NC0034932_Owner Name Change_20141208

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.
1. NPDES Permit No.(for which the change is requested): N C 0 0 3 4 9 3 2
or
Certificate of Coverage#:
g N C G 5
II. Existing Permittee Information:
a. Permit issued to(company name): Town of Tryon
b. Person legally responsible for permit: Jim Fatland
First M I Last
Town Manager
Title
301 N. Trade Street
Permit Holder Mailing Address
Tryon NC 28782-
City State Zip
[phone] [phone]
Phone Fax
c. Facility name: Tryon Middle School WWTP
d Facility's physical address: N.Harmon Field Court
Address
Tryon NC 28782-
City State Zip
e. Facility contact person: Deborah M. Bradley [phone]
First / MI / Last Phone
III. Applicant Information:
a. Request for change is a result of ❑ Change in ownership of the facility
El Name change of the facility or owner
If other please explain:
b. Permit issued to(company name): Town of Tryon
c. Person legally responsible for permit: Joey Davis
First MI Last
Town Manager
Title
301 N. Trade Street
Permit Holder Mailing Address
RECEIVED/DENR/DWR Tryon NC 28782-
DEC - 8 2014 City State Zip
[phone] [e-mail]
Phone E-mail Address
Water Quality
Page 1 oft Permitting Section Revised 7/01,2014
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December 1,2014
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh,NC 27699-1617
Subject: Delegation of Signature Authority
Tryon Wastewater Plant
NPDES Number NC0021601
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 Tryon Wastewater 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.
Deborah Bradley ORC
Ronnie Pack Back-up Operator
If you have any questions regarding this letter,please feel free to contact me at(828)859-
6654.
Sincerely,
Joey Davis
Town Manager
cc: NC DWR Asheville Regional Office,Water Quality Permitting Section
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