NC0089834_Draft Permit_20190206

,. ,,,?-i'",'' 7t,
ROY COOPER ' I i
Governor -6 \ ' e.nll a
MICHAEL S.REGAN . , �b
Secretary "4' `.0
LINDA CULPEPPER NORTH CAROLINA
Director Environmental Quality
February 6,2019
Mr.Tom Buller
Low&Bonar,Inc.
1301 Sandhill Road
Enka,NC 27828
Subject: Draft NPDES Permit NC0089834
Low&Bonar,Inc.
Physical Chemical Not Classified WPCS
Buncombe County
Dear Mr.Buller:
In response to your request to apply for the subject NPDES permit,the Division of Water Resources(DWR or the
Division)hereby transmits this draft for your review and comment.Please review this document to assure your
understanding of the permit limits and monitoring conditions,and to correct errors,if any.
Information for the engineering alternatives analysis(EAA)was received on June 15,2018,July 27,2018 and
October 23, 2018.The Division concurs that alternatives such as land application of wastewater,pump&haul,
water evaporator, and sewer connection are cost prohibitive and/or technologically infeasible as compared to a
NPDES discharge.
It our understanding that there have been personnel changes to this facility since the application was received.
Please make any necessary updates to owner and permit affiliations by completing the attached Name-Ownership
Change Form and Delegation of Signatory Authority Notification Form.These forms will be essential for
registering for electronic reporting(eDMR).Registration forms for eDMR and the forms mentioned above can be
downloaded from the following webpage: https://deq.nc.gov/about/divisions/water-resources/edmr/forms-and-
reports.
Concurrent with this notification,the Division will solicit public comment on this draft by publishing a notice in
newspapers having circulation in the general Buncombe County area, as required by the NPDES Program.Please
provide any comments to me via email [[e-mail]] or write to my attention care of DEQ/DWR/
NPDES Program no later than March 8,2019.Written comments are welcome but not mandatory.
Following the mandatory 30-day public comment period,the Division will review all pertinent comments on your
permit draft, and take appropriate action prior to issuing your NPDES permit final.
®^
owN a m9^w ���,- 512 NorthN Carolina
thSli
Department of Environmental Quality I Division of Water Resources
NO r1R,H ci.a orasbury Street 116I7 Mail Service Center I Raleigh.North Carolina 27699-1617
^iu,r�9ews� � 919 707.9000

Mr.Buller
February 6,2019
Page 2 of 2
If you have questions concerning this draft,please e-mail me or call my direct line(919) 707-3618.
Sincerely,
, ----;/1.41t,CorY:44.A.-44---
Derek Denard,Environmental Specialist
Division of Water Resources,NCDEQ
Enclosure:NPDES Permit NC0089834 (DRAFT)
hc: NPDES Program Files
ec: DWR/MRO,Landon Davidson[[e-mail]];Tim Heim[[e-mail]];
Linda Wiggs[[e-mail]]
WSS/Aquatic Toxicology Branch,Susan Meadows[[e-mail]];Cindy Moore[[e-mail]]
Daniel March,Pisgah Environmental Services,LLC[[e-mail]]
Tom Buller,Low&Bonar Inc.[[e-mail]]

NPDES Permit NC0089834
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE,ELIMINATION SYSTEM
(NPDES) e
In compliance with the provisions of North Carolina'General Statute l43-215.1, other lawful standards
and regulations promulgated and adopted by/the North Carolina E vironmental Management
Commission, and the Federal Water Pollution Control Act, s amended,
Lo'w & Bonar, Inc.
is hereby authorized to discharge wastewater from,a facility located at
Low & Bonar Inc;.-
<'1301`�Sandhill\Road;Enka 2:8728
Vlit. be(C\o\ unty
to receiving waters-designated as�an innamed t\butarry to,Hominy Creek in the French Broad River
Basin in accordance with effluent limitations,monitornng requirements, and other conditions set forth
in Parts`I, III, and IV hereof.
\\\\ • \
This permit shall become effective , 2019.
\\\\ ) )
This permit and authorization to disc arge shall expire at midnight on , 2024.
Signed this day , 2019.
Linda Culpepper, Director
Division of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 8

NPDES Permit NC0089834
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked. As of this permit issuance, any previously issued permit bearing this number is no longer
effective. Therefore,the exclusive authority to operate and discharge from this facility arises under the
permit conditions,requirements, terms, and provisions included herein.
Low & Bonar, Inc
is hereby authorized to:
1. to discharge water from non-contact cooling watl, cooling tower blowdow condensate,
groundwater from a dewatering system, and stormwater with wastewatei't eatment that includes
the following components:
• dichlorination equipment
o free chorine probes \\\
o a GC Formula 6600 Decchiorinator with con roller for addition of sodium bisulfite
o a 250-gallon surge tank
o a weir,overflow to pit
o a 500-gallonsump\pit
located at Low &Bo ar, Inc., 13011Sandhill Road, Enka, Buncombe County; and
2. dischargefrom said-treatment works via-Outfall 001 (flood gate to east ditch), at a location
specified on theeaattached mapinto an unnamed'tributary to Hominy Creek [Stream Segment 6-76],
currently a Class C wat body withii Subbasin 0403-02 [HUC 060101050503] of the French
Broad\ ver Basin.
Page 2 of 8

