NC0026271_Owner (Affiliation Change)_20240112

ROY COOPER
Via-=- Gorrrna,•
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g, MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Water Resources G,lerrrn D,ree,a,
ENVIRONMENTAL QUALITY
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION: LoQc.SoOl`?5
2
Permit Number: NC00 2 / 6 / 2 / 7 / 1 or NCG5 / / / /
1. Facility Name: Tavlorsville WWTP
H. NEW OWNER/NAME INFORMATION: RECEIVED
1. This request for a name change is a result of:
JAN Y 2 2024
a. Change in ownership of property/company
_x_b. Name change only
NCDEQ/DwR/NPDES
c. Other(please explain):
2. New owner's name (name to be put on permit):
Aaron Wike
3. New owner's or signing official's name and title: Aaron Wike
(Person legally responsible for permit)
Town Manager
(Title)
4. Mailing address: 67 Main Ave Drive City: Taylorsville
State:NC_ Zip Code: 28681 Phone: (828) 632-221.8
E-mail address: awike(a�tavlorsvillnc.com
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles of
incorporation, or sales agreement)
[see reverse side of this page for signature requirements]
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh,NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deq.nc.gov/about/divisions/water-resources/water-resources-perm its/wastewater-branch/npdes-wastewater-perm its

NPDES Name&Ownership Change
Page 2 of 2
Applicant's Certification:
I, ila cr , attest that this 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 and attachments are not included, this application
package will be returned as incomplete.
Signature: Date: I/,kozy
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 11/2017