WQCSD0522_Letter letting facility know they needd to complete a change of ownership form._20220830

ROY COOPER
Governor
ELIZABETH S. BISER
Secretory
RICHARD E. ROGERS, JR.
Director
CT Corporation System, Registered Agent
West Wood MHC, LLC
160 Mine Lake Ct.
Suite 200
Raleigh, NC 27615
NORTH CAROLINA
Environmental Quality
August 30, 2022
SUBJECT: Request to Complete Change of Ownership Form
Collection System Permit No. WQCSD0522
West Wood Mobile Home Park Collection System
Pitt County
Dear Permittee:
There has been a review of the Westwood Mobile Home Park Collection System (Permit No. WQCSD0522). Our
records indicate that the current ownership has changed and has not been updated since HDP, LLC owned the
facility. I have attached a change of ownership form with this letter or use the link below for access to the form.
https://deq. nc.gov/about/divisions/water-resources/water-quality-permitting/municipal-npdes-pretreatment-and-
col lection-system/col lection-systems/name-and-ownership-change
Please complete the form so that the transfer can be completed in a timely manner. If the form has not been
completed and returned by September 30, 2022, a Notice of Violation will be issued.
If you have any questions, please do not hesitate to contact Sarah Toppen with the Water Quality Section in
the Washington Regional Office at 252-946-6481 or via email at [e-mail].
Sincerely,
°act JcPP0(k--)
Sarah Toppen, Environmental Specialist
Water Quality Regional Operations Section
Washington Regional Office
Division of Water Resources, NCDEQ
Attachments: Name Change/Change of Ownership Form
Cc: Laserfiche
North Carolina Department of [nvhorvnno l Quality I DNlslon of Wale, Resources
Washlngion Regional Ofrce 194.3 Washington Square Man l Waah.Tons North Carolina 27889
tSL.946.M$l

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
INSTRUCTIONS FOR FORM: PNOCF 01-16
This form is for ownership changes or name changes of a sewer system permit. Please note that "Permittee" references the
existing permit holder, and that "Applicant" references the entity applying for the ownership/name change.
Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the subject field. This
form should not be used for permits with NC, NCG, SW or other types of non -sewer permits beginning with WQ.
For more information, visit the Division's Water Quality Permitting's website:
A. Sewer System Permit Ownership/Name Change (FORM: PNOCF 01-16) Application (All Applications):
❑ Submit an original completed and appropriately executed application (PNOCF 01-16).
❑ The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T
.0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T .0106(b).
❑ The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria
in 15A NCAC 02T .0106(b).
B. Existing Permit (All Applications):
❑ Submit a copy of the most recently issued permit and certification.
C. Property Ownership Documentation (All Applications):
➢ The Applicant shall demonstrate they are the owner of all property containing the sewer system facilities:
❑ Legal documentation of ownership (i.e., GIS, deed, article of incorporation, or contract), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
O Approved board minutes
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
O Per 15A NCAC 02T .0115(a)(1), provide one copy of the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non -discharge system.
E. Operational Agreements (Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to be
sold):
➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit an original properly executed Operational Agreement (FORM: HOA).
O Per 15A NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws that contain the language required by the Operational Agreement.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit an original of the properly executed Operational Agreement (FORM: DEV).
F. Package Submitted in Duplicate
❑ Submit a copy of all required documents in Instructions A-E as required
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE
TO:
NCDEQ - DWR
Water Quality Permitting Section
PERCS Unit
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY ST.
SUITE 925
RALEIGH, NORTH CAROLINA 27604
INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
INSTRUCTIONS FOR FORM: PNOCF 01-16
I. EXISTING PERMITTEE INFORMATION:
1. Permittee's name:
2. Signature authority's name: per 15A NCAC 02T .0106(b)
3. Signature authority's title:
4. Pennittee's mailing address:
City: State: Zip:
5. Permittee's contact information: Phone number: ( ) _- Fax Number ()
Email Address:
II. APPLICANT INFORMATION:
1. Applicant's name:
2. Signature authority's name: per 15A NCAC 02T .0106(b)
3. Signature authority's title:
4. Applicant's mailing address:
City: State: Zip:
5. Applicant's contact information: Phone number: (_) _ Fax Number (_) _-
Email Address:
6. Representative's name:
7. Representative's title:
8. Representative's contact information Phone number: (_) - Fax Number ( ) -
Email Address:
III. PERMIT INFORMATION:
I. Existing permit number: and most recent issuance date:
2. Reason for the permit application: Select If other, attach detailed explanation
3. Has the facility been constructed? ❑ Yes or ❑ No
4. Has the facility been certified per 15A NCAC 02T .0116? ❑ Yes or ❑ No
FORM: PNOCF 01-16 Page 1 of 2

IV. CERTIFICATIONS:
Existing Permittee's Certification per 15A NCAC 02T .0106(b):
I, attest that this application
(Signature Authority's name & title from Application Item I.2 & 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, I will continue to be responsible for compliance with the current permit and any discharge of wastewater
from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will also make no claim against the Division of Water Resources should a condition of the existing permit
be violated. I also understand that if all required parts of this application are note completed and that if all required supporting
information and attachments are not included, this application will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date:
Applicant's Certification per 15A NCAC 02T .0106(b):
I, attest that this application
(Signature Authority's name & title from Application Item II.2&3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into
the Applicant's name, I will be responsible for compliance with the issued permit and any discharge of wastewater from this non -
discharge system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition of this permit be violated.
I also understand that if all required parts of this application package are not completed and that if all required supporting information
and attachments are not included, this application package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date:
FORM: PNOCF 01-16 Page 2 of 2