WQ0038703_Permit (Modification)_20170727

Water Resources
Environmental Quality
July 27, 2017
Patrick C. Jennings
Old North Utility Services
193 Armistead Street
Fort Bragg NC 28307
SUBJECT: Change of Ownership Approval
Permit No. WQ0038703
PN 61064 — SOF Upgrade Training Facility
Moore County
Dear Mr. Jennings:
ROY COOPER
Governor
MICHAEL S. REGAN
Secrermv
S. JAY ZIMMERMAN
Dig ecror
Division personnel have reviewed and approved your permit modification request on July 12, 2017 for Permit No.
WQ0038703. This modification is to change ownership from Moore County to Old North Utilities Services,
effective July 17, 2017, is now responsible for the continued operation and maintenance of the subject wastewater
collection extension. Our database has been revised to reflect the ownership change.
This approval letter shall be considered part of the permit and is therefore incorporated by reference. Other than
ownership transfer, this modification includes no changes to the originally issued permit on September 22, 2016 and
is subject to the conditions and limitations specified therein.
The Permittee shall maintain compliance with its individual system -wide collection system permit for the operation
and maintenance of these facilities as required by 15A NCAC 2T .0400 and G.S 143-215.9B. If an individual permit
is not required, the performance criteria as required by 15A NCAC 02T .0403shall be met. If you have any other
questions regarding this matter please contact Johnathan Watts by phone at [phone] and by email at
Johnathan. watis(h?ncdenr.gov.
Sincerely,
for Jay Zimmerman, Director
Division of Water Resources, NCDEQ
enclosures: WQ0038703 , 15A NCAC 02T .0403
cc: Water Resources Central Files — WQ0038703
PERCS Files (electronic copy)
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State of North Carolina I Environmental Quality
225 Green Streek Suite 714 i Fayetteville. North Carolina 28301
910-433-3300

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J U L 12 2017 State of North Carolina
Department of Environmental Quality
WQRO S Division of Water Resources
DWR.—AYET iT EVIL.L.[ cr;�nAi c�i' SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16
This form is for ownership changes or name changes of a sewer system permit. Please note that "Permitee" 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 .01061b). 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
❑ Approved board minutes
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
❑ Per I SA 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).
❑ 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 .01 15(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: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1636 SUITE 925
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page I of I

DWR
Mvlslon of Water Resources
I. EXISTING PERMITTEE INFORMATIONN:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
INSTRUCTIONS FOR FORM: PNOCF 01-16
1. Pennittee's name: Moore County
2. Signature authority's name: Randy Gould, P.E. per 15A NCAC 02T .0106(b)
3. Signature authority's title: Public Works Director
4. Permittee's mailing address: PO Box 1927
City: Carthage' State: NC Zip: 28327-_
5. Permittee's contact information: Phone number: (910) 47-6315 Fax Number 910 947-1992
Email Address: r og uldAmoorecountvnc.g_o_v
11. APPLICANT INFORMATION:
1. Applicant's name: Old North Utility Services
2. Signature authority's name: Patrick C. Jennings per 15A NCAC 02T .0106(b)
3. Signature authority's title: Senior Engineer
4. Applicant's mailing address: 193 Armistead Street
City: Fort Bragg NC State: NC Zip: 28307
5. Applicant's contact information: Phone number: 336) 686-4886 Fax Number (_)
Email Address: patick.jenningsAasusinc.com
6. Representative's name: same as applicant
7. Representative's title:
8. Representative's contact information
III. PERMIT INFORMATION:
Phone number: �) _-_ Fax Number �)
Email Address:
1. Existing permit number: W00038703 and most recent issuance date: September 22, 201a�
2. Reason for the permit application: Other 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 I of 2

IV. (;ERTIFICATIONS:
Existing Permittee's Certification per 15A NCAC 02T ,0106(b):
I, Randy Gould P-E. Public Works Director 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 e as evil p ie $25,0 0 r violation.
Signature: Date:
1 � ,117
Applicant's Certification per 15A NCAC 02T .0106(b):
I, Patrick C. Jennings Senior Engineer attest that this application
(Signature Authority's name & title from Application Item H.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. 1 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.
SignaWre: _ Date:2017.07.11 Date: 07/11/2017
11:08:01-04'00'
FORM: PNOCF 01-16 Page 2 of 2