HomeMy WebLinkAboutNCS000450_Email RE Contact Updates and eDMR Registration_20240812 Georgoulias, Bethany
From: Dylan Kirk <dkirk@carrboronc.gov>
Sent: Monday, August 12, 2024 1:17 PM
To: SW-eDMR; Sanford, Joyce
Cc: Reed, Isaiah L; Georgoulias, Bethany; Holloman, Tevye L
Subject: [External] NCG080676 & NCS000450 Town of Carrboro - Completed Permit Owner
Affiliations & eDMR eReporting Registration From
Attachments: NCS000450 2024.07.17 Permit Summary Report.pdf, NCG080676 2024.07.31 NCDEQ
Owner Verification Report.pdf, NCS000450 2024.07.18 Annual Premit Fee (Invoice
2024PR005338) Paid (Voucher 211996).pdf, NCS000450 2024.07.17 PERMIT OWNER
AFFILIATION DESIGNATION FORM (Executed).pdf, NCS000450 2024.07.17 PERMIT
CONTACT UPDATE REQUEST WEB FORM (Submitted).pdf, NCG080676 2024.08.12
SW-Electronic-Reporting-Registration-Form-Rev-20230608-DEMLR-SW
(Executed).pdf
Importance: High
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Hello NCDEQ staff and Ms. Sanford,
Per the instructions on the NCDEQ NPDES MS4 & Industrial websites I am submitting this email to notify you of
permit affiliation updates/changes. Additionally, I have sent in wet signature forms to the instructed
addresses/contacts. I thought it best to chronologically explain changes/requests made and summarize actions
below:
The Town of Carrboro is a permittee of two (2) NPDES permits that should be impacted by these changes
Permit#: NCG080676 & NCS000450). Relevant changes include:
• Former Town Manager, David Andrews retired on effective July 31, 2021 (See Owner Verification
Report/ Permit Summary Report)
• Effective May 6, 2024 Patrice Toney became our acting Town Manager (New Permit(s) Owner)
• Effective June 20, 2024 Stormwater Manager Randy Dodd Retired.
• Effective July 15, 2024 Dylan Kirk started as Stormwater Manager (New Permit Contact).
• 2024.07.17: D.Kirk self-reports to NCDEQ of late payment on Invoice #2024PR005338
• 2024.07.18: Town of Carrboro issues check voucher#211996 for full $1000.00 payment of Invoice
#2024PR005338. Tev, please let me know if this is still outstanding.
Required Changes/Comments:
1. 2024.07.17—The Permit Owner Affiliation form was signed and submitted through the Permit Contract
Update Request web form. The wet signature version was mailed via USPS (7/18/2024).
a. New permit owner Patrice Toney is identified as well as permit contact Dylan Kirk.
2. 2024.08.12—Stormwater eReporting Registration form attached to this email. This was also sent via
USPS today (8/12/2024).
i
a. Requests access to eDMR for Town of Carrboro staff members Dylan Kirk and Heather Holly.
3. Don't know if this matters but both permits list "City of Carrboro" as the permittee, if possible, I would
like to have that updated to "Town of Carrboro" which better reflects our branding and municipal size.
Please let me know if I have left anything outstanding or if you wish to discuss any changes with me.
Best,
Dylan Kirk(he/him/his)
Stormwater Manager
Town of Carrboro I www.Carrboronc.gov
P:919-918-7341
Get Carrboro News&Updates
www.carrboronc.gov/SIGNUP
a
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1
TOWN OF CARRSORO • NC
Town of Carrboro, NC Website - https://www.carrboronc.gov
E-mail correspondence to and from this address may be subject to the North Carolina Public Records
Law and may be disclosed to third parties.
2
E Q� Division of Energy,Mineral, and Land Resources FOR AGENCY USE ONLY
NORTH CAROLINA �' Date Received
�o.p„ ,a�mmental ` �✓ Land Quality Section/Stormwater Program Year Month Day
�+ National Pollutant Discharge Elimination System(NPDES)
PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
Use this form if there has been:
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name-Ownership Change Form
and submit the completed form with all required documentation.
What does"legally responsible individual"mean?
