NCC214145_Contact Update Request_20240805

NCG01 Legally Responsible Individual Change Form
Use this form when:
The person who is legally responsible for the permit has changed, but there is NO CHANGE in the project name
or ownership.
**If the project name has changed, or if the ownership of the project has changed, do NOT use this form.**
Instead,you must submit a new NCG01 electronic Notice of Intent(eNOI).
Directions:
Print this form, complete, scan and upload to the Construction Stormwater Permit MODIFICATION Form.
Then, mail the original form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N.Salisbury Street, 6t"Floor(Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM UNTIL YOUR MODIFICATION HAS BEEN REVIEWED AND ACCEPTED AS COMPLETE.
THE FORM YOU MAIL MUST BE COMPLETED WITH AN C"IGINAL SIGNATURE(NOT DIGITAL) [40 CFR 122.22]
Certificate of Coverage (COC) Number: NCC214145
Name of Project: Two Hearted Substation
Legally Responsible Organizational Entity: Blue Ridge Power
PREVIOUS Legally Responsible Individual: Ben Catt
NEW Legally Responsible Individual: Rick Backus
The following section isto be completed and signed by the NEW Legally Responsible Individual.
Per NC General Statute 143-215.6E(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 o fine not to exceed ten thousand dollars($10,000).
Page 1 of 2

NCG01 Legally Responsible Individual Change Form
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE(NOT DIGITAL) [40 CFR 122.22]
Under penalty of law, I certify that(check all boxes to indicate your agreement):
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.
I will abide by all conditions of the NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
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.
VI 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.
VThis form has been reviewed and is accurate and complete to the best of my knowledge.
f
*Signature: , ^ -^^ Date:
Print Name of Signed:1 'Ck Backus
Title:VP Project Ek ution/Authorized Officer
Mailing Address: 105 Fairview Rd, Suite 30, Asheville, NC 28803
Street Address: 105 Fairview Rd, Suite 30, Asheville, NC 28803
Email Address: [e-mail]
Phone Number:
*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 B, Item(6)of the NCGO10000 permit.
For more information on signatory requirements,see Part IV,Section B, Item(6)of the NCGO10000 permit.
Page 2 of 2

NCG01 legally Responsible Individual Change Form
Use this form when:
The person who is legally responsible for the permit has changed, but there is NO CHANGE in the project name
or ownership.
**If the project name has changed, or if the ownership of the project has changed, do NOT use this form.**
Instead,you must submit a new NCG01 electronic Notice of Intent(eNOI).
Directions:
Print this form, complete,scan and upload to the Construction Stormwater Permit MODIFICATION Form.
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(Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM UNTIL YOUR MODIFICATION HAS BEEN REVIEWED AND ACCEPTED AS COMPLETE.
THE FORM YOU nAAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE(NOT DIGITAL) [40 CFR 122.22]
Certificate of Coverage (COC) Number: NCC210832
Name of Project: Pelham Solar Substation
Legally Responsible Organizational Entity: Blue Ridge Power
PREVIOUS Legally Responsible Individual: Ben Catt
NEW Legally Responsible Individual: Rick Backus
The following section is to be completed and signed by the NEW Legally Responsible Individual.
Per NC General Statute 143-215.6E(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).
Page 1 of 2

NCG01 legally Responsible Individual Change Form
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE(NOT DIGITAL) [40 CFR 122.22]
Under penalty of law, I certify that(check all boxes to indicate your agreement):
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.
I will abide by all conditions of the NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
V 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 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.
This form has been reviewed and is accurate and complete to the best of my knowledge.
*Signature: Date:
Print Name of Signed: ; Rick Backus
Title:VP ProjectfExecution/Authorized Officer
Mailing Address: 105 Fairview Rd, Suite 30, Asheville, NC 28803
Street Address: 105 Fairview Rd, Suite 30, Asheville, NC 28803
Email Address: [e-mail]
Phone Number:
*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 B, Item(6)of the NCGO10000 permit.
For more information on signatory requirements,see Part IV,Section B, Item(6)of the NCGO10000 permit.
Page 2 of 2

