NCC200197_Contact Update Record_20250226

Action History(UTC-05:00)
Submit by Anonymous User 2/21/2025 12:34:52 PM (Contact Changes Submitted)
Approve by bethany.georgoulias 2/26/2025 8:25:05 AM (NCG01 Contact Update Review Step)
• The task was assigned to bethany.georgoulias.The due date is: February 28,2025 5:00 PM
2/21/2025 12:34:54 PM

NCGO1 Construction Stormwater Permit
Contact Update - •
This request must be submitted by the legally responsible individual or someone withir. _.
Permittee organization authorized to do so.
Certificate of Coverage(COC)No.* General Permit
NCC200197 NCGO10000
Use capital letters General Permit No.
Originally Issued* NC Reference No. Original NOI No.*
1/23/2020 N CG01-2020-0197 20778
Project information associated with this permit(Cannot Change)
Please note: Permitted Entity name changes or ownership transfers are not possible at this time.An ownership
transfer requires the new responsible entity to obtain a separate Certificate of Coverage(COC).
Permittee Entity Columbus County Schools
Listed
Project Name Tabor City PK-8 Grade School Abatement Demolition+Soils Remediation
Address 203 Stake Rd,Tabor City, NC
County Columbus
Latitude 34.1519
Longitude -78.8739
COC Effective Date* Prior Rescission Date
01/23/2020 (Stays blank if COC active)
(May reflect most recent renewal)
IMPORTANT: Where no changes are needed, please leave information in the field as is.
Which Contacts Have Changed?Scroll down to sections below to review details if necessary.
BOTH Legally Responsible Individual and Site Contact
Legally Responsible Individual Only
Site Contact Only
Billing Only
Has Billing Contact Changed?*
Choose'Yes'to revise Billing Contact details.
No
Yes
Billing Email May be blank if COC issued before we collected billing-specific contacts.
Billing Telephone No. May be blank if COC issued before we collected billing-specific contacts.
Billing Email(NEW) [e-mail]

Billing Telephone [phone]
(NEW)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY.KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Individual(Previous)
Jonathan Williams
First Name(New)* Timmy
Last Name(New)* Ward
Legally Responsible Individual(NEW)*
Reflects any revisions above
Timmy Ward
Permittee Email(Previous)
[e-mail]
Permittee/Legally Resp. Individual Email(NEW)*
[e-mail]
Permittee/Legally Resp. Individual Telephone No.(Previous)
910-642-5168
Permittee/Legally Resp. Individual Telephone No.(NEW)*
910-642-0161
Permittee Mailing Address(Previous)
817 Washington St,0,Whiteville, NC 28472
Permittee Mailing Address(NEW)*
Street Address
89 School Rd.
Address Line 2
City State/Province/Region
Hallsboro North Carolina
Postal/Zip Code Country
28442 United States
Permittee Street Address(Previous)
817 Washington St,0,Whiteville, NC 28472
Permittee Street Address(NEW)*
Street Address
89 School Rd.
Address Line 2
City State/Province/Region
Hallsboro North Carolina
Postal/Zip Code Country
28442 United States
For changes to the legally responsible individual,you must complete a copy of this form
and upload it below to submit this request.

Legally Responsible Individual Please upload completed and signed copy
Change Form TCS Responsible
117KB
Change Form.pdf
Must be PDF format
Site Contact Information
REVISE ONLY WHERE NECESSARY.KEEP INFORMATION THE SAME IF NO CHANGES!
Site Contact(Previous)
Jonathan Williams
Site Contact Title(Previous)
Associate Superintendent
Organization(Previous)
Columbus County Schools
First Name(New)* Timmy
Last Name(New)* Ward
Site Contact(NEW)*
Reflects any revisions above
Timmy Ward
Site Contact Title(NEW)
Maintenance Director
Organization(NEW)
Columbus County Schools
This field was not required on the NOI form and may not pre-populate.
Site Contact Email(Previous)
[e-mail]
Site Contact Email(NEW)*
[e-mail]
Site Contact Telephone No.(Previous)
910-642-5168
Site Contact Telephone No.(NEW)*
910-642-0161
Site Contact Mailing Address(Previous)
817 Washington St,0,Whiteville, NC 28472
Site Contact Mailing Address(NEW)*
Street Address
89 School Rd.
Address Line 2
City State/Province/Region
Hallsboro North Carolina
Postal/Zip Code Country
28442 United States
Additional Information for this update to contact information:

