NCC191891_NOI Signed Certification_20190916

NCG01 Notice of Intent (N01) Certification Form
Directioris-
mms
Then, mail the original form to the NC DEMLR Stormwater Program (with $100 check ifpaying by check) at:
Valision of n,
, _L�? iCg-hdYt(
512 N. Salisbury Street, 61h Floor
1612 Mail Service Center
77refyto, Knowingly makes onyfalse statement, representatiorr,
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):
1 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.
The information submitted in this NOl 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 N(..,G.Q1000!, e ntr tai F'Iem'0t and the approved Erosion and
Sediment Control Plain.
If the approved Erosion and Sedirnent Control Plan is not compliant with Pairt 11 (Stormwater Pollution
Prevention Plan) of the NCG01,00C)() Geriei - -aR ' P ' e ' i ' �rflt, I will nonetheless ensure that all conditions of
Part H of the permit are rnet on the project at all times,
I hereby request coverage underthe Perrnit and understand that coverage under
this permit will constitute the permit requirements for the I d i .- s . c I h airge(s) and is enforceable in the
sa rne manner as an individual permit.
Name of Project: Uwhafrr[i!Trail artments
Legally Responsible Organizational Entity: UWharrie Trail, LLC
Legally Responsible Person- Mark Morgan
Title of Legally Responsible Person: Managlinig Vember: Uwharrie Trail, LLC
(I—
Thisforrn 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 o manager that is
authorized in accordance with Part IV, Section B, Item (6)of the NCGO10000i permit.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCGO1 0000 permit,