HomeMy WebLinkAboutNCC220963_NOI Signed Certification_20220307NCQ41 Notice of latent (NO[) Certification Forrn
tiIrectlons:
Print this form, rvmpl-ete, scan and upload to the eleLtronic NOI,
Then, mail the origlnal form to the NC DE MLR Stormwa ter grogram {witfi $10D check if payim} by check at:
DiVigion of E ri R g r Mineral & Land Rasoumt!t 5tormwater Program
512 N. Salisbury Street, 61h Floor (Office 54M)
1612 Mail Service Center
Raleigh, NC2769§•1612
DO NOT MAIL THIS FORM OR PAr.Vl I L!11lit YOUR APPLICATION NP5 BEE& ACi=F#TED A5 COMPLETI,
THE rQR NI YOU MAIL MUST 3E CONIPLI: rFD WITH AN ORIGINAL 51G NATURE ( NOT OI OFTALI (40 CPR 122.221
Per NCGenero?SlatuteJ4.�,-235,68(r),arlypersortwho know;grgymakesgr7yfaisestatement reprewr3fotion,Or
certl#icotinn in any oporcar w6 record, report, pion, or otirltr dvcumen t foied or required to be rnolrrtained under rhis
Article or a rule implemenfiny this Article. _ . shallbe grlAty of a Cloys 2 misrfemearror which may include a fine riot to
exceed ten thawandd& iars ($101000).
Under Pena Ity Df Law, I oeetlfy that (cheek all boxes to Indicate your agrrern");
Q 1 am the person responsible for rhP coristfuction artiwities of this proj2Ctr for satisfying the requirements of thls
permit, and For any rrivil or CrErnir<al penalties Incurred due to violations of this permit.
0 The informaGorr tuhrr,itbp.d in this NOI is, to the best of my knowledge and belief, true, accurate, and complete
based an my inquiry of the person or persons who rnanagg the system, or those persons directly eevolitible for
gathering the information,
0 I wlll ablde by aM conditions of the NCGO10WO General RE!*m.il and the approved Eroslon and Sediment Control
Plan.
v If the approved Erosion and Sedlfnernt Control Plan is not oompl+ant with Part II [Stofmwater P❑llution
Prvvention Planlofthe Nggi;jgoogGE!nflraI Permit. Iwill nonetheless ensure that alltUnditeDrE5of Part II of the
permit are met on the project at all times,
❑✓ I hereby request Coverage under th permit and understand that or}verage underthis
permit will constltute the permit requirements for the discharge{s} anti is enforceable in the same meaner as an
indEvidual perralt.
Pro'ed Name (must motch Ala)- Frog reen
Spedfic lot Nurnber5 imustmotchAlb). 1
Pefmltxee {rrrusimwtcir 8��: Batts Invesmients, LLC
Legally Responsible Person must match 112 & 83I: Wally Batts
Title of Legally Responsityde Ferran (mu5tmotch 83b); President
Name & Tltle of Signed if Authorized Individual
Differs from Legaly Responsible Person: NA
Phor,P, Number 819-497-6974
I&
Slgnatute of Legally Responsible Person or Authorized Irrdiwidual
�-
bate
IAVO iTAOYT NOTE; Thus form mw5t sfgried oy d responVtk corporate officer that awm or opemfes xhe comtnot l" aetivky,
such osn president secretory, trgmwrer, orrice presiden4 or amanogerthQi $ authorizeQrn ipocardance with P&rt t4; Srrtion 6,
ilea+ 16) of fire NCG0180 0 permit.