NCC205628_Contact Update Request_20230103

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 NCGO1 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: NCC205628
Name of Project: Carolina Sunrock LLC - Burlington North
Legally Responsible Organizational Entity: Caswell Properties, LLC
PREVIOUS Legally Responsible Individual: Gregg Bowler
NEW Legally Responsible Individual: Terry Manis
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):
IX 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.
X I will abide by all conditions of the NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
X If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the .4CGO10000 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.
X This form has been reviewed and is accurate and complete to the best of my knowledge.
*
Print Name of Signed: (Jerry Manis
Title:
Chief Financial Officer
Mailing Address: Carolina Sunrock LLC
Street Address: 200 Horizon Drive Suite 100
Email Address: [e-mail]
Phone Number: [phone]
Date: 01-03-2023
* 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: Scott Martino <[e-mail]>
Sent: Tuesday, January 3, 2023 9:26 AM
To: Georgoulias, Bethany; Holloman, Tevye L
Cc: Tracy Davis
Subject: RE: [External] FW: Construction 2022 Annual Fee Invoice for NCC205628 Due
Attachments: NCG01- Legally- Resposible-Change-Form-01-03-2023.pdf
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Report Spam.
Hello Bethany,
Attached is the completed form. III get the original out in the mail today.
Thanks for your help
Scott
From: Georgoulias, Bethany <[e-mail]>
Sent: Tuesday, January 3, 2023 8:39 AM
To: Scott Martino <[e-mail]>; Holloman, Tevye L <[e-mail]>
Cc: Tracy Davis <[e-mail]>
Subject: RE: [External] FW: Construction 2022 Annual Fee Invoice for NCC205628 Due
Good morning,
Any changes to legally responsible person require the attached form to be completed. The original signed copy must be
sent in to our office, but you can email me a scanned copy so we can record the changes right away.
If Gregg had been listed as this official, this form needs to be completed by Terry Manis before we can make the update.
Also, I will need a mailing address for Tracy, and then I'll be able to update facility contact as well.
Thank you!
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/stormwater

NORTt+CAROU IA
Utop ribomwp Erwi om l.k Q-1ity
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Scott Martino <[e-mail]>
Sent: Tuesday, January 3, 2023 7:46 AM
To: Georgoulias, Bethany<[e-mail]>; Holloman, Tevye L <[e-mail]>
Cc: Tracy Davis <[e-mail]>
Subject: [External] FW: Construction 2022 Annual Fee Invoice for NCC205628 Due
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Report Spam.
Good Morning Bethany and Tev,
Hope you both are doing well. Let me know if you still have not received this payment for the noted annual fee
bellow. I processed the payment on December 8t" and the check was sent via our accounts payable department. Either
way let me know and I'll try and track down the check or get another issued, maybe it got lost in the mail. We have yet
to begin construction at this facility, thus we wish to keep our permit open.
In addition we have went through a change in management and I need to update the responsible party, however there
is no guidance on the web -page or form. Our new CFO (Chief Financial Officer) Terry Manis, is now overall our
environmental permitting and I need to get him added to this permit and remove Gregg Bowler. Terry's email is
[e-mail]; the remaining contact information will remain unchanged.
You can also replace myself as the facility contact and replace me with Tracy Davis ([e-mail])
Phone [phone].
Let me know if you need any further information and I'll be happy to take care of it for you.
Thanks
Scott
Scott Martino
200 Horizon Drive Suite 100
Raleigh NC 27816
Cell-(984)-202-4761
From: [e-mail] <[e-mail]>
Sent: Monday, January 2, 2023 12:01 AM
To: Gregg Bowler <[e-mail]>
Cc: [e-mail]; [e-mail]; Scott Martino <[e-mail]>
Subject: Construction 2022 Annual Fee Invoice for NCC205628 Due

The 2022 annual fee for Invoice No. NCC205628-2022 was due on 1/1/2023. Please address the outstanding
fee for this Construction Stormwater NPDES permit as soon as possible.
To pay electronically, go to: https:Hdeq.nc.gov/SW-epgyments and enter the permit number. You will also find
details about the project listed there.
This COC is for Carolina Sunrock LLC - Burlington North in Caswell County, issued to Caswell
Properties, LLC.
If this project has been closed -out, it is important that you submit a Notice of Termination request here:
hnps://edocs.deq.nc.gov/Forms/NCGO 1-Termination
For questions, contact the Stormwater Program at [phone] or [e-mail]
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