WQCS00331_Owner (Affiliation Change)_20240702

North Carolina Department of Environmental Quality
Division of Water Resources
Permit Number: WQCS00331
Permit Type: Collection system management and operation
Facility Name: Belvedere Plantation Collection System
Facility Addressi:
Facility Address2:
City, State & Zip:
Owner Information Details:
MUST submit a Change of Name/Ownership form to DWR to make any changes to this Owner information.
(Click Here for "Change of Name/Ownership Form)
Owner Name: Carolina Water Service Inc of North Carolina
Owner Type: Non -Government Owner Type Group: Organization
*** Legally Responsible for Permit ***
(Responsible corporate officer/principle executive officer or ranking elected official/general partner or proprietor;
or any other person with delegated signatory authority from the legally responsible person.)
Owner Affiliation: Gary Mack Peacock Title: Director Operations of
Addressl: PO Box 240908
Address2:
City, State & Zip: Charlotte, NC 28224-0908
Work Phone: [phone] Fax:
Email Address: [e-mail]
If any information related to specified contact persons is incorrect or no longer valid, please contact the regional office with jurisdiction
for your facility. Changes must be requested by an individual with signature authority in accordance with 15A NCAC 02T.0106.
Information and area of coverage for regional offices can be obtained at https://deg.nc.gov/contact/regional-offices.
Owner Contact Person(s)
Contact Name Title Address Phone Fax Email
Travis Dupree VP Project 130 S Main St, Ste 800, Greenville, SC 864-203-0233 Travis. [e-mail]
Management & 29601 m
Engineering
Tony Konsul Operations Director 4944 Parkawy Plaza Blvd Ste 375, 704-319-0523 704-525-8174 tony.konsul@carolinawat
Charlotte, NC 28224-0908 erservicenc.com
Donna Stegall Admin. Assistant PO Box 240908, Charlotte, NC 28224 704-319-0506 donna.stegall@carolinaw
aterservicenc.com
Facility Contact Person(s)
Contact Name Title Address Phone Fax Email
Permit Contact Person(s)
Contact Name Title Address Phone Fax Email
Tony Konsul Regional Manager PO Box 240908, Charlotte, NC 704-319-0523 704-525-8174 Tony.Konsul@carolinawa
28224-0908 terservicenc.com
Permit Billing Contact Person(s)
Contact Name Title Address Phone Fax Email
Matthew Klein 5821 Fairview Rd Ste 302, Charlotte, 704-525-7990
NC 28209
7/1/2024 Page 1

Permit Number: WQCS00331
Permit Type: Collection system management and operation
Facility Name: Belvedere Plantation Collection System
Facility Addressl:
Facility Address2:
City, State & Zip:
Persons with Signatory Authority
Type Contact Name Title
Address
Phone Fax
Email
Permit Dana Hill
PO Box 240908, Charlotte, NC
252-269-2540
dana.hill@carolinawaters
28224-0908
ervicenc.com
Owner Brent Milliron
PO Box 240908, Charlotte, NC
704-319-0504
brent.milliron@carolinaw
28224-0908
aterservicenc.com
Permit J Bryce VP of Operations
444 Parkway Plz Blvd Ste 375,
704-319-0517
Mendenhall
Charlotte, NC 28217
Permit Tony Konsul
PO Box 240908, Charlotte, NC
704-525-7990
28224-0908
Permit Gary Mack
PO Box 240908, Charlotte, NC
828-242-7588
gary.peacook@carolinaw
Peacock
28224-0908
aterservicenc.com
Designated Operators
If the designated operators listed below are incorrect or no longer associated with the collection system, the information can be updated by s
"Operator Designation Form" (Click Here for ORC Designation Form). Please provide specific details as to the changes requested, including ft
designated operators For all other operator questions or issues, please call 919-807-6353,
Facility Classification: CS2
Operator Name Role
Cert Type Cert Status
Cert #
Effective Date
Anthony Garland Futrell Backup
CS-4 Active
1009027
11/1/2021
Stacy Allen Goff Backup
CS-3 Active
999872
11/1/2021
Mathew Golden Backup
CS-2 Active
1002998
11/1/2021
Dana D Hill Backup
CS-4 Active
1009343
5/1/2021
7/1/2024 Page 2