NC0086975_owner (name change)_20231219

NORTH CAROLINA
Environmental Quality
NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NPDES PERMITTING
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NCO086975 or
1. Facility Name: Laurel Road WTP — Carteret County
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
_X_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):
Carolina Water Service, Inc. of North Carolina
3. New owner's or signing official's name and title: Tony Konsul
(Person legally responsible for permit)
Director, State Operations
(Title)
4. Mailing address: P.O. Box 240908 City: Charlotte
State: NC_ Zip Code: 28224-0908 Phone: [phone]
E-mail address: Tonv.Konsul(@carolinawaterservicenc.com
III. FACILITY AND DISCHARGE INFORMATION
1. Will the waste stream for the facility remain the same asunder the previous owner? Yes ❑x No ❑
2. Will the treatment system and discharge location remain the same? Yes ❑x No ❑
"No Responses"
If either or both of these questions are answered "No" then more information will be needed to review the
request. Please attach documentation to describe and explain the changes to the facility activities, waste
stream, treatment process or outfall location. The Division may not be able to process the Permit
Name/Ownership Change request and may require that the new owner file a new permit application.
North Carolina Department of Environmental Quality I Division of Water Quality
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
uawamenfo7inrnonmvnmou.ney
919.707.9000

NPDES Name and Ownership Change
Page 2 of 2
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)
3. Information to document facility, waste stream, treatment system or outfall changes as noted in
item III above (if appropriate)
Applicant's Certification:
I, Tony Konsul , 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. I understand that Permit Name/Ownership Change can only take place through
action taken by the Division of Water Resources and that no actions on my part or the part of my
company result in the automatic transfer of permit coverage.
Digitally signed by Tony Konsul
D N : OU="Director, Slate Operations", O=Carolina Water Service
Tony Ko n s u I of Reason:
Carolina vinTony Konsul, nt Tony Konsul@
carol I nawaterservicenc.com
Reason: I am approving this document
Location: 5821 Fairview Road, Charlotte NC 28209
Signature: FDoxittPDFR aderlVerrsio8112'012 Date: 12/18/2023
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 07/2021