Georgoulias, Bethany
From: Sean Andersen <[e-mail]>
Sent: Monday, August 5, 2024 12:52 PM
To: Georgoulias, Bethany; Holloman, Tevye L
Cc: Zach Wells; Gregory Castillejo
Subject: Re: [External] NCDEQ Updated Contact Summary: Apex, Pelham, Two Hearted, West
River
Attachments: Two Hearted Substation LRC 8.5.2024.pdf, Pelham Substation LRC 8.5.2024.pdf
Follow Up Flag: Follow up
Flag Status: Completed
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Hi Teyve,
Blue Ridge Power has provided two updated forms for the NCDEQ's review-one for Two Hearted Solar and another for
Pelham Solar.
Could you please review and update the agency records on your end? If you have any follow up questions, feel free to
reach out.
Best,
IF 115 Is Sean Andersen
VP, Project Development
Olson C: [phone] 1 O: [phone]
OMEN pinegaterenewables.com
From: Georgoulias, Bethany<[e-mail]>
Sent:Thursday, August 1, 2024 5:50 PM
To: Sean Andersen <[e-mail]>; Holloman,Tevye L<[e-mail]>
Cc:Zach Wells<[e-mail]>; Gregory Castillejo<[e-mail]>
Subject: RE: [External] NCDEQ Updated Contact Summary:Apex, Pelham,Two Hearted, West River
Hi, Sean,
None of the three signed Legally Responsible Change forms was for NCC210832, unless I missed an attachment in
an earlier email.To update that person,we need a signature.
Please provide that form, and Tev should be able to take care of that while I'm out. Otherwise I will make the
update when I return in mid-August.
Thankyou,
1

