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HomeMy WebLinkAboutNCG110079_Permit Contact Update Request_20230508 Action History (UTC-05:00)Eastern Time(US&Canada) Submit by Anonymous User 5/8/2023 10:48:56 AM (Permit Contact Update Request) Approve by Joyce Sanford 5/19/2023 11:32:23 AM (Contact Update Review) • The task was assigned to DEMLR SW Admin General.The due date is:June 19,2023 5:00 PM 5/8/2023 10:49:02 AM • The task was assigned to Joyce Sanford by round robin distribution 5/8/2023 10:49:02 AM DEQIwo NPDES Stormwater -Request Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number. Number* NCG110079 Begins with NCS,NCG,or NCGNE(no exposure) Facility Name* Anson County Regional WWTP (Used to verify permit number) Check permit contact information for your permit by running a Stormwater Permit Summary Report. Guidance for COC holders: Do not enter the General Permit number with all 0's(for example, NCG030000)but instead your Certificate of Coverge(COC)number. Check all that Owner Affiliation(Legally Responsible Individual)Update * apply: Permit Ownership Transfer or Facility Name Change Delegation of Signature Authority(DOSA) Permit Contact Update Billing Contact Update Facility Contact Update Other Contact Update Facility Contact Update Provide new facility contact information This person should REPLACE the current facility contact. This person should just be added as another facility contact. New Contact Name* First and Last Name Gary Garrison E-mail Address* ggarrison@ansoncountync.gov Phone No.* 7049943281 Mailing Address* PO Box 553,Wadesboro, NC 28170 Physical Address If different than mailing address 1360 Hollywood Road,Wadesboro, NC 28170 Add another facility contact if needed by clicking the'Add'button below Other Contact Updates Only use this section if none of the categories above apply. Provide details about Mike Sessions, Utilities Director,address update:575 US highway 52 South another contact Wadesboro, NC 28170 Phone 704-994-3050 update:* Email: msessions@ansoncountync.gov Submitter's Name* Please enter your FIRST and LAST name Gary Garrison Phone Number* Please enter your phone number 704-99-3281 Any format is fine. Email Address* Please enter a valid e-mail address ggarrison@ansoncountync.gov A confirmation of submission will be e-mailed to this address. * By checking the box and signing below, I certify that: I have given true,accurate,and complete information on this form; I agree that submission of this form is a"transaction"subject to Chapter 66,Article 40 of the NC General Statutes(the "Uniform Electronic Transactions Act'); I agree to conduct this transaction by electronic means pursuant to Chapter 66,Article 40 of the NC General Statutes(the "Uniform Electronic Transactions Act'); I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature(except for any uploaded Owner Affiliation Change or Delegation of Signature of Authority forms,which also must be mailed in with original signature);AND I intend to electronically sign and submit this Permit Contact Update Request form. Signature Date 5/8/2023 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCG 110079