The URL can be used to link to this page

Home My WebLink AboutNCG020853_Owner Affiliation Change_20250529 D_a Q� NPDES Stormwater Permit Contact Update Request NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number. Number* NCG020853 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* Twiford IV LLC Facility Name* Rose Pit County* Pasquotank Check permit contact information for your permit by running a Stormwater Permit Summary Report (https://reports.ncdenr.org/BOE/Open Document/2002150408/CrystalReports/viewrpt.cwr? id=585684&apsuser=Bl MS_U&apspassword=bl OMs_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 p 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 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* Value is required. pdf only 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 David W Cross E-mail Address* david@crossre.com Phone No.* 2522027653 Mailing Address* 125 Woodwinds Industrial Ct Cary NC 27511-6240 Physical Address If different than mailing address Submitter's Name* Please enter your FIRST and LAST name David Cross Phone Number* Please enter your phone number 252-202-7653 Any format is fine. Email Address* Please enter a valid e-mail address david@crossre.com A confirmation of submission will be e-mailed to this address. * p 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://mailto:bethany.georgoulias@deq.nc.gov). Submit