NC0028711_Signatory Authority_20151215

ATM
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory John E.Skvarla, III
Governor WATER QUALITY PERMITTING SECTION Secretary
PERMIT NAME/OWNERSHIP CHANGE REQUEST
This form is for ownership changes or name changes of NPDES wastewater permits.
• "Permittee"references the existing permit holder
• "Applicant"references the entity applying for the ownership/name change.
I. NPDES Permit No.(for which the change is requested): N C 0 0 2 8 7 1 1
or
Certificate of Coverage#: N C G 5
II. Existing Permittee Information:
a. Permit issued to(company name): Mecklenburg County Schools
b. Person legally responsible for permit: George M Jones
First MI Last
Director of Maintenance, Engineering & Energy
Management
RECEIVED/DENR/DWR Title
3301 Stafford Drive
DEC 1 5 201 Permit Holder Mailing Address
Charlotte NC 28208-
Water Quality City " State - Zip
• Permitting Section [phone] [phone]
Phone Fax
c. Facility name:- Berryhill Elementary School WWTP
d. Facility's physical address: 10501 Windy Grove Road
Address
x,
Charlotte NC 28278-
x r �;4 ;' City State Zip
e. Facility contact person: Jeffery G. Mitchell [phone]
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
if other please explain: Name of road needs to be updated as well as name change of owner.
b. Permit issued to(company name): Charlotte-Mecklenburg Board of Education
c. Person legally responsible for permit: George M • Jones
First MI Last
Director of Maintenance, Engineering& Energy
• Management - .
Title
3301 Stafford Drive
• Permit Holder Mailing Address
Charlotte NC 28208-
City State Zip
Page 1 of 2 Revised 7/01/2014

Phone E-mail Address
d. Facility name: Berryhill Elementary School WWTP
e. Facility's physical address: 10501 Windy Grove Road
Address
Charlotte NC 28208
City State Zip
f Facility contact person: Jeffery G Mitchell
First MI Last
Environmental, Health & Stewardship Specialist
Title
[phone] [e-mail]
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,Mark Jones, 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.
W441 //Y2' /026/
ignature Date
APPLICANT CERTIFICATION
•
-I,Jeff Mitchell,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
**************************
•
- • PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO: •
-
Division of Water Resources
NPDES PERMIT NAME/OWNERSHIP CHANGE REQUEST
Page 2 of 2 Revised 7/01/20/4

eDMR Owner Verification Report
Permit No. : NC0028711 Version: 4.00 Permt Status: Active
Owner/Permittee : Mecklenburg County Schools
Responsible Official: Mark Jones
Resp. Official Title:
Facility Name : Berryhill Elementary School WWTP
Facility Address: 10501 Walkers Ferry Rd
Charlotte, NC 28208
Registered for eDMR? : No
Facility Classification: WW-2 -
ORC Name Certification# Cert Status ORC Designation
Smith, James J. WW-4/ 1001846 Active ORC
Mitchell, Jeff G. WW-1 /996082 Active Backup
Moorer,Jevon L. WW-1 /993989 Active Backup
•
•
•
•
•
•Page#: 1
Date: 12/9/2015

Permit NC0028711
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provisions of North Carolina General Statute 143-215.1,other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,the
Charlotte-Mecklenburg Board of Education
- is hereby authorized to discharge wastewater from a facility located at the
Berryhill Elementary School WWTP
10501 Windy Grove Road
West of Dixie
Mecklenburg County
to receiving waters•designated as the Catawba River(Lake Wylie)in the Catawba River Basin •
in accordance with effluent limitations,monitoring requirements, and other conditions set forth in Parts
I, II, III and IV hereof.
This permit shall become effective August 1, 2015.
This permit and authorization to discharge shall expire at midnight on June 30, 2020.
Signed this day July 24, 2015
'rn-
_
S, Zimmerman, L.G., Director
)�sion of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 6

1617 Mail Service Center
Raleigh, North Carolina 27699-1617
•
NPDES PERMIT NAME/OWNERSHIP CHANGE REQUEST
Page 3 of 2 Revised 7/01/2014