NCC222158_Contact Update Request_20230629

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 NCGO1 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, 611 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.
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.22)
Certificate of Coverage(COC) Number: N W pa 15 b
Name of Project: V %r\q--A2I1 1 21 d a 2_ UX.
Legally Responsible Organizational En ity: K-Ag3�y Xt d ej 4 LL G
PREVIOUS Legally Responsible Individual: r), pu; . ptn fi * 1-9
NEW Legally Responsible Individual: P, QQ,([//y 9'4'kem
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
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE(NOT DIGITAL) [40 CFR 122.221
Under penalty of law, I certify that(check all boxes to indicate your agreement):
11 1 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.
I will abide by all conditions of the NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
S/ If the approved Erosion and Sediment Control Plan is not compliant with Part 11 (Stormwater Pollution
Prevention Plan) of the NCGO10000 General Permit, I will nonetheless ensure that all conditions of
Part II of the permit are met on the project at all times.
Ycl
understand that coverage under this permit will constitute the permit requirements for the
ischarge(s)and is enforceable in the same manner as an individual permit.
his form has been reviewed and is accurate and complete to the best of my knowledge.
0*Signature: ��44+ Date: a� -
Print Name of Signed:
- , q
Title: eonlo ' �MzLeyage'6
Mailing Address: ,2�j1oI 03r[eZeJ'Jdopi 4yP • �G. 100 TWY2#CVJ/I4 ' �IC o2d3Qj
Street Address: 2qI9 �raGz2l )oocJ �V2 94c (Dd A/It'� Q ,�a2�
Email Address: ��},lA � t (Ami��ln iC� Cnnf) /
Phone Number: ko - 3oa.- 31A O
* 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 B, Item(6)of the NCG010000 permit.
For more information on signatory requirements,see Part IV,Section B, Item(6)of the NCG010000 permit.
Page 2 of 2

Georgoulias, Bethany
From: Kathryn Brown <kathrynbrown@ Huff FamilyOffice.com>
Sent: Thursday, June 29, 2023 4:32 PM
To: Georgoulias, Bethany
Subject: RE: [External] NCG01 Legally Responsible Individual Change Form - Kingsbury Ridge
Attachments: 20230629165510320.pdf
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Bethany,
Sorry about that, please see the attached, thanks!
Kathryn Brown
Land Development Coordinator
2919 Breezewood Ave
Suite 100
Fayetteville,NC 28303
Mobile [phone]
Email [e-mail]
T/� HUFF
11 Family Office
PRIVILEGED AND CONFIDENTIAL This communication and any accompanying documents are confidential and privileged.They are intended for the sole use of the
addressee.If you receive this transmission in error,you are advised that any disclosure,copying,distribution,or the taking of any action in reliance upon this
communication is strictly prohibited.Moreover,any such disclosure shall not compromise or waive the attorney-client,accountant-client,or other privileges as to this
communication or otherwise.If you have received this communication in error,please contact me at the above email address.Thank you.
From: Georgoulias, Bethany<[e-mail]>
Sent:Thursday,June 29, 2023 4:24 PM
To: Kathryn Brown <kathrynbrown@ Huff Fa m i lyOffice.com>
Subject: RE: [External] NCG01 Legally Responsible Individual Change Form - Kingsbury Ridge
Kathryn,
I noticed that the top of the form was left incomplete. Can you please send a completed copy with the
acknowledgement boxes checked/marked?
Thank you!
i

