NC0063096_Signature Authority_20240920

Docusign Envelope ID 4C283373-E047-4CF1-B2B1-2F5BD673AD34
September 16,2024
RECEIVED
Wastewater Branch
Water Quality Permitting Section CCD 2 0 2024
Division of Water Resources
1617 Mail Service Center
Raleigh,NC 27699-1617 NCDEQ/DWR/NPDES
Subject: Delegation of Signature Authority
HOLLY SPRINGS WWTP
NPDES Permit Number NC0063096
To Whom It May Concern:
By notice of this letter, I hereby delegate signatory authority to each of the following individuals for all
permit applications, discharge monitoring reports, and other information relating to the operations at
the subject facility as required by all applicable federal, state, and local environmental agencies
specifically with the requirements for signatory authority as specified in 15A NCAC 2B.0506.
Individual #1 Individual #2 (if applicable)
Name: Rachel Ingham
Interim Deputy Director Of Water
Title: Resources
128 S. Main St,
Mailing Address: Holly Springs,Nc 27540
Physical Address: 150 Treatment Plant Rd.
(if different) Holly Springs,Nc 27540
Email Address: [e-mail]
Office Phone: 919 - 577 - 3151 - -
Mobile Phone: 919 - 501 - 0741 - -
If you have any questions regarding this letter, please feel free to contact me at
[e-mail].
Sincerely,
,--DocuSigned by:
11..L.✓,, Q
"—A3B6E125C87C4AE
Kendra D. Parrish,P.E.
Executive Director Of Utilities And Infrastructure
Town of Holly Springs,PO Box 8 1 128 S Main Street l Holly Springs,NC 27540
[e-mail]
919-577-3935
cc: Raleigh Regional Office, Water Quality Permitting Section

Docusign Envelope ID.4C283373-E047-4CF1-B2B1-2F5BD673AD34
ROY COOPER
MICI-IAEL S. REGAN
LINDA CULPEPPER
Water Resources
ENVIRONMENTAL QUALITY
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NCO() 6 / 3 / 0 / 9 / 6 or NCG5 / / / /
1. Facility Name: Holly Springs WVVTP
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
a. Change in ownership of property/company
b. Name change only
_X_c. Other(please explain): Change in Owner Contact Person, Facility Contact Person, and
Persons with Signatory Authority. Please remove Seann Byrd from this permit#and replace
with the following.
2. New owner's name (name to be put on permit):
3. New owner's contact or signing official's name and title: Rachel Ingham
(Person legally responsible for permit)
Interim Deputy Director of Utilities and Infrastructure
(Title)
4. Mailing address: PO Box 8 City: Holly Springs
State: NC Zip Code: 27540 Phone: (919) 577-3151
E-mail address: rachel.inghamAhollyspringsnc.qov
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
91'9 807 6300 919-807-6389 FAX
https://deq.n c.gov/abo ut/drvi sion s/water-resou rceshvater-resources-perm i is/wastewater-bran ch/npdes-wastewater-permits

Docusign Envelope ID:4C283373-E047-4CF1-B2B1-2F5BD673AD34
NPDES Name&Ownership Change
Page 2 of 2
Applicant's Certification:
Kendra Parrish
, 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.
c DocuSIgned by
ul, 9/17/2024 1 8:56 AM PDT
Signature: Date:
—A.3Bbt 12b1.8/IAAt.
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

North Carolina Department of Environmental Quality
Division of Water Resources
Permit Number: NC0063096
Permit Type: Municipal Wastewater Discharge, Large
Facility Name: Holly Springs WWTP
Facility Addressl: 150 Treatment Plant Rd
Facility Address2:
City,State&Zip: Holly Springs, NC 27540
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: Town of Holly Springs
Owner Type: • Government-Municipal 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: Kendra D Parrish Title: Executive Director of Utilities&Infrastructure
Addressl: P0 Box 8
Address2:
City,State&Zip: Holly Springs, NC 27540-0008 •
Work Phone: [phone] Fax:
Email Address: [e-mail]
Owner Contact Person(s)
Contact Name Title Address Phone Fax Email
Seann Byrd Deputy Director of PO Box 8, Holly Springs, NC 919-577-3151 seann.byrd@hollysprings
Utilities& 27540-0008 nc.us
Infrastructure
• Services
Theresa Randall Asset 919-567-4009 theresa.randall©hollyspri
Management/ADA ngsnc.gov
Coordinator
•
Facility Contact Person(s) _
Contact Name Title Address Phone Fax Email
Seann Byrd PO Box 8, Holly Springs, NC 919-577-3151 919-577-2280 seann.byrd@hollysprings
27540-0008 nc.us
Permit Contact Person(s)
Contact Name Title Address Phone Fax Email
Permit Billing Contact Person(s)
Contact Name Title Address Phone Fax Email
Kendra D Parrish PO Box 8, Holly Springs, NC 27540-0008 919-557-3933 kendra.parrish@hollysprin
gsnc.gov
Persons with Signatory Authority
Type Contact Name Title Address Phone Fax Email
Permit Seann Byrd PO Box 8, Holly Springs, NC 919-577-1090
27540-0008
9/16/2024 Pau" 1

Permit Number: NC0063096
Permit Type: Municipal Wastewater Discharge,Large
Facility Name: Holly Springs WWTP
Facility Addressl: 150 Treatment Plant Rd
Facility Address2:
City,State&Zip: Holly Springs, NC 27540
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 th
designated operators. For all other operator questions or issues,please call 919-807-6353.
Facility Classification: WW4.
Operator Name Role Cert Type Cert Status Cert# Effective Date
Casey M Denton ORC WW-4 Active 1001109 12/1/2021
Terry Ray Foster Backup WW-4. Active 992459 12/1/2021
Jeremy Charles Monroe Backup WW-4 Active 1009175 8/1/2022
9/16/2024 L. 2