NCC242278_NOI Signed Certification_20240726

NCG01 Notice of Intent JNCIQ Certification Form
Ui 90tont:
Print this form.complete,scan and upload to the electronic N01.
T1kn,mail the original form to the NC DEMLR Stormwater Program(with$120 check if paying by check)
at:
Dlvtsion of Energy,Mineral&land Resources Stormwater Program
512 N.Salisbury Street,6*Floor(Office 64DK)
1612 Mail Service Center
Raleigh,NC 27699-1612
ft#a01t A*W"MUST It COMPLETED W"AN ORIGINAL siGNATtlRE(NOT DIGIMAL)140 CFR 122.22)
Per NC Gentrnl Stotute 143-215.69(Q,any person who knowingly makes any fohe statement,representation,or
certliC060n in arty apphC06m,record,report,plan,or other document filed or required to be maintained under this
Article or o rule implementing this Ankle...shaft be guilty of a Class 2 misdemeanor which may include a fine not to
emceed ten thousand dollars($I0,000).
Under penalty of law.I certify that{dmKk aM bores to inmate your ag eement):
Q 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.
0 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.
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 11(Stormwater Pollution
Prevention Flan)of the NCGO10000 General Permit,I will nonetheless ensure that all conditions of Part 11 of the
permit are met on the project at all times.
0 l hereby request coverage underthe NCG010000 General Permit and understand that coverage under this
permit will constitute the permit requirements for the discharges)and is enforceable in the same manner as an
individual permit_
Project Name(must match Ala):6 Lennox Manor
Specific Lot Numbers(must match Alb): Lot 6
Perrnittee(must match sly On Point Construction, LLC
Legally Responsible Person(must match 82&63):Joseph King
Tide of Legally Responsible Person(mustmatch 83b):Member
Print Name&True of Signed if Authorized
InKvidual D ffers from Legally Responsible Person:
Phone Number. 919.524.
7/24/24
SWwture of Ir
Responsible Pe n o rized Individual Date
• JiW101fMANTNOM This form must be signed by a Nrrslbie oj9�loer that owns or operates the c�ommiction octylriry,
such as a presid 4 secretary,tre�ataer,a vta Ares manager that 8 outhorke+d In aowrdamv with Part IV.Sectim 8y
item(6)al the NCGOI Wpem0t