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Home My WebLink AboutNCG110158_Permit Contact Update Request_20231128 Action History (UTC-05:00)Eastern Time(US&Canada) Submit by Anonymous User 11/28/2023 8:26:02 AM (Permit Contact Update Request) Approve by Joyce Sanford 12/1/2023 2:29:22 PM (Contact Update Review) • The task was assigned to DEMLR SW Admin General.The due date is:January 9,2024 5:00 PM 11/28/2023 8:26:06 AM • The task was assigned to Joyce Sanford by round robin distribution 11/28/2023 8:26:06 AM pEQNPDES Stormwater Permit Contact Update Request Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number. Number* NCG110158 Begins with NCS,NCG,or NCGNE(no exposure) Facility Name* French Broad River Water Reclamation Facility (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 p Delegation of Signature Authority(DOSA) ❑ Permit Contact Update Q Billing Contact Update Q 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 Bart Farmer E-mail Address* bfarmer@msdbc.org Phone No.* 828-225-8224 Mailing Address* 2028 Riverside Dr Asheville, NC 28804 Physical Address If different than mailing address 2225 Riverside Dr Asheville, NC 28804 Facility Contact Update Provide new facility contact information ................................. ........... QQ This person should REPLACE the current facility contact. 0 This person should just be added as another facility contact. New Contact Name* First and Last Name Bart Farmer E-mail Address* bfarmer@msdbc.org Phone No.* 828-225-8224 Mailing Address* 2028 Riverside Dr Asheville, NC 28804 Physical Address If different than mailing address 2225 Riverside Dr Asheville, NC 28804 Add another facility contact if needed by clicking the'Add'button below Submitter's Name* Please enter your FIRST and LAST name Bart Farmer Phone Number* Please enter your phone number 828-225-8224 Any format is fine. Email Address* Please enter a valid e-mail address bfarmer@msdbc.org 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 ffrt tC V,?tow"t Date 11/28/2023 Questions? Contact bethany.georgoulias@deq.nc.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCG110158