Addional Explanation
(Optional)
Requester's Name* Timmy Ward
Requester's Title* Maintenance Director
Requester's Columbus County Schools
Organization* Requester must be associated with Permittee Entity listed above
Requester's Email* Please enter a valid email address:
[e-mail]
A confirmation of submission will be e-mailed to this address.
Requester's Phone [phone]
Number*
* By checking the box and signing below, I certify that:
I have given true,accurate,and complete information on this form;
I am authorized to submit changes and updates to contact information associated with this NPDES construction
stormwater permit on behalf of the Permittee entity;
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 Legally Responsible Individual Change Change form,which also must be mailed in
with original signature);AND
I intend to electronically sign and submit this Construction Stormwater Permit Contact Update Request form.
Signature
�i�rirrJ�2td
Date and Time 02/21/2025
Signed
12:34:52 PM
Summary of Contact Names Pre-and Post-Submission for Review Purposes:
Legally Responsible Individual(Current) Legally Responsible Individual(As Submitted)
Jonathan Williams Timmy Ward
Prior to approval As it will be updated(if changes)
Site Contact Name(Current) Site Contact(As Submitted)
Jonathan Williams Timmy Ward
Prior to approval As it will be updated(if changes)
Billing Email(Current) Billing Email(As Submitted)
Prior to approval [e-mail]
As it will be updated(if changes)
Change Requested Timmy Ward (Maintenance Director)
by: Include any additional correspondence records in the Repository COC folder if needed.
Review Date 2/26/2025

i i

Georgoulias, Bethany
From: lase [e-mail]
Sent: Wednesday, February 26, 2025 8:25 AM
To: [e-mail]
Cc: Georgoulias, Bethany; Holloman, Tevye L; Williams, Jonathan
Subject: [External] Construction SW Permit Contact Information Update for NCC200197
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.
This email is to notify you that contact information has been updated for Tabor City PK-8 Grade School
Abatement Demolition +Soils Remediation, under COC No. NCC200197.You can review the
information in the permit folder in our Laserfiche Repository. Please note that original contacts have
been copied on this notification.
The following contact information is now associated with this permit record. If anything is in error, please
contact Bethany Georgoulias at bethan eorgoulias _ deq.nc.gov.
Legally Responsible Individual
Timmy Ward
[e-mail] 2.nc.us
910-642-0161
(Mailing Address) 89 School Rd., , Hallsboro, North Carolina, 28442, United States
(Street Address) 89 School Rd., , Hallsboro, North Carolina, 28442, United States
Site Contact
Timmy Ward
(Organization) Columbus County Schools
[e-mail] 2.nc.us
910-642-0161
(Mailing Address) 89 School Rd., , Hallsboro, North Carolina, 28442, United States
Billing Contact (if available)
[e-mail] 2.nc.us
9106420161
This change was requested by:Timmy Ward (Maintenance Director) on 2/21/2025
Additional Information(if provided):
Be sure to add laserfiche.ncdenr.gov@mccic loud.io to your contacts to avoid future e-mails about this
application from going into Spam filters.
The NC DEMLR Stormwater Program
512 N. Salisbury Street,Archdale Building 6th Floor, 1612 Mail Service Center, Raleigh, NC 27699-1612
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This email was automatically generated by Laserfiche. Please do not respond to this email address, as
responses are not monitored.
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