NCG01 Legally Responsible Individual Change Form
T11�:F6Ri� ":V ')U'M' AtL-PA'''�T E:'Cd PLETtD'.WITH.A.N-0R.�C�1Pl�i1.` iG�€1�ATURE:t ��:f�IC1-TAL) 4001111
Under penalty of law, I certifv that (check all bones to Indicate your agreement).-
El I am the person responsible for the coltstructlon act]vities of this project,for satisfying the
requirements of this permit,, and for any civil or cr[rninal penalties incurred due to violations of
permit.
❑ 1 will obi-de by all conditions of the K(WIC000 General.Perrn.1 and the approved Erosion and
Sediment Control Plan.
❑ If the approved Erosion and Sediment Control Plan is not compliant with part 11 (Storm ater Pa
Prevention Plan)of the N G010000 General Permit, [urill nonetheless ensure that a11 condition.
Part 11 of the permit are met on the project at all tirnes,
❑ 1 understand that coverage underthis permit will constitute the permilt requirements for the
discharge(s) and is enforceable in thesanne manneras an individual permit.
❑ This faun has been revi~2d anti is accurate and corn plete to the best of my knowlLdge_
{
Bethany Georgoulias (she/her)
Environmental Engineer, Stormwater Program
DEMLR Laserfiche Administrator
Division of Energy, Mineral,and Land Resources
N.C. Department of Environmental Quality
919 707 3641 office
[e-mail]
DEQ is updating its email addresses to @deq.nc.gov in phases from May 1st to June 9th. Employee email addresses
may look different, but email performance will not be impacted.
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
Website: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
From: Kathryn Brown <kathrynbrown@ Huff FamilyOffice.com>
Sent: Wednesday, June 28, 2023 5:34 PM
To: Georgoulias, Bethany<[e-mail]>
Subject: [External] NCG01 Legally Responsible Individual Change Form - Kingsbury Ridge
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Hello, please see the attached
2

TT
HFamily Office
Kathryn Brown
Land Development Coordinator
2919 Breezewood Ave.
Suite 100
Fayetteville, NC 28303
Mobile [phone]
Email:[e-mail]
PRIVILEGED AND CONFIDENTIAL This communication and any accompanying documents are confidential and privileged. They are
intended for the sole use of the addressee. If you receive this transmission in error, you are advised that any disclosure, copying,
distribution, or the taking of any action in reliance upon this communication is strictly prohibited. Moreover, any such disclosure shall
not compromise or waive the attorney-client, accountant-client, or other privileges as to this communication or otherwise. If you
have received this communication in error,please contact me at the above email address. Thank you.
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.
3

Georgoulias, Bethany
From: Ralph Huff <[e-mail]>
Sent: Tuesday, June 27, 2023 2:28 PM
To: Holloman, Tevye L; Georgoulias, Bethany
Cc: 'lase [e-mail]'
Subject: [External] RE: Construction SW General Permit Annual Fee Received - NCC222158
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Hello,
Rebecca Treadaway is no longer with our company. My name is the responsible party on the COC. Can you please
update your records to [e-mail] for Denver Ralph Huff and delete Rebecca Treadaway's email
address?
Thank you.
Ralph
Ralph Huff
Huff Family Office
2919 Breezewood Avenue I Suite 100
Fayetteville NC 28303
Office: 910-302-3608
Mobile: [phone]
Fax: [phone]
Email: DRHuff@ Huff FamilyOffice.com
Over 10,000 homes since 1991!
From: [e-mail]<[e-mail]>
Sent:Tuesday,June 27, 2023 9:34 AM
To: Rebecca Treadaway<RebeccaTreadaway@ Huff FamilyOffice.com>; [e-mail]
Cc:[e-mail]; [e-mail]; Rebecca Treadaway
<RebeccaTreadaway@ Huff FamilyOffice.com>
Subject: Construction SW General Permit Annual Fee Received - NCC222158
Dear Construction General Permit Permittee:
Certificate of Coverage (COC) no. NCC222158 has been successfully renewed by payment of the 2023 annual fee, as long
as all other annual fees have been paid. If no fees are owed,this project remains actively covered under North Carolina's
NPDES General Stormwater Permit for Construction Activities.
(Note, if this COC was recently terminated, the payment was successfully applied to invoice period.)
This COC is for Kingsbury Ridge in Cumberland County, issued to Kingsbury Ridge LLC.The payment was applied to
Invoice no. NCC222158-2023.
If you have any questions, please contact the Stormwater Program at(919) 707-3649, or visit https://deq.nc.gov/NCG01.
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Be sure to add [e-mail] to your contacts to avoid future e-mails from going into Spam filters.
The NC DEMLR Stormwater Program
512 N. Salisbury Street, Archdale Building 6th Floor(640K), 1612 Mail Service Center, Raleigh, NC 27699-1612
This email was automatically generated by Laserfiche. Please do not respond to this email address, as responses are not
monitored.
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