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Home My WebLink AboutNCS000456_Permit Contact Update Request_20230421 Action History (UTC-05:00)Eastern Time(US&Canada) Submit by Anonymous User 4/21/2023 8:24:58 AM (Permit Contact Update Request) Approve by Joyce Sanford 5/8/2023 3:25:10 PM (Contact Update Review) • The task was assigned to DEMLR SW Admin General.The due date is:June 2,2023 5:00 PM 4/21/2023 8:25:01 AM • The task was assigned to Joyce Sanford by round robin distribution 4/21/2023 8:25:01 AM pEQNPDES Stormwater Permit Contact Update Request Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number. Number* NCS000456 Begins with NCS,NCG,or NCGNE(no exposure) Facility Name* Culpeper of Cove City, LLC (Used to verify permit number) Check permit contact information for your permit by running a Stormwater Permit Summary Report. Guidance for COC holders: Do not enter the General Permit number with all 0's(for example, NCG030000)but instead your Certificate of Coverge(COC)number. Check all that J Owner Affiliation(Legally Responsible Individual)Update * apply: ❑ Permit Ownership Transfer or Facility Name Change ❑ Delegation of Signature Authority(DOSA) ❑ Permit Contact Update Q Billing Contact Update ❑ Facility Contact Update 7 Other Contact Update Stormwater Program's Billing Specialist will be notified about the billing update request by email upon approval. Billing Contact Update Provide new billing contact information ................................................................ ............................................................................................................................................................................................................................................ Note:This person will REPLACE the current billing contact.We can only designate one billing contact in our permitting database. New Contact Name* First and Last Name Josh Adkins E-mail Address* jadkins@culpeperwood.com Phone No.* 803-566-3270 Mailing Address* PO Box 469 Orangeburg,SC 29116 Physical Address If different than mailing address 11065 Old Hwy 70 W. Cove City, NC 28523 ................................................................................ Submitter's Name* Please enter your FIRST and LAST name Josh Adkins Phone Number* Please enter your phone number 803-566-3270 Any format is fine. Email Address* Please enter a valid e-mail address jadkins@culpeperwood.com A confirmation of submission will be e-mailed to this address. * By checking the box and signing below, I certify that: I have given true,accurate,and complete information on this form; I agree that submission of this form is a"transaction"subject to Chapter 66,Article 40 of the NC General Statutes(the "Uniform Electronic Transactions Act'); I agree to conduct this transaction by electronic means pursuant to Chapter 66,Article 40 of the NC General Statutes(the "Uniform Electronic Transactions Act'); I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature(except for any uploaded Owner Affiliation Change or Delegation of Signature of Authority forms,which also must be mailed in with original signature);AND I intend to electronically sign and submit this Permit Contact Update Request form. Signature ��ITC�.flirJ Date 4/21/2023 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCS000456