NPDES Permit NC0089834
PART I
A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B .0400 et seq., 02B .0500 et seq.]
Physical Chemical Not Classified Water Pollution Control System [15A NCAC 08G .0302]
During the period beginning on the effective date of the permit and lasting until expiration,the Permittee is
authorized to discharge waters from non-contact cooling water, cooling tower blowdown, condensate, groundwater
from a dewatering system, and stormwater from Outfall 001 (flood gate to-east ditch). Such discharges shall be
limited,monitored and reported' by the Permittee as specified below/
EFFLUENT CHARACTERISTICS LIMITS MONITORING REQUIREMENTS 1
[parameter codes] Monthly Daily Measurement Sample Sample
Average Maximum Frequency Type Location2
Flow(MGD) 50050 Monitor&/Report \Continuous Recording E
Temperature(°C) 00010 See F�Footnote 3 Daily\\ Grab E,U&D
Total Residual Chlorine \
q /50060 \288 p,g/4 .) Weekly\ \Grab E
(TRC)(µg/L) `. )))
Not<6.0or">9.0 i
pH(su) 00400� ,\\standard uni s\ Weekly vGrab E
Oil&Grease(O&G)(mg/L)5
00556 \15.0 mg/.L 20.0 mg/L 2/Month Grab E
EPA Method 1664(SGT-HEM) \ \ \ \
Total Suspended Solids `"CO530 30.0ing/L 45.00mg/L \,/Month Composite E
(TSS)(mg/L) \ \ /
Chemical Oxygen Demand N \ \ \/ / ` '
(COD)(mg/L) \ 00\340 Monitor/ Report J 2/Month Composite E
Total Copper(µg/L)6 \\ 0�042L 114.43 µ �\ 17.91 µg/L7 Monthly Composite E
v
Total Zin5,@ L))6 �\ \ 01092 213 µ8 g//L \\�13.8 µg/L7 Monthly Composite E
Total Molybdenum(µg/L)8\\ 01\62\ Monitor)&Report Monthly Composite E
Hardness Total as \\ \ 6 0090 Monitor&Report Quarterly Composite E
[CaCO3 or(Ca+Mg)] (mg/1) \
Hardness-Total`as \
[CaCO3 or(Ca+Mg)] (ing/1)8 100900 Monitor&Report Quarterly Grab U 8
Total Nitrogen(TN)(mg/L\ /)c0600 Monitor&Report Semi-annually Composite E
Total Phosphorus(TP)(mg/L\ /C0665 Monitor&Report Semi-annually Composite E
TGP3B
Chronic Toxicity 9 711P3B See Footnote 9 Quarterly Composite E
Organics,Total Purgeables(VOCs)
(EPA Method 624)(µg/L) 10 76029 Monitor&Report Annually Composite E
Base Neutrals&Acids(Semi-VOCs)
(EPA Method 625)(µg/L)
10 76028 Monitor&Report Annually Grab E
Footnotes:
1. The Permittee shall submit Discharge Monitoring Reports electronically using NC DWR's eDMR application
system. See Condition A. (5.).
2. E=Effluent(Outfall 001 -flood gate to east ditch);U=Upstream(UT to Hominy Creek) 100-feet west of
Outfall 001; D=Downstream(UT to Hominy Creek) 300-feet north of Outfall 001.
Page 3 of 8

NPDES Permit NC0089834
3. The temperature of the effluent will be regulated so that the temperature of the receiving stream does not
increase more than 2.8°C above the natural water temperature.Receiving water temperature shall not exceed
a maximum of 29°C due to the facility's operation.
4. The Division shall consider all effluent TRC values reported below 50 µg/1 to be in compliance with the
permit.However,the Permittee shall continue to record and submit all values reported by a North Carolina
certified laboratory(including field certified), even if these values fall below 50 µg/l.
5. EPA method 1664(Revision A or B)using Silica Gel Treated N-Hexane Extractable Material(SGT-HEM;
Non-polar Material)by Extraction and Gravimetry shall be used to monitor for Oil&Grease.
6. Effluent hardness sampling should be performed in conjunction with/sampling for hardness dependent metals
(Copper,Zinc).
7. Compliance with this limit shall commence on , approximately 48 months from the permit
effective date. See Compliance Schedule Condition A. (2). /
8. The Permittee shall sample instream hardness,upstream of the facility's discharge. The sample shall be
representative of the hardness in the receiving stream. y
9. Chronic Whole Effluent Toxicity(WET)testing(Cerzoda hnia dubia):�/-day chronic pass/fail test;permit
limited; at 57%in January,April,July, and Oct�eT Se Condition A. (4).
10. For the eDMR application system, any detections shall be reported by entering"1'\[Yes (Y)=1] and no
detection shall be reported by entering"0" [NO (N)"0] Any detections for Tota 1%rgeables Organics
(EPA Method 624)or Base Neutrals&Acids(EPA�Me hod 625)'shall be noted in the comments section by
noting the compound detected and the'repo ted concentrat l eion.,Laboratory reports shal kept on file in
accordance with records retention requirements found in P II. Section D. 6.
Conditions: \\\\ NN` \
• There shall be no discharge of floating solids or visib e foam other than trace amounts.
A. (2.) SCHEDULE OF,CO 'PLIANCE (OUTFALL 001)
[G.S:143-215.1(b)
1. Within o e year from-the day o permit the Permittee shall submit to the Division of Water
Resources a Corrective Action Plan summarizing the actions to be taken to achieve compliance with Total
Coppr\ad Total Zinc lix its at\Outfail\001\and a schedule of activities to implement the Plan.
2. Within two year from the effe tiv�e date of h�permit submit a report to the Division summarizing actions
taken in accordance with the Corrective Action Plan.
3. Within three years from the effective date of the permit submit a report to the Division summarizing actions
taken in accordance with the Corrective Action Plan.
4. Within four years fron the effectiveedate of the permit submit a report to the Division