NCC216851_Contact Update Request (Legally Resp)_20220119

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
NCC216851
Certificate of Coverage (COC) Number:
Name of Project: Gardner -Lee Residence
Legally Responsible Organizational Entity: Gardner -Lee Properties III, LLC
PREVIOUS Legally Responsible Individual: Lucy Stokes
NEW Legally Responsible Individual: Alston Gardner, Managing Member
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
Under penalty of law, I certify that (check all boxes to indicate your agreement):
Ek 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.
EX I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and
Sediment Control Plan.
IR If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCG010000 General Permit, I will nonetheless ensure that all conditions of
Part 11 of the permit are met on the project at all times.
l 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:�14
�zff Date: January 17, 2022
Print Name of Signed: John Alston Gardner
Title: Managing Member
Mailing Address: 623 E. Franklin St. Chapel Hill, NC 27514
Street Address: same
Email Address: [e-mail]
Phone Number: 404-610-0499
*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 8, Item (6) of the NCG010000 permit.
For more information on signatory requirements, see Part IV, Section 8, Item (6) of the NCG010000 permit.
Page 2 of 2

Georgoulias, Bethany
From: Broussard, Brooklyn C
Sent: Wednesday, January 19, 2022 6:55 AM
To: Georgoulias, Bethany
Subject: FW: [External] Fwd: Gardner -Lee Residence Follow -Up NCG01-2021-6851
Attachments: NCG01- Legally- Responsible-Change-Form-20201205-DEMLR-SW EXECUTED.pdf
Good morning,
I don't know if you need this or if the process is electronic and they just sent this to confirm the change.
This is the project from the folks that we met with Doug about.
From: Lucy Stokes <[e-mail]>
Sent: Monday, January 17, 2022 11:14 AM
To: Broussard, Brooklyn C <[e-mail]>
Cc: Tom Kagarise (veteranenginee [e-mail]) <veteranenginee [e-mail]>; Tom
Kagarise <tom@veteranenginee ringassociates.com>; Alston Gardner <[e-mail]>
Subject: [External] Fwd: Gardner -Lee Residence Follow -Up NCG01-2021-6851
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Brooklyn,
Here is the change you requested.
Lucy Stokes
Gardner Stokes, Inc.
101 W Chapel Hill St.
#312
Durham, NC 27701
919-730-8520
---------- Forwarded message ---------
From: Alston Gardner <[e-mail]>
Date: Mon, Jan 17, 2022 at 11:01 AM
Subject: Re: Gardner -Lee Residence Follow -Up
To: Stokes Lucy <[e-mail]>
see attached completed and signed document

From: Broussard, Brooklyn C[maiIto: Brooklyn. Broussard (Jancdenr.aov]
Sent: Tuesday, January 04, 2022 7:34 AM
To: Tom Kagarise
Cc: Morman, Alaina; Georgoulias, Bethany; Ansel, Douglas R
Subject: Gardner -Lee Residence Follow -Up
Tom,
After conferring with NCDE(Xs Assistant General Counsel, Douglas Ansel, regarding this matter, we're in
agreement that agents shall not sign the NCG01 NOI permit application, Modification form, or Notice of
Termination (NOT) form.
15A NCAC 02H .1040(1)(a) states that the signatory requirements for LLCs are:
in the case of a corporation, by a principal executive officer of the level of vice-president or his
authorized representative. In the case of a limited liability corporation (LLQ, by a manager or
company official as those terms are defined in G.S. 57D "North Carolina Limited Liability
Company Act;"
Additionally, the NCG01 General Permit is an NPDES permit, which means it must adhere to the
signatory requirements in 40 CFR § 122.22. All permit applications must be signed by high level,
responsible officers or partners. LLCs are not specifically called out as a distinct category, but since they
are a hybrid between a partnership/sole proprietorship and a corporation, it is understood that the
entity has responsible officers or partners that can sign.
Although 15A NCAC 02H .1040(1) would allow for an agent to sign an application for a state permit
when a letter of authorization (i.e., agency) is provided, this is not specifically allowed under 40 CFR
122.22, and therefore is not acceptable for the NCG01. Even if it were allowed, no such authorization
letter was provided.
It has been determined that your current NCG01 COC needs to be modified since Lucy Stokes does not
meet the signatory requirements. The person that needs to be listed as the Legally Responsible
Individual must be a manager or company official employed by Gardner -Lee Properties III, LLC.
Please use the Modification form to submit a "NCG01 Legally Responsible Individual Change Form" and
let us know if you have any further questions.
Brooklyn Broussard
Administrative Officer III

Stormwater Program, Division of Energy, Mineral, and Land Resources
North Carolina Department of Environmental Quality
Phone: [phone]
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