The person is either:
• the responsible corporate officer(for a corporation);
• the principle executive officer or ranking elected official(for a municipality,state,federal or other public
agency);
• the general partner or proprietor(for a partnership or sole proprietorship);
• or,the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual("Owner Affiliation")
applies:
Individual Permit (or) Certificate of Coverage or No Exposure
N I C I S 0 0 0 4 5 10 1 1 N I C I G
2) Facility Information:
Facility name: Carrboro - Small MS4
Company/Owner Organization: Government - Municipal
Facility address: 301 W Main St
Address
Carrboro NC 27510
City State Zip
To find the current legally responsible person associated with your permit,go to this website:
https://deg.nc.gov/sw/ Navigate to the "NPDES Industrial Program"section and run the Stormwater Permit
Contact Summary Report for your permit number.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: David Andrews
First MI Last
4) NEW OWNER AFFILIATION(legally responsible for the permit):
Person legally responsible for this permit: Patrice Toney
First MI Last
Page 1 of 2
Last revised 2C Feb 2022
NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
Town Manager
Title
301 W Main St
Mailing Address
Carrboro NC 27510
City State Zip
(919 ) 918-7315 ptoney@carrboronc.gov
Telephone E-mail Address
(919 ) 918-4456
Fax Number
5) Reason for this change:
0Employee or management change
A result of: ❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
...................................................................................................................
The certification below must be completed and signed by the permit holder.
Note: 40 CFR 122.22(c) requires an original signature (not digital)
PERMITTEE CERTIFICATION:
I, ,attest that this application for this change in Owner Affiliation
(person legally*sponsible foy the permit)has been reviewed and is accurate and complete to the best of
my knowledge. I understand that if all required parts of this form are not completed,this change may not
be processed.
Dq
0 Signat Date
PLEASE SEND THE ORIGINAL SIGNED COPY OF THE COMPLETED
OWNER AFFILIATION CHANGE FORM TO:
DEMLR- Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh,North Carolina 27699-1612
For more information or staff contacts,please call(919)707-9220 or visit the website
at: http://deg.nc.gov/sw
Per NC General Statute 143-215.613(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 2 of 2
Last revised 2C Feb 2022
�EQ�� NPDES Stormwater Permit Contact Update
Request
NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number.
Number* NCS000450
Begins with NCS,NCG,or NCGNE(no exposure)
The information below is auto-filled after the permit number is entered and you click outside the box:
Permittee* City of Carrboro
Facility Name* Carrboro-Small MS4
County* Orange
Check permit contact information for your permit by running a Stormwater Permit Summary Report
(https://reports.ncden r.org/BO E/Open Docu ment/2002150408/Crystal Reports/viewrpt.cwr?
id=585684&apsuser=B1 MS_U&apspassword=b10Ms_cr%28ddnri59%29&apsauthtype=secEnterprise&cmd=EXPORT&EXPORT_FMT=U2
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 Q Owner Affiliation (Legally Responsible Individual)Update
*
apply: ❑ Permit Ownership Transfer or Facility Name Change
❑ Delegation of Signature Authority(DOSA)
Q Permit Contact Update
Q Billing Contact Update
Q Facility Contact Update
❑ Other Contact Update
Owner Affiliation (Legally Responsible Individual) Change
Upload a copy of the completed and signed Permit Owner Affiliation Designation Form (https://deq.nc.gov/energy-mineral-
and-land-resources/stormwater/npdes-miscellaneous-forms/npdes-stormwater-owner-affiliation-change-
form/download)below.We can begin making updates with this submittal, but please note that you must mail in the
original signed copy to our office, in accordance with requirements in 40 CFR 122.22.
Staff may contact you to confirm the requested change if this Owner is also associated with other permits in our system.
Changes to Owner Affiliation affect all permits tied to that Owner.
Owner Affiliation Please upload the signed"Permit Owner Affiliation Designation Form"
Change Form Upload
Upload* NCS000450 PERMIT OWNER AFFILIATION DESI... 1.3MB X
pdf only
Permit Contact Update
Provide new permit contact information
* QQ This person should REPLACE the current permit contact.
Q This person should just be added as another permit contact.