Bethany Georgoulias(she/her)
Environmental Engineer,Stormwater Program
DEMLR Laserfiche Administrator
Division of Energy,Mineral,and Land Resources
N.C. Department of Environmental Quality
919 707 3641 office
[e-mail]
512 N. Salisbury Street,Raleigh, NC 27604 (location)
1612 Mail Service Center,Raleigh, NC 27699-1612 (mailing)
Website: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
From: Sean Andersen <[e-mail]>
Sent:Thursday, August 1, 2024 4:49 PM
To: Georgoulias, Bethany<[e-mail]>; Holloman,Tevye L<[e-mail]>
Cc:Zach Wells<[e-mail]>; Gregory Castillejo<[e-mail]>
Subject: Re: [External] NCDEQ Updated Contact Summary:Apex, Pelham,Two Hearted, West River
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Thanks, Bethany! After a review of the emails you distributed, I think the only adjustment will be the Legally Responsible
contact for Pelham Substation - NCC210832. I've provided the correct information below. Apologies if I missed this
originally!
Legally Responsible Individual
Rick Backus
[e-mail]
[phone]
(Mailing Address) 105 Fairview Road, Suite 30, Asheville, NC, 28803-2307, US
(Street Address) 105 Fairview Road, Suite 30, Asheville, NC, 28803-2307, US
Sean Andersen
VP, Project Development
MEMO C: [phone] 1 O: [phone]
OMEN pinegaterenewables.com
From: Georgoulias, Bethany<[e-mail]>
Sent:Thursday, August 1, 2024 12:03 PM
To: Sean Andersen <[e-mail]>; Holloman,Tevye L<[e-mail]>
Cc:Zach Wells<[e-mail]>; Gregory Castillejo<[e-mail]>
Subject: RE: [External] NCDEQ Updated Contact Summary:Apex, Pelham,Two Hearted, West River
Sean,
I've made the updates as requested.
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Note: I only updated legally responsible person fort he 3 COCs corresponding to the signed forms you sent.The
forms did not list multiple COCs,so we assume you only wanted these 3 updated with new legally responsible
individuals. For the other COCs in your list, I only made site contact updates.
For the others:
NCC212327(Apex, Substation) had been rescinded, so no updates.
NCC210832(Pelham,Substation), NCC214145(Two Hearted, Substation), NCC240881 (West River, Substation)—
I can only add/update one site contact. I used the first one listed for those.
For Rick Backus,there was no phone number listed on the form. I used Adam Pinkston's.
Please review the attached confirmations and let us know if you have questions.
I'll be out starting tomorrow through next week, so please let Tev Holloman know if you have any questions.
Thankyou,
Bethany Georgoulias (she/her)
Environmental Engineer, Stormwater Program
DEMLR Laserfiche Administrator
Division of Energy, Mineral,and Land Resources
N.C. Department of Environmental Quality
919 707 3641 office
[e-mail]
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
Website: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
From: Sean Andersen <[e-mail]>
Sent:Tuesday,July 30, 2024 5:04 PM
To: Georgoulias, Bethany<[e-mail]>; Holloman,Tevye L<[e-mail]>
Cc:Zach Wells<[e-mail]>; Gregory Castillejo<[e-mail]>
Subject: [External] NCDEQ Updated Contact Summary:Apex, Pelham,Two Hearted, West River
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Hi Bethany,Teyve,
There are four separate North Carolina solar projects that we'd like to update with the NCDEQ. I've provided the
updated summaries below along with the signed NCG01 forms.
In addition, we're looking to pin down the COC#for our West River Solar array permit in Guilford County. We don't seem
to have a record of that. Would you be able to help look into this?
If there's anything else you need to process the updated contacts, please let me know. Finally, if any fees are
outstanding for the listed permits, we'll be prepared to cure that immediately.
Pelham Solar:
• COC#-Array: NCC230766
• COC#-Substation: NCC210832
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• Legally Responsible person: Blue Ridge Power
• Site Contacts:
o Adam Pinkston_Project Manager; 704-975-1798; [e-mail]; 105 Fairview
Rd, Suite 30, Asheville, NC 28803
o Will Foster_ Construction Manager; 207-431-7614;[e-mail]; 105 Fairview
Rd, Suite 30, Asheville, NC 28803
o Wayne Moyers_APM; 336-460-1089;[e-mail]; 105 Fairview Rd, Suite
30, Asheville, NC 28803
o [e-mail]
Two Hearted:
• COC#-Array: NCC230616
• COC#-Substation: NCC214145
• Legally Responsible person: Blue Ridge Power
• Site Contacts:
o Adam Pinkston_Project Manager; 704-975-1798; [e-mail]; 105 Fairview
Rd, Suite 30, Asheville, NC 28803
o Jeremy Emery_Construction Manager;407-414-6096; [e-mail]; 105 Fairview
Rd, Suite 30, Asheville, NC 28803
o Wayne Moyers_APM; 336-460-1089;[e-mail]; 105 Fairview Rd, Suite
30, Asheville, NC 28803
o [e-mail]
Apex:
• COC#-Array: NCC230592
• COC#-Substation: NCC212327
• Legally Responsible person: Blue Ridge Power
• Site Contacts:
o Adam Travis_Project Manager; 517-224-0750; [e-mail]; 105 Fairview Rd,
Suite 30, Asheville, NC 28803
o George Falk_APM; 801-645-7737;[e-mail]; 105 Fairview Rd, Suite 30,
Asheville, NC 28803
West River:
• COC#-Array: status unknown
• COC#-Substation: NCC240881
• Legally Responsible person: Blue Ridge Power
• Site Contacts:
o Adam Travis_Project Manager; 517-224-0750; [e-mail]; 105 Fairview Rd,
Suite 30, Asheville, NC 28803
o George Falk_APM; 801-645-7737;[e-mail]; 105 Fairview Rd, Suite 30,
Asheville, NC 28803
Thanks,
Sean Andersen
Sean Andersen
VP, Project Development
C: [phone] 1 O: [phone]
OMENpinegaterenewables.com
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Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.
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