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Home My WebLink AboutNC0020737_Legally Responsible 2016_20160610 NCDENR North Carolina Department of Environment and Natural Resources Division of Water Resources Pat McCrory Donald R.van der Vaart Governor WATER QUALITY PERMITTING SECTION Secretary PERMIT NAME/OWNERSMP CHANGE REQUEST This form is for ownership changes or name changes of NPDES wastewater permits. • "Permittee"references the existing permit holder • "A licanf'references the entity applying for the ownership/name change 1. NPDES Permit No.(for which the change is requested): N C 0 0 2,0137 or Certificate of Coverage#: N C Ci rJ If. Existing Permittee information: a. Permit issued to(company name): t�(f e) J�j/16V, A",.. //",//`t/' b. Person legally responsible for permit: 41 e�� (�VllS Fvst � MI 1 � Last Pmt— lXtl'C« /f"P� r Title ermtt older Mailing Address cipfl State Zip (lay 1134--*5as ('k//) X30-•213a- ,�one Fax c. Facility name: ! t h2taceU)2dr.,U r 1;,i / d d. Facility's physical address: axef k 6d Address Ca State Zip e. Facility contact person: /j m _els (7049729 713l First / MI / Last Phone III. Applicant Information: a. Request for change is a result of: ❑ Change in ownership of the facility ❑ Name change of the facility or owner in If other please explain: � 1 b. Permit issued to(company name . c. Person legally responsible for permit: C C First MILast r-e�s i rBc_10r Title Permit Holder Mailing Address 9�11/1Pxs f&1z41jW M!', --28086 Cilly State l.zip /r a 7341-5�� I"(e_LLJ& :1�Xl JT l coo Phone E-mail Addkess Page I oft Revised 7/01/10/4 d. Facility name: �p{ t�p�oQ�((/&)0, p -]/mei l TCL[^ fi Y�f e. Facility's physical address: /( J3 Creek�la-� Address pe C�nj"m `y s_r /& f. Facilitycontact person: First MI Last �r/O Qr, Title ow_719- IGintn. fiA;L.!'AIL Phone E-mail Address IV. Will the permitted facility continue to conduct the same commercial/industrial activities conducted prior to this ownership or name change? ❑ Yes ❑ No(please explain) If applicable,the applicant shall submit a major permit modification request to DWR.A major modification shall be defined as one that increases the volume, increases the pollutant load,results in a significant relocation of the discharge point,or results in a change in the characteristics of the waste generated. V. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE INCOMPLETE OR MISSING: 1. This completed application is required for both name change and/or ownership change requests. 2. Legal documentation of the transfer of ownership(such as relevant pages of a contract deed,or a bill of sale)is required for an ownership change request. Articles of incorporation are not sufficient for an ownership change. Applicable regulations:40 CFR 122.41,40 CFR 122.61 and 15A NCAC 02H.0114 ..................................................................................................................... The certifications below must be completed and signed by both the permit holder prior to the change(Permittee),and the new applicant in the case of an ownership change request. For a name change request,the signed Applicant's Certification is sufficient. PERMITTEE CERTIFICATION(Permit holder prior to ownership change): I,.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 is not included,this application package will be returned as incomplete. Signature Date APPLICANT C�CATION I, 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 inflo i 's not included,this application package will be returned as incomplete. Signature Date ++++++++++++++++++++++++++ PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO: Division of Water Resources Water Quality Permitting Section 1617 Mail Service Center Raleigh,North Carolina 27699-1617 NPDES PERMIT NAME/OWNERSHIP CHANGE REQUEST Page 2 of 2 Revised 7/01120/4 THE CITY OF KINGS MOUNTAIN q - P.O.BOX 429 • KINCS MOUNTAIN,NOKf H CAROLINA 28086 • 704734-0333 June 2, 2016 Wastewater Branch Water Quality Permitting Section Division of Water Resources 1617 Mail Service Center Raleigh,NC 27699-1617 Subject: Delegation of Signature Authority Pilot Creek Wastewater Treatment Facility NPDES Number NCO020737 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 monitory reports, and other information relating to the operations at Pilot Creek Wastewater Treatment Plant 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. Ricky C. Duncan Water Resources Director If you have any questions regarding this letter, please feel free to contact me at 704-734-0333. Sincerely, �� ,f7LO7ti G. Scott Neisler Mayor, City of Kings Mountain Cc: NCDWR Mooresville Regional Office, Water Quality Permitting Section The Historical City . _ THE CITY OF KINGS MOUNTAIN !' 11 BOX 429 • KINGS MOUNTAIN.,NORTH CAROLINA 28086 • 704-734-0333 June 2,2016 Wastewater Branch Water Quality Permitting Section Division of Water Resources 1617 Mail Service Center Raleigh,NC 27699-1617 Subject: Delegation of Signature Authority Pilot Creek Wastewater Treatment Facility NPDES Number NCO020737 To Whom It May Concern: By notice of this letter, 1 hereby delegate signatory authority to each of the following individuals for all permit applications,discharge monitory reports,and other information relating to the operations at Pilot Creek Wastewater Treatment Plant 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. Kim Moss Richelle Meek Wastewater Plant Supervisor/ORC Laboratory/Pre-Treatment Analyst City of Kings Mountain City of Kings Mountain P O Box 429 P O Box 429 200 Potts Creek Road 200 Potts Creek Road Kings Mountain,NC 28086 Kings Mountain,NC 28086 kimmnir.citvofkm.com richelle.meek( cityofkm.com 704-739-1731 (office) 704-739-1731 (office) 704-472-7472(mobile) 704-734-7851 (mobile) If you have any questions regarding this letter,please feel free to contact me at 704-7344525. Sincerely, Ricky C. Duncan Water Resources Director City of Kings Mountain P O Box 429 Kings Mountain,NC 28086 704-734-4525 (office) 704477-2928(mobile) Cc: NCDWR Mooresville Regional Office, Water Quality Permitting Section The Historical City