NC0001406_Ownership Change_20080213

Harnett
COUNTY
NORTH CAROLINA
February 13, 2008
NCDENR/Division of Water Quality
Attn: Coleen H. Sullins
Surface:WaterProtection Section
1617 Mail Service Center
Raleigh, NC 27699L1617
auali
`ft On p,
AWINA e
MEMBER
Public Utilities Department
RECEIVED
Re: Town of Erwin WWTP #2 Ownership Change
Dear Ms. Sullins,
FEB 202009.
DENR WATER QUALITY
POINT SOURCE BRANCH
www.harnett.org
PO Box 1119
308 West Duncan Street
Lillington, NC 27546-1119
ph: 910-893-7575
fax: [phone]
The reason for the length of time between the Erwin Town Manager's signature and Harnett
County Department of Public Utilities' signature is due to the fact that Bill of Sale and
Assignment was just completed.
If you have an • ue ions, please do not hesitate to contact m
Sincerely
odney M. Tart
HCDPU Director
RMT/ckm
strong roots • new growth

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IJRF.
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
E/OWNERSHIP . -.40
Please enter the permit number for which the change is requested.
NPDES Permit (or)
N
0
0
0
1
4
0
6
Permit status prior to status change.
a. Permit issued to (company name):
b. Person legally responsible for permit:
c. Facility r�ame,(ischarge):
d. Facilitya diess:
DENIR`J���T�� IlJA! ITY
P05?4TrW t r o 'CH
Coleen H. Sullins, Director
Division of Water Quality
Certificate of Coverage
N
C
G
Town of Erwin
First
S . A.c is on
MI Last
Title
PO Box 459
Permit Holder Mailing Address
Erwin NC 28339
City State Zip
(rtto ) 53S'1-54: () 4341-sS43
Phone Fax
en -of Erwin WWTP #2
20
Erwin
Address -106 SOu- "Z. 0-v4A SA _
NC 28339
City State Zip
kk k isc,t-N
First / MI / Last Phone
t0) tkgf(
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: El Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
Harnett County Public Utilities
Rodney M Tart
First MI Last
Director Of Public Utilities
Title
PO Box 1119
Permit Holder Mailing Address
Lillington NC 27546
City
(910) 893- 7575
Phone
State
[e-mail]
E-mail Address
Erwin WWTP-#2
Zip
Address
City
Charles
First
[phone]
State
L
MI
[e-mail]
Zip
Fiero
Last
Phone
E-mail Address

PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: Rodney M Tart
First MI Last
Director, Public Utilities
V.
VI.
Title
PO Box 1119
Lillington
City
Mailing Address
NC 27546
State Zip
[phone] rtartharnett.org
Phone E-mail Address
Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
, aitestarat`t)us application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature
APPLICANT CERTIFICATION
I, Rodney M. Tart, attest that this application for a name/ownership change has been reviewed and is
accurate and complet • o the best of my knowledge. I understand that if all required parts of this
application are no .mpleted and that if all required supporting information is not included, this application
package will be rned as incomplete.
1l -Q,Citya
Date
Signature Da
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617