NCS000245_OTHER_20170804

STORMWATER DIVISION CODING SHEET
M54 PERMITS
PERMIT NO.
I v CS o o
DOC TYPE
❑FINAL PERMIT
❑ ANNUAL REPORT.
❑ APPLICATION
0 CoPLIANCE
ER
DOC DATE
❑
YYYYMMDD

ARmA
NCDENR
Npnm CMouDV4RTKiR or -
FJn' 0—tw ma Nxnov& ftsouKu
Division of Energy, Mineral and Land Resources -
Land Quality Section•/ Stormwater Permitting Program
National Pollutant Discharge Elimination System (NPDI-"S)
PERMIT OWNER. AFFILIATION DESIGNATION FORM
(Individual, Legally Responsible for Permit)
Use this forme if there has been:
FOR AGrNCY USE ONLY
Dale Received
Year
Month
I]n
NO CHANGE in facility ownership -or facility name, but the individual
who IsCegally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general pat9ner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
j'N'j_,d.].S.j a 1 o 10 12 15
2) Facility Information:
(ar) Certificate of.Coverage
'N,' ,U' .G'.
Facility name: Raleigh City - MS4 `
Company/Owner Organization:. r; , ; City of Raleigh, SiormwateiManagemerit Division,;.-;,
Facility address:
Address
Raleigh NC 27601
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
littp:Hportal.tiedeiir.orehweb/Ir/s�v-permit-contacts and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed-.
Previous legally responsible individual: Robert Massengill
]Mist M1 Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit
Blair
First MI
Page l of 2
Hinkle
Last
SWU-0WNERAFFIL-25Ju1y2014

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
We NO
Moiling Address
Raleigh NC 27601
City State Zip
( 919)996-3940 [e-mail]
Telephone F-mail Address
Fax Number
5) Reason for this change:
A result of: ❑ Employee or management change
Inappropriate or incorrect designation before
Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
1, Blair Hinkle , attest that this application for this change in Owner Affiliation
(person legally responsible for.the permit) has been reviewed and is accurate and complete to the best of my
knowledge. 1 understand that if all required parts of this form are not completed, this change may not be
processed.
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral and hand Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff conlacts, please call 919-707-9220 or visit the website at:
http:llportal .ncdenr.or,Uweblh•/storinwater
Page 2 of 2
SW U-CW N ER AF F I L-25J ul y2014

t - - 1.
Boyer, Kevin
From: Boyer, Kevin
Sent: Thursday, January 26, 2017 10:44 AM
To:'[e-mail]'
Cc: Hinkle, Blair; Massengill, Robert; Kelly, Richard; [e-mail]
Subject: Permit Owner Affiliation Form, City of Raleigh NPDES MS4 Individual Permit NCS000245
Attachments: Scan of Permit Owner Affiliation Form, COR NPDES Permit NCS000245, signed
1-10-17.pdf
Hello Bethany,
Robert Massengill and Blair Hinkle forwarded your email to me to take care of the Owner Affiliation Change Form for the
City of Raleigh MS4. As you suggested, a scan of the signed form changing our Owner Affiliation to Blair Hinkle is
attached. We will mail you the original form.
Also, the NPDES Stormwater Permit Contacts Summary form gives Mark Senior as "Permit Contact Person", and the
Permit Owner Affiliation Designation Form does not provide a place to correct this. Please change this to make me the
Permit Contact Person, information below.
Thank you, Kevin
Kevin Boyer, PE Water Quality Manager City of Raleigh Stormwater Management Division
PO Box 590, Raleigh, NC 27602 Office: [phone] Cell: [phone]
[e-mail] www,raleighnc.gov
From: Georgoulias, Bethany[mailto:[e-mail]]
Sent: Friday, January 6, 2017 2:09 PM
To: Massengill, Robert
Cc: Hinkle, Blair; Kelly, Richard
Subject: RE: Electronic Reporting Update for NPDES Stormwater Permits
Thanks for the email, Robert. I've attached a permit summary contact report for this permit.
The Owner Affiliation is the person legally responsible for the permit, so if that needs to be changed, I've attached an
Owner Affiliation Change form that you can use. We will need a hard copy of that form sent to us to make the change
for the permit records, but feel free to scan and email it back to us before you drop it in the mail; that will give us a head
start on making the change in our database.
Best regards,
Bethany Georgoulias
Environmental Engineer
Stormwater Program, Division of Energy. Mineral; and Land Resources
N.C. Department of Environmental Quality P t-: L: r, 1r-7
919 807 6372 office IN R 1 2o�i
bethan eor [e-mail] � �
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing) 3';�y;iy}, r ftliFt:i�wly'lINO
512 N. Salisbury Street, Raleigh, NC 27604 (location)
Website: htt ://de .nc. ,ov/aboLit/division s/ever -mineral-land-resourceslstorntwater

