HomeMy WebLinkAboutNCC191840_NOI Signed Certification_20190913NCG01 Notice of Intent (N01) Certification Form
Directions:
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512 N. Salisbury Street, 611 Floor
1612 Mail Service Center
or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule implementing this Article ... shall be guilty of a Class 2 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):
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.
K/ The information submitted in this N01 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/ I will abide by all conditions of the NCG0100ene 00 Gra� Permit and the approved Erosion and
..... .. .......
Sedliment Control Plan.
If the approved Erosion and Sediment Control Plan is not compliant with Part 11 (Stormwater Pollution
Prevention Plan) of the N( G010000 Gene4 PerrnIt, I will nonetheless ensure that all conditions of
Part 11 of the permit are met on the project at all times.
I hereby request coverage under the " 00 NCG0).00Genelirg' Pe - r-irrft ' 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.
W01
Legally Responsible Organizational Entity:U-c-
Legally Responsible Person: 01.
am
Signature-
*IMPORTANTNOTE. Thisform must be signed by a responsible corporate officer that owns or operates the
construction activity, such as a president, secretary, treasurer, or vice president, or a manager that is
authorized in accordance with Part IV, Section B, Item (6) of the NCGO10000 peirmit.