NC0090158_Owner (Affiliation Change)_20240124

ROY COOPER
Water Resources
ENVIRONMENTAL QUALITY
MICHAEL S. REGAN
LINDA CULPEPPER
i, ,,n,_.,,
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NCO0 9 / 0 / 1 / 5 / 8
1. Facility Name: W Carson Blvd & S. Tryon Street
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
1 a. Change in ownership of property/company
b. Name change only
c. Other (please explain
2. New owner's name (name to be put on permit):
CC TREA Carson Station, LLC
or NCG5 / / / /
3. New owner's or signing official's name and title: Sagar Rathie
(Person legally responsible for permit)
Managing Director
(Title)
4. Mailing address: 601 South Tryon Street, Suite 800 City: Charlotte
State: NC Zip Code: 28202 Phone: (919 ) 949-9229
E-mail address: srathieacrescentcommunities.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/di vi s ions/water-resources/water-resources-penni ts/wastewater-brancli/npdes-wastewater-permits

NPDES Name & Ownership Change
Page 2 of 2
Applicant's Certification:
1, Sagar Rathie , 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 requiredVereptur�nedas
ormation and attachments are not included, this application
package willcomplete.
Signature:
Date: 1/8/2024
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 1112017