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Home My WebLink AboutNCG110151_Permit Contact Update Request_20240409 Action History (UTC-05:00)Eastern Time(US&Canada) Submit by Anonymous User 4/9/2024 11:07:47 AM(Permit Contact Update Request) Approve by Austin Sanderford 5/22/2024 12:53:33 PM (Contact Update Review) 0 Updated 5/22/2024 AAS • The task was assigned to DEMLR SW Admin General.The due date is: May 21,2024 5:00 PM 4/9/2024 11:07:53 AM • The task was assigned to Joyce Sanford by round robin distribution 4/9/2024 11:07:53 AM • Joyce Sanford reassigned the task to Austin Sanderford 4/29/2024 10:56:11 AM DEQIwo NPDES Stormwater -Request Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number. Number* NCG110151 Begins with NCS,NCG,or NCGNE(no exposure) Facility Name* West Brunswick Regional WRF (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 Owner Affiliation(Legally Responsible Individual)Update * apply: Permit Ownership Transfer or Facility Name Change Delegation of Signature Authority(DOSA) Permit Contact Update Billing Contact Update Facility Contact Update Other Contact Update Permit Contact Update Provide new permit contact information This person should REPLACE the current permit contact. This person should just be added as another permit contact. New Contact Name* First and Last Name Krysden Burden E-mail Address* krysden.burden@brunswickcountync.gov Phone No.* 910-253-1757 Mailing Address* P.O. Box 249 Bolivia, NC 28422 Physical Address If different than mailing address Add another permit contact if needed by clicking the'Add'button below 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 Daphne Peeples E-mail Address* daphne.peeples@brunswickcountync.gov Phone No.* 910-253-1786 Mailing Address* P.O. Box 249 Bolivia, NC 28422 Physical Address If different than mailing address Submitter's Name* Please enter your FIRST and LAST name Krysden Burden Phone Number* Please enter your phone number 910-253-1757 Any format is fine. Email Address* Please enter a valid e-mail address krysden.burden@brunswickcountync.gov 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 Zy, sdeti 3u aleo Date 4/9/2024 Questions? Contact bethany.georgoulias@deq.nc.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCG110151