NCC190229_Contact Update Request (Leg Resp Change)_20220421

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 MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.22]
Certificate of Coverage (COC) Number: NCC 19 0 P.M
Name of Project: V IiWS so Phase
Legally Responsible Organizational Entity: W)(Zl56 Acgv+si+iOh , LI-C
PREVIOUS Legally Responsible Individual: I'1 a,��( K6 p G,Lhs k1
NEW Legally Responsible Individual: Nvia L • SwtN�it ��
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 COMPI FTFn 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.
LR� I will abide by all conditions of the NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
Yr If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCG010000 General Permit, I will nonetheless ensure that all conditions of
Part 11 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: 0 4�v 4; Date: l • 2 2
Print Name of Signed: pave d L. S W ;n de
Title:
Mailing Address:
Street Address:
Email Address:
Phone Number:
Men, lo-er , WXZ/SG acgg&S'J1 iq LLC
A4 % 441 a 6
d 6W14*11) IS WXZ IY1C. co
440. 01- 1610
* 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 NCG010000 permit.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCG010000 permit.
Page 2 of 2

Georgoulias, Bethany
From: Mark Kopcienski <[e-mail]>
Sent: Thursday, April 21, 2022 5:05 PM
To: Georgoulias, Bethany; Selkane, Aziza
Cc: Dave Swindell; Dan Barrett; Brad McLean
Subject: [External] RE: Construction Stormwater Permits - NCC190229 & NCC211735 Contact
Updates
Attachments: SKM_C650i22042117020.pdf, SKM_C650i22042117021.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Bethany,
Please see below the responses to your questions. I have additionally attached two NCGO1 responsibility
change forms originals of which I will mail as instructed after you have accepted them as complete.
Please let me know if you should have questions or require additional information. Effective Monday April
25' all communication will need to be directed to the contacts as listed below.
Best regards,
Mark
WXz
Mark G. Kopcienski
Sr. Development Manager
D 440 686 1443
M 440 476 9867
O 440 801 1690
A 22720 Fairview Center Dr #150 Fairview Park, OH 44126
wxzinc.com
Please note we have changed our email and website address.
From: Georgoulias, Bethany <[e-mail]>
Sent: Monday, April 18, 2022 3:17 PM
To: Mark Kopcienski <[e-mail]>; Selkane, Aziza <[e-mail]>
Cc: Dave Swindell <[e-mail]>; Dan Barrett <[e-mail]>; Brad McLean
<[e-mail]>
Subject: RE: Construction Stormwater Permits - NCC190229 & NCC211735 Contact Updates
Importance: High
Hi, Mark,
We need some additional information and forms to complete these updates.
For NCC211735:
The legally responsible person is James Wymer (but with Mark Kopcienski's email as the contact).
The site contact is Mark Kopcienski.
The billing contact info uses Mark Kopcienski's email.

4 Please specify who should replace Mark Kopcienski as legally responsible. That person must fill out the attached
form and email/send in an original signed copy.
David L. Swindell, Member WXZ/SG Acquisition LLC
4 Please specify who should be the new site contact and provide mailing address, email, and phone
David L. Swindell, [e-mail] 440-801-1690 22720 Fairview Center Drive #150,
Fairview Park OH 44126
4 Please specify whose email and phone should be used for billing purposes.
Dan Barrett, [e-mail] 440-801-1690
For NCC190229:
The legally responsible person is Mark Kopcienski.
The site contact is Mark Kopcienski.
4 Please specify who should replace Mark Kopcienski as legally responsible. That person must fill out the attached
form and email/send in an original signed copy.
David L. Swindell, Member WXZ/SG Acquisition LLC
4 Please specify who should be the new site contact and provide mailing address, email, and phone
David L. Swindell, [e-mail] 440-801-1690 22720 Fairview Center Drive #150,
Fairview Park OH 44126
4 Please specify whose email and phone should be used for billing purposes.
Dan Barrett, [e-mail] 440-801-1690
You can email the forms and info back to me (and mail in those hardcopies). I'll be glad to take care of the updates and
import a record of the request for each.
Best regards,
Bethany Georgoulias (she/her)
Environmental Engineer
Stormwater Program, 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/stormwatgr
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your
requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.

From: Mark Kopcienski <[e-mail]>
Sent: Monday, April 18, 2022 2:42 PM
To: Selkane, Aziza <[e-mail]>; Georgoulias, Bethany<[e-mail]>
Cc: Dave Swindell <[e-mail]>; Dan Barrett <[e-mail]>; Brad McLean
<[e-mail]>
Subject: [External] Construction Stormwater Permits - NCC190229 & NCC211735
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Aziza Et Bethany,
Please revise your records for the above noted (and attached) stormwater permits by adding the 3 folks
named below and their e-mail addresses for notifications going forward.
• Dave Swindell [e-mail]
• Brad Mclean [e-mail]
• Dan Barrett [e-mail]
The office number and address below remain valid for notifications to the permittee, WXZ/SG Acquisition,
LLC
Please confirm back to all of us when this has been completed.
Best Regards,
Mark
WXz
Mark G. Kopcienski
Sr. Development Manager
D 440 686 1443
M 440 476 9867
O 440 801 1690
A 22720 Fairview Center Dr #150 Fairview Park, OH 44126
wxAnr, rnm
Please note we have changed our email and website address.
From: [e-mail] <[e-mail]>
Sent: Tuesday, March 1, 2022 6:15 AM
To: Mark Kopcienski <[e-mail]>
Cc: Mark Kopcienski <[e-mail]>; Mark Kopcienski <[e-mail]>;
[e-mail]; [e-mail]
Subject: Construction Stormwater Permit Annual Fee - NCC211735
Attached is the 2022 annual fee invoice for your Construction Stormwater NPDES permit, COC no. NCC211735. When
using the ePayment website, be sure to enter ONLY the COC number (not the invoice number with "-2022" after it).
Please contact Aziza Selkane at [e-mail] or [phone] with any questions.
If this project has been closed out, you must submit a Notice of Termination (NOT) request here:
https://edocs.deg.nc.gov/Forms/NCGOI-Termination
Sincerely,
The DEMLR Stormwater Program
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Disclaimer
The information contained in this communication from the sender is confidential. It is intended solely for use by the recipient and
others authorized to receive it. If you are not the recipient, you are hereby notified that any disclosure, copying, distribution or
taking action in relation of the contents of this information is strictly prohibited and may be unlawful.
This email has been scanned for viruses and malware, and may have been automatically archived by Mimecast Ltd, an innovator in
Software as a Service (SaaS) for business. Providing a safer and more useful place for your human generated data. Specializing in;
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