NCC230909_NOI Signed Certification_20230403

NCGO1 Notice of Intent (N01) Certification Form (
Directlons:
Print this form, complete, scan and upload to the electronic N01.
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, 6,h Floor (Office 640K)
1612 Mail Service center
Raleigh, NC 27699-1612
DO NET
MAIL THIS
FORM
OR
PAYMENT UNTIL YOUR APPLICATION HAS BEEN ACCEPTED AS COMPLETE,
THE FORM
YOU MAIL
MUST
BE
COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL)
[40 CFFi 122.221
Per NC General Statute 143-2I5.6B (i), any person who knowingly makes any false sia[emenc, representation, or
certification in any application, record, report, plan, or other document filed or required to be maintained under this
Article or a rude implementing this Article ...shall 6e guilty of a Class 1 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):
r h construction activities of this project, for satisfying the requirements of this
lam the Person responsible fo the co s P 1
permit, it, and for any civil or criminal penalties incurred due to violations of this Permit.
in this N oI is to the hest of rr� knowledge and belief, true, accurate, and complete
The information submittedr Y
i f the person or persons who manage the system, or those persons directly responsible for
based �n rx�y inquiry Q p p g
gathering the information.
✓[] I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control
Plan.
✓Q 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.
0
l hereby request coverage under the NCG010000 Genera! 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.
Project Name (must march ala): Wells Fargo CIC Parking Expansion
Specific Lot Numbers (must match Alb). 4711104
Permittee (must match 131): WelIS Fargo Bank, N.A.
Legally Responsible Person (must match 82 & B3): Christopher Hale
Title of Legally Responsible Person (must match B36): WeIIS Fargo, Construction Project Manager
Name & Title of Signed if Authorized Individual
Differs from Legally Responsible Person:
Rho
., 904-718-:7069
Signature of
e Person or Authorized Individual
03/29/23
Date
* IMPORT.+ NT NOTE: This form rust be signed by a responsible corporate officer that owns or operates the construction octivlity,
s as Q president, residers t, secretary, treasurer, or vice president, or a manager that is authorized in occordance with Port IV, Section BB.,
Item (6) of the NCG010000 permit.

WELLS FARGO BANK, NATIONAL ASSOCIATION
DELEGATION OF AUTHORITY
October 23, 2017
The undersigned, being a duly appointed Vice President of Wells Fargo Bank, National
Association (the "Bank"), and acting pursuant to Part D of resolutions adopted by the Board of
Directors of the Bank on November 25, 2003, as amended (the "Resolutions"), hereby authorizes
each of the persons named below, acting alone as a designated signer ("Designated Signer"),
namely:
Kelly E. Christian
Cheryl D. Conway
Robert Dirmyer
Christopher Hale
Paula G. Hanson
to execute and deliver on behalf of the Bank:
The right and authority herein delegated to sign any and all documents
encountered in the normal course of their jobs in the Project Management Office
of the Wells Fargo Corporate Properties Group including, without limitation, any
and all types of permits and permit applications and related documents (including,
among others, building, signage and construction permits), zoning applications
and related documents, variance applications and related documents, land survey
affidavits and related documents, any and all mechanics' and/or materialmen's
lien documentation (including, among others, notices of commencement, lien
waivers, cancellations of liens, etc.), jurisdictional hurricane or other weather
related building documents, and certificates of occupancy.
IN WITNESS WHEREOF, I have signed this Delegation of Authority as of the day and
year first above written.
Valerie H. Goble
Vice President
S:\RUEDP011WFB1Desigmeon9lWFB DOA - CPG -Goble Digtn (2017.10-23).doe