NCC213559_Contact Update Record (Addresses Only)_20220620

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 6/20/2022 1:54:41 PM (Contact Changes Submitted)

Certificate of NCC213559
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-3559
Original NOI No.* 55277
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Pine Ridge Housing Associates, LLC
Project Name Pine Ridge Apartments
Address 4525 Fayetteville Rd, Raleigh, NC
County Wake
Latitude 35.7174
Longitude-78.6535
Date COC Issued* 06/11/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
• BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? • No
Yes
Billing Email [e-mail]
Billing Telephone No. 919-848-2041
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible
Timothy Morgan
Individual (Previous)
First Name (New)*
Timothy
Last Name (New)*
Morgan
NEW Legally
Reflects any revisions above
Responsible
Timothy Morgan
Individual*

Permittee Email
(Previous)
NEW Permittee
Email*
[e-mail]
[e-mail]
Permittee Telephone [phone]
No. (Previous)
NEW Permittee 919-848-2041
Telephone No.*
Permittee Mailing 7706 Six Forks Road, 0, Raleigh, NC 27615-
Address (Previous) 5067
NEW Permittee Street Address
Mailing Address* 5711 Six Forks Road
Address Line 2
Suite 300
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27609
us
Permittee Street 7706 Six Forks Road, 0, Raleigh, NC 27615-
Address (Previous) 5067
NEW Permittee Street Street Address
Address* 5711 Six Forks Road
Address Line 2
Suite 300
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27609
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Rod Miller
(Previous)
Site Contact Title Project Manager
(Previous)
Organization Evergreen Construction Company
(Previous)
First Name (New)* Rod
Last Name (New)* Miller
NEW Site Contact* Reflects any revisions above
Rod Miller
NEW Site Contact Project Manager
Title

NEW Organization Evergreen Construction Company
This field is not required on the NOI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 919-427-4010
Telephone No.
(Previous)
NEW Site Contact 919-427-4010
Telephone No.*
Site Contact Mailing 7706 Six Forks RD, 0, Raleigh, North
Address (Previous) Carolina 27615
NEW Site Contact Street Address
Mailing Address* 5711 Six Forks Road
Address Line 2
Suite 300
City
State / Province / Region
Raleigh
North Carolina
Postal / Zip Code
Country
27609
United States
Change Requested Permittee via mark-up on invoice included with fee payment (received 6/9/2022)
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation Both legally responsible individual and site contact addresses updated
(Optional)
Date * 06/20/2022

571 1
North Carolina Department of Environmental Quality RECEIVE
Division of Energy, Mineral, and Land Resources
Stormwater Program
NPDES Construction Stormwater Permit
INVOICE
➢ro, ., a, E� � n DEMLFt-Stom�water Arog
Annual Permit Fee
This Construction Stormwater annual fee is required by the North Carolina Administrative Code 143-
215.13(a). The fee covers the administrative costs associated with your permit. The fee is required of
any person holding a permit for any time during the annual fee period, regardless of the facility's
operating status. Failure to pay the fee by the due date will subject the permit to revocation.
Operating without a valid permit is a violation and is subject to a $10,000 per day fine. If the permit is
revoked and you later decide a permit is needed, you must reapply, with the understanding the permit
request may be denied due to changes in environmental, regulatory, or modeling conditions.
Invoice No: NCC213559-2022
(Certificate of Coverage No.: NC_C213559
Effective Date: 6/11/2021
ect Name: Pine Ridge Apartments
Ily Responsible Person:
othy Morgan
ine Ridge Housing Associates, LLC
�6 Six Forks Road
eigh, NC
Invoice Date: 6/1/2022
Due Date: 7/1/2022
nnual Fee Period: Jun 2022 to Jun 2023
nnual Fee: $100
ail: '1`im(c)eccmgt.com
ITelephone: 919-848-2041
Site Contact: Rod Miller
ite Contact E-mail: [e-mail]
:tropic payment option is preferred. Type https://deg.nc.gov/SW-epaVments into your browser. If
select eCheck, there is no convenience fee. The convenience fee for a credit card is 2.65% and
venience fee for debit card is $3.95.
f you must pay with paper check, please make your check payable to "DEMLR Stormwater Program"
ind include the Certificate of Coverage No. in the memo field along with a copy of this invoice.
$25.00 processing fee will be charged for returned check in accordance with North Carolina General
atute 25-3-512. Contact Aziza Selkane at [e-mail] or (919) 707-371D with questions.
Remit to: NCDEQ-- Division of Energy, Mineral, and Land Resources
Stormwater Program
1612 Mail Service Center
Raleigh NC 27699-1612
1f this project has been closed out, you must submit a Notice of Termination (NOT) request here:
https://edocs.deu. nc.eov/Forms/NCG01-Termination