NC0040339_Owner (Affiliation Change)_20160216

Feb 11, 2016
Division of Water Resources
Water Quality Permitting Section RECEIVED/NCDEQ/DWR
1617 Mail Service Center FEB 16 2016
Raleigh, NC 27699-1617
Water Quality
Permitting Section
RE: B.H. Corpening Mountain Training Facility
NPDES Permit # NC0040339
Request change in the name of the Responsible Official
To whom it may concern:
Please find enclosed with this letter a request to change the name of
the Responsible Official for NPDES Permit # NC0040339. The individual listed,
David Lane, is no longer affiliated with the facility. Please update your records
accordingly so that we may proceed with eDMR Registration.
Thank you

A7:1111746,
RECEFEB- 1IVED/NCD62016EQ/DWR
®ENR Water Quality
North Carolina Department of Environment and Natural Resources ermltting Section
Division of Water Resources
Pat McCrory Donald R.van der Vaart
Governor WATER QUALITY PERMITTING SECTION Secretary
PERMIT 1NAME/OWNERSYIIP.CHANGE'REQUEST
This form is for ownership changes or name changes of NPDES wastewater permits.
• "Permittee"references the existing permit holder
o "Applicant"references the entity applying for the ownership/name change.
I. NPDES Permit No.(for which the change is requested): C 0 0 4 Il
or
Certificate of Coverage#: N C G 5
II. Existing Permittee Information:
a. Permit issued to(company name): North Carolina Forest Service
b. Person legally responsible for permit: David Lane
First MI Last
Responsible Official
Title
6065 Linville Falls Hwy
Permit Holder Mailing Address
Crossnore NC 28616-
City State Zip
( ) ( )
Phone Fax
c. Facility name: B.H. Corpening Mountain Training Facility
d. Facility's physical address: 6065 Linville Falls Hwy
Address
Crossnore NC 28616-
City State Zip
e. Facility contact person: David Lane ( )
First / MI / Last Phone
III. Applicant Information:
a. Request for change is a result of: 0 Change in ownership of the facility
0 Name change of the facility or owner
/f other please explain: New Responsible Official is managing the facility
b. Permit issued to(company name): North Carolina Forest Service
c. Person legally responsible for permit: Chaslty E'.chv
First MI Last
Title
60 min i1i
'emit Holder Mailing Address
land \t
-Ci y State Zip
(828) 733-42- chas t\..\1ebbncagr.go\
Phone E-mail Address
Page I ort Revised 7/01/2014

d. Facility name: B.H. Corpening Mountain Training Facility
e. Facility's physical address: 6065 Linville Falls Hwy
Address
Newland NC 28657-
City State Zip
f. Facility contact person: Chasity Webb
First MI Last
Facility Manager
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:
I. 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
reauired 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 I5A 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):
1, ,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 CERTIFICATION
1.Chasity Webb,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.
7 .• a
Kec._4
1W/(iti--- a/6?O115
1iSignature Date
******************xx xxxxxx
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 7/01/2014

• February 19,2015
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh,NC 27699-1617
Subject: Delegation of Signature Authority
B.H. CORPENING MAOUNTAIN TRAINING FACILITY WWTP
NPDES Permit Number NC0040339
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 26.0506.
Individual #1 Individual#2 (if applicable)
Name Ken Deaver Rachael Kramer
PAL: > `4' '` _ ' Compliance Manager
Title:, '= President, Kace Environmental, Inc.
mak: s d jam- Kace Environmental, Inc.
<Mitin : n ' 2905 Wood Road ¢r'2 2905 Wood Road
'Matlm Addressa ,
t - : �g rat Mooresboro,Nc 28114 . Mooresboro,Nc 28114
tPhysical flddress
FOrgingfirla [e-mail] [e-mail]
®ffice=l'lio e@: , 828-657- 1810 ri; 828 -657 - 1810
M813tle,PhonePA - - - -
If you have any questions regarding this letter, please feel free to contact me at 828.733.4242 or
[e-mail].
Sincerely,
Chasity Webb/
Facility Manager
6065 Linville Falls Hwy.,Newland,NC 28657
Chasity.Webb c@i Ncagr.Gov
828.733.4242
cc: Asheville Regional Office,Water Quality Permitting Section