NCC231416_NOI Signed Certification_20230511

NCGO1 Notice of intent (N01) Certification Form
. .. .
I Directions::
Pivit this farm,,cconp!este,%t3ri a-rid upload to the electronic NOI.
Then,znail the citie,inal foam Witte NC DEMLPStorrtiviratai PICS44Mlat:
i 'Den:slots of Energy,Mineral&Land Prewurces Storriwater Pragt a rn
512 N.fialisbLiev Street,6"Flom
1642 Mad Survrice Center
i Raleit4h,NC 2709-1612_ i Pei NC G rig Etc;f Sr of OE 143-21.5.63 171,any penori 11A0 is?'air.,in g'y makes arty fai.lr ttatern vet,reprelletriation.,
or certificate:71 ill pay apolicatA313,recarct repart.,,p)ari,or other akar-voted:filet:1,yr.reaoired to be emir2tainect
under t frit Ar licit.rze a nate intoterrierrting!frit.Article,. .thaN he 9uittp,of cr c'..7173..s 2 rnisderneorror siAtticer rrray
in cilde a fine oat.to exceed ten thous:end do[fart if$1i...1,C1CO.i.
Linder penalty of'.i.aty,-r certify that(check a7;boxes toirr.licate ijot-LIpptrei-o•Imtli:
X: I..sri the perf,or.respant.P'e fo•ine 03 71.{t"4-,..t ion acti,Aties of it s proje,:t,liar satisfy ntr tie
rettAirernents of init.;prm t...n.L.,for anet citii.ar cri,ri la per altie.s i-it.L.:..red dt.s,to vialittiors tiF ti',,t
permit.
rite ir.tomiatie.in et:lint:tied in ti,s N Otis,to the best of new trow.leclae aric Iief,tr ac,„accc•ate...ind
r..wric,ete bosed on 171'i 17111L.7 S'of i,he persori or ptr 1...',rit..VettO frt. the‘Ay:Acri,ar tterAc penstris
&Ito:A.4'•uzipant..ble for gather lig,the inforritaticot.
yfill a aide tly it1 conditions of vie N:C-fiCti.0...7,10-. e Intl P,II'iil and tee 3:sprovisi Erosior:,44-41
Sea:Tient Control Plan,
X, If the approtted ttosion anti S ediment Control F..in..is not ccirrepliant'dm+Part It IStorrawater Pc:Cation
Prevention Min)of the'4:::„,2:4,11MILS'enVrjt.2f•'TA,I will rionethelst.erei are Lf...it all corift ons r.51
Part it cif l.ne per mit.a re-met or Int:,pioject at a. tirie5.
k_. I'le:eby ree,itett cootrase-ander the Ni''''-'. .'.ICILCIL.Serk'r al '...,-'.Lnil And uncieTtiteld that coverave.ander
this per[nit will constitute tt-e oe-rnit re,:t airernents kir the:lite'trited s';ant -t erforceaVe in 11:x
s3trie,rianrer:!1 d.1 indhrida al perm, t.
-fizt.Trie of Project: Slarrecrest Lot ..1,7
. tega7");Responsible Organizational Entity: Paul& Sandra Messinger
it 0:',..4'Itti.-,riirlle Pr.triiri: rata & Sandra Mcssinrer _ _ .
Title of Lega *oasible F'e ;$In: Owners
Sigootur., : / -,41//./ 4P
ill
...
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, itOPORTAIIII NOTE.: Mi.s form maze6....f Nipred by o retporeibie corporate officer thor ewes ar operattet the,
conttructico asetlsrity,such o o prerldent,secretary, Vectsorer or vice preaidert.or a sporia9ec Choi.isi
authorized re accordance wirer Port le',Section B. le,r•ri(6,1 of the-M."6010000 permit.
For more irktormtrriory an 543outoriFeriairerocw/4-, re,•Part it,Section fi.l'tem(6)Of Me h'CCO.IDOLV perrxra.