NCC205244_Contact Update Request (Legally Resp Change)_20230203 (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 (eNO1).
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 ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.221
Certificate of Coverage (COC) Number:
NCC213178
Name of Project: Herrin Stock Pile
Legally Responsible Organizational Entity:
Grubb Properties
PREVIOUS Legally Responsible Individual:
Eric Applefield
NEW Legally Responsible Individual:
Connor Marshall
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.
�l 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.
X This form has been reviewed and is accurate and complete to the best of my knowledge.
*Signature: A-& Date: 2/2/2023
Print Name of Signed: Connor Marshall
Title: Project Manager
Mailing Address: 117 Edinburgh S Dr, Suite 110, Cary, NC 27511
Street Address: 117 Edinburgh S Dr, Suite 110, Cary, NC 27511
Email Address: [e-mail]
Phone Number: 585-519-1578
* 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: Connor Marshall <[e-mail]>
Sent: Thursday, February 2, 2023 11:16 AM
To: Georgoulias, Bethany; Holloman, Tevye L
Subject: [External] RE: Construction 2023 Annual Fee Invoice for NCC205244 Due - Update Leg
Resp Person
Attachments: NCG01- Legally- Responsible-Change-Form-20210517-DEMLR-SW.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Thank you! See attached — and will send in the mail shortly.
Thanks,
onnor Marshall
evelopment Project Manager
rubb Properties
17 Edinburgh South Drive
uite 110, Cary, NC 27511
lobile: 585.519.1578
ffice: 919.388.5762
From: Georgoulias, Bethany <[e-mail]>
Sent: Thursday, February 2, 2023 10:42 AM
To: Connor Marshall <[e-mail]>; Holloman, Tevye L <[e-mail]>
Subject: RE: Construction 2023 Annual Fee Invoice for NCC205244 Due - Update Leg Resp Person
Importance: High
CAUTION: Email originated from outside Grubb Properties. Do not click links or open attachments unless you know the
content is safe.
Good morning,
If there has been a change in legally responsible person, the attached form needs to be filled out and returned to our
office (paper copy). Please also scan it and email it to me, or upload it through the NCG01 Modification request form,
and we will process it through that. We need a signed form because this person was listed as the legally responsible
individual.

B. Permittee Information
Part B.
r�mnee rrl�rrrelian - I x�t+e l3YlC� era rl�+ln.>o
h
Irnp-arkant, The person vwho srgrrs the NO; Cer:Uftafion Form and -,4 ins the Certri-rcatkm ir? Section r= of this application
form should be the so person as Ilsted in THIS SECTION- or an authorized responsible individual Within, the
organization- Thal person must he a responsible corporate officer Who OVM or operates the construction activIly, such
as a president, sneretary, treasurer, or vlm prosldeni, or a managor that Is authoftwel In aaacrdanco vAlh Bart IV,
Sectian 8, Me ib} of the r4CG41 0000 General Permit- For mare information on signatory require manta, see Port
IV, Section U, Item (6) of that perinit,
1, Organization Iegalt R=sp(—bL,Bxy
Name * GeUtih PeOpOrtie :t
WparritlwEa mirffNdAkio, mpnEAKr LWWki.
NJvte; TNe orgarrizotion name rrwsl nWth the bvSinem entily rWve registered vAth the NC-%Oretary of SWO- You Car)
verity the registration here.
2. First Name`
3, Last Name
3b. 716m
4, Permitee Email
.address
Thank you!
Eric
I QrprxAm. aV.q R3.gs11=rfa AgPrii I M119riP
Applefield
r Orxwralo. woo "erect ApA Lost Nm
DIrimGcr, Devol r*nt
[e-mail]
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
D_E
NORTH CAROLINA
Department of Environmental quality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Connor Marshall <[e-mail]>
Sent: Thursday, February 2, 2023 10:34 AM
To: Holloman, Tevye L <[e-mail]>; Georgoulias, Bethany<[e-mail]>;

[e-mail]
Subject: [External] RE: Construction 2023 Annual Fee Invoice for NCC205244 Due
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
NC DEQTeam,
Can you please make me the main contact for this job / permit? Eric Applefield is no longer with Grubb.
Thanks,
onnor Marshall
evelopment Project Manager
rubb Properties
17 Edinburgh South Drive
uite 110, Cary, NC 27511
lobile: 585.519.1578
ffice: 919.388.5762
marshall(cDerubborooerties.com
From: [e-mail] <[e-mail]>
Sent: Thursday, February 2, 2023 12:01 AM
To: Eric Applefield<[e-mail]>
Cc: [e-mail]; [e-mail]; [e-mail]
Subject: Construction 2023 Annual Fee Invoice for NCC205244 Due
CAUTION: Email originated from outside Grubb Properties. Do not click links or open attachments unless you know the
content is safe.
The 2023 annual fee for Invoice No. NCC205244-2023 was due on 2/1/2023. Please address the outstanding fee for this
Construction Stormwater NPDES permit as soon as possible.
To pay electronically, go to: https://deg.nc.gov/SW-epaVments and enter the permit number. You will also find details
about the project listed there.
This COC is for Herrin Stock Pile in Mecklenburg County, issued to Grubb Properties.
If this project has been closed -out, it is important that you submit a Notice of Termination request here:
https://edocs.deg.nc.gov/Forms/NCGOI-Termination
For questions, contact the Stormwater Program at [phone] or [e-mail]
This email was automatically generated by Laserfiche. Please do not respond to this email address, as responses are not
monitored.