NCC190253_Hazel Creek Return Check eNOI Fee_20190605

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Interim Director
CERTIFIED MAIL
Ben Munn, P.E.
Civil Design Concepts
P.O. Box 5432
Asheville, NC 28813
Subject:
Dear Mr. Munn,
NORTH CAROLINA
Environmental Quality
June 4, 2019
Hazel Creek Construction, LLC.
705 Bee Tree Rd.
Check 5433
At this time the Stormwater Program is not collecting the permit fees for the NCG01. I am returning
check number 5433 in the amount of $100.
If you have questions about this matter, please contact Annette Lucas in our Central Office at 919-707-
3639.
Sincerely,
';�� w"'Cn
Suzanne McCoy
Administrative Assistant
Stormwater Program
Enclosures
D E Qom- North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
512 North Salisbury Street 1 1612 Mail Service Center I Raleigh, North Carolina 27699-1612
NORTH CAROI.INA �`
919.707.9200

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N lie t of Environmental Quality
NCG01 Notice of Intent (NOI) Certification or�m
MAY 15
Directions:
Print this form, complete, scan and upload to the electronic N01. Ra.leigh Regional
Then, mail the original form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6th Floor
1612 Mail Service Center
Raleigh, NC 27699-1612 MAY 2 3 2019
DENR-LAND QUALITY
MRK/MT R PENIVi t i iNG
Per NC General Statute 143-215.68 (i), any person who knowingly makes any false statement, representation,
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):
L� 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.
LEI 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 NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
L 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.
I hereby request coverage under the NCG010000 General 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.
Name of Project: 705 Bee Tree Rd
Legally Responsible Organizational Entity: Hazel Creek Construction, LLC
* Legally Responsible Person: Timothy Swann
Title of Legally Responsible "on:
Signature:
Date: J r V
* IMPORTANT NOTE: This form 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 8, Item (6) of the NCGO10000 permit.
For more information on signatory requirements, see Part IV, Section 8, Item (6) of the NCGO10000 permit.