Nothing Compares --,,-
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Massengill, Robert [mailto: Robert. [e-mail]
Sent: Friday, January 06, 2017 2:00 PM
To: Georgoulias, Bethany<[e-mail]>
Cc: Hinkle, Blair <Blair,[e-mail]>; Kelly, Richard <[e-mail]>
Subject: RE: Electronic Reporting Update for NPDES Stormwater Permits
Bethany,
This permit should not be in my name as the Public Utilities Director. I have copied Blair Hinkle, who oversees the City's
stormwater program MS-4 permit, so he is aware.
Robert L. Massengill, PE
Public Utilities Director
City of Raleigh
PO Box S90
Raleigh, NC 27601
919-996-3479
From: Georgoulias, Bethany [mailto:bethany aeorgoulias(@ncdenr.gov]
Sent: Friday, January 6, 2017 1:14 PM
To: Massengill, Robert
Subject: Electronic Reporting Update for NPDES Stormwater Permits
Dear NPDES Stormwater Permit -Haider:
We are contacting you about Permit Number NCS000245 for Raleigh City-Ms4. You may receive this message multiple
times if we have your email contact for different affiiiations and/or other permits.
We are sending an update about electronic data monitoring requirements. You may be aware that Federal Electronic
Reporting Rule requirements mandated that electronic submittol of data monitoring report (DMR) data must begin by
December 21, 2016; however, NC DEQ's system is not yet ready to accept Stormwater Program permit DMR data
electronically. If your permit requires you to submit analytical monitoring reports (DMRs), you should continue to send
paper DMRs to DWR Central Files as before until further notice. Note **If your permit only requires qualitative ("visual")
monitoring reports that are kept on site, you are not impacted by the electronic reporting requirements at this time."
What is the Federol F-Reporting Rule?
The U.S. Environmental Protection Agency (EPA) published the National Pollutant Discharge Elimination System (NPDES)
Electronic Reporting Rule in 2015. The rule requires NPDES regulated facilities to report information electronically,
instead of filing written paper reports. The rule does not change what information is required from facilities; it only
changes the method by which information is provided (i.e., electronic rather than paper -based). EPA is phasing in the
requirements of the rule over a 5-year period.

Phase 1 of the rule requires regulated entities to submit Discharge Monitoring Reports (DMRs) electronically by December
21, 2016, Currently NPDES Wastewater Permit -holders may register and report DMR data electronically through the
State's eDMR System. Our agency is working towards expanding eDMR to accept Stormwater Program DMRs, but eDMR
does not yet have the capability to accept those DMR data. EPA, is aware that NC is octively working on eDMR's expansion
to include Stormwater Program DMR reporting. As soon os eDMR is ovoilable for your permit, we will notify you.
Soon we will be gathering information about the discharge outfails at this facility to prepare the system to flow data to
EPA as federal rule mandates. Please be on the lookout for more communication soon.
For more information on EPA's NPDES Electronic Reporting Rule, visit http://www2.epa.gov/compliance/final-national-
pollutant-discharge-elimination-system-npdes-electronic-reporting-rule. For more information on electronic reporting to
NC DEMLR, visit http://deg.nc.goy/about/divisions/energy-mineral-lland-resources/stormwater/ereporting-rule or contact
Bethany Georgoulias at [phone] or via email at [e-mail].
Sincerely,
The DEMLR Stormwater Program
INC Department of Environmental Quality
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
512 N. Salisbury Street, Raleigh, NC 27604 (location)
Website: http / deg.nc,goy/about/`di_v_isions/energy-mineral-land-resources/stormwater
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed
to third parties.

IN
'�"PAIL
'�
NCDENR
LKIRCu.En um f4 fuG RESOURCES
Division of Energy, Mineral and Land Resources
Land Quality Section / Stormwater Permitting Program
National Pollutant Discharge Elimination System (NPDES)
PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
Use this form if there has been:
FOIE AGENCY Us]-, ONLY
Datc Reccived
Yeas
hto11ah
1 tea,
NO CHANGE in facility ownership or facility name, but the individual
who is(legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state. federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit (a) Certificate of Coverage
N j C S I o I o I a 2 1 N LCy I G
2) Facility Information:
Iacility name: Raleigh City - MS4
Company/Owner Organization: City of Raleigh, Stormwater Management Division.,
IaciIity address: -
Address
Raleigh NC 27601
City State Zip
To find the current legally responsible person associated with your permit; go to this website:
http;//portal.ncdenr.org/web/lr/sw-permit-contacts and run the Permit Contact Summary Report. .jAw 312017
3) OLD OWNER AFFILIATION that should be removed:
.:r1{ ,.rC_i 1 i• �iVti..
Previous legally responsible individual: Robert Massengill
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Blair Hinkle
first M1 Lust
["age I of 2
SWU-OWNERAFFI L-25July2014

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
Asslstanl (=i1gln rinn Sep,1M ^GC D"ror•+nr
Tille
P.O. Box 590
Mailing Address
Raleigh NC 27601
Cil} State Zip
( 919)996-3940 [e-mail]
'I'elcphone E-mail Address
Fax NUmber
5) Reason for this change:
A result of: ❑ Fmplovee or management change
Inappropriate or incorrect designation before
Other
bother please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
1, Blair Hinkle , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processed.
�-
to - I
-]
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts; please call 919-707-9220 or visit the website at:
http://p,or-tal.ncdenr.org/web/ir/storinwater
Page 2 of 2
SWU-0WNERAFFIL-25July2Ql 4