindicate your agreement):
FV-1 I am the person responsible for the construction activities of this projec-131, for satisfying the requirements of this
permit, and for any civil or criminal penalties incurred due to violations of this permit.
The information submitted inthis NO|is, tothe best ofmyknowledge and belief, true, accurate and complete
based on my inquiry of the person or persons who manage the system, or those persons directly responsibie 7Cr
gathering the information.
[7l \ will abide byall conditions ofthe and the approved Enos�'onand Sediment [ontroi
F�l If the approved Erosion and Sediment Control Plan is not compliant with Part 11 (Stormwater Pollution
Prevention Plan) ofthe \ will nonetheless ensure that all conditions ofPart Uofthe
permit are met on the project at all times,
[�l | hereby request coverage under the 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.
Project Name (must match Ala): PittSb8r0Hanks Chapel 23UKVSubstation
Specific -Lot- Numbers (must match Alb):
Permittee (must match BP: Duke Energy Progress, LLC
Wijesuriya
Title of Legally Responsible Person (must match B3b): Lead Transmission Permitting Manager
Name 8^Title ofSigned ifAuthorized Individual
Differs from Legally Responsible Person:
Phone Number: 19-540-2OSO
/
^� �-'^~~~~�~--�u�--�'=—;~^�
Signature of Legally Resp(Wsible Persc(Vor Authorized Individual
*IMPORTANTNOTE. This form must be signed byoresponsible corporate officer that owns moperates the construction activity,
such as a president, secretary, treasurer, or vice president, or a manager that isauthorized hnocovdmncewith Part IV, Section 8,
Item (6)oythe 0[G0 0000pennit.