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215 <br /> Engineer Option Permit Common Form LHD Reference: <br /> Re-submittal of NOI with missing items included <br /> This Section is for use by the owner or PE to submit items noted as missing during LHD Completeness Review above. <br /> Resubmittals must be accompanied by a cover letter from the PE. <br /> LHD USE ONLY: This NOI resubmittal received: by <br /> Date Initials <br /> Item#from initial NOI Resubmittal description <br /> Attestation by Professional Engineer licensed in North Carolina pursuant to G.S.89C <br /> I, hereby attest that the information re-submitted for this Notice of <br /> Licensed Professional Engineer(Print Name) <br /> Intent to Construct is accurate and complete to the best of my knowledge and that the proposed system shall <br /> meet applicable federal,State,and local laws, regulations, rules and ordinances in accordance with G.S. 130A-336- <br /> 1(e)(6). <br /> Signature of Licensed Professional Engineer Date <br /> The section below is for Local Health Department use after submittal of items noted as missing above. <br /> LHD Follow-up Completeness Review of Notice of Intent to Construct <br /> This follow-up review for completeness of this Notice and Intent was conducted in accordance with G.S. 130A- <br /> 336.1(c). This NOI is determined to be: <br /> ❑ INCOMPLETE <br /> Based upon review of information submitted in the RESUBMITTAL above,this Notice of Intent remains INCOMPETE <br /> because the following items from Part 1 of this form remain missing: <br /> Copies of this signed form were sent to the design PE and the Owner on via <br /> Date Email,FAX,USPS,Hand-delivered <br /> Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date <br /> ❑ COMPLETE <br /> Based upon review of information submitted in the RESUBMITTAL above in addition to information provided in <br /> Part 1 of this form,this NOI is deemed complete. <br /> Copies of this signed form were sent to the PE and the Owner on via <br /> Date Email,FAX,USPS,Hand-delivered <br /> A complete copy of this form with tracking information was sent to the State: via <br /> Date Email,FAX,USPS,hand-delivered <br /> Print name of authorized Agent of the LHD Signature of authorized Agent of the LHD Date <br /> DHHS/EHS/OSWP—EOP COMMON FORM Updated April 2022 Page 5 of 6 <br />