New Contact Name* First and Last Name
Dylan Kirk
E-mail Address* dkirk@carrboronc.gov
Phone No.* 919-918-7341
Mailing Address* 301 W Main Street,Carrboro, NC 27510
Physical Address If different than mailing address
100 Public Work Drive,Carrboro, NC 27510
...............................................................................................................................................................................................................................................................................................................................................
Add another permit contact if needed by clicking the'Add'button below
Add
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
Dylan Kirk
E-mail Address* dkirk@carrboronc.gov
Phone No.* 919-918-7341
Mailing Address* 1301 W Main Street, Carrboro, NC 27510
Physical Address If different than mailing address
100 Public Work Drive,Carrboro, NC 27510
Facility Contact Update
Provide new facility contact information
* Q This person should REPLACE the current facility contact.
Q This person should just be added as another facility contact.
New Contact Name* First and Last Name
Dylan Kirk
E-mail Address* dkirk@carrboronc.gov
Phone No.* 919-918-7341
Mailing Address* 301 W Main Street,Carrboro, NC 27510
Physical Address If different than mailing address
100 Public Work Drive,Carrboro, NC 27510
...............................................................................................................................................................................................................................................................................................................................................
Add another facility contact if needed by clicking the'Add'button below
Add
Submitter'sName* Please enter your FIRST and LAST name
Dylan Kirk
Phone Number* Please enter your phone number
919-918-7341
Any format is fine.
Email Address* Please enter a valid e-mail address
dkirk@carrboronc.gov
A confirmation of submission will be e-mailed to this address.
* Q 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* X
Date Date will be captured on form submission
Questions? Contact bethany.georgoulias@deq.nc.gov(http://maiIto:bethany.georgouIias@deq.nc.gov).
Submit
NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for your permit as of 7/17/2024.
Permit Number: NCS000450 Permit Status: Active
Permit Type: Stormwater Discharge, Individual (MS4)
Facility Name: Carrboro-Small MS4
Facility Addressl: 301 W Main St
Facility Address2:
City,State&Zip: Carrboro, NC 27510
Owner Information Details:
MUST submit a Change of Name/Ownership form to DEMLR to make any changes to this Owner information.
(Click Here for "Change of Name/Ownershka"Form)
Owner Name: City of Carrboro
Owner Type: Government- Municipal Owner Type Group: Organization
*** Legally Responsible for Permit ***
(Responsible corporate officer/principle executive officer or ranking elected official/general partner or proprietor;
or any other person with delegated signatory authority from the legally responsible person.)
Owner Affiliation: David Andrews Title: Town Manager
Addressl: 301 W Main St
Address2:
City,State&Zip: Carrboro, NC 27510
Work Phone: 919-918-7315 Fax: 919-918-4456
Email Address: dandrews@townofcarrboro.org
*** Permit Annual Fee Billing ***
Billing Month: July
Invoice Number Invoice Date Invoice Due Date Invoice Amount Invoice Status
2024PR005338 6/1/2024 7/1/2024 $1,000.00 Overdue
Owner Contact Person(s)
Contact Name Title Address Phone Fax Email
Facility Contact Person(s)
Contact Name Title Address Phone Fax Email
Randy Dodd Stormwater Program 301 W Main St, Carrboro, NC 27510 919-918-7341 rdodd@townofcarrb
Administrator oro.org
Permit Contact Person(s)
Contact Name Title Address Phone Fax Email
7/17/2024 Page 1
NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for your permit as of 7/17/2024.
Permit Billing Contact(s)
Contact Name Title Address Phone Fax Email
Randy Dodd 301 W Main St, Carrboro, NC 27510 919-918-7341 rdodd@carrboronc.g
ov
Person(s) with Delegated Signatory Authority
Type Contact Name Title Address Phone Fax Email
Person(s) with Electronic Signature Authority
Type Contact Name Title Address Phone Fax Email
Outfalls
Outfall #: Outfall Description:
Outfall Lattitude: Outfall Longitude: Represented by Outfall:
Stormwater: % Industrial:
Stream Waterbody
Basin Waterbody Name Index Number Classification
7/17/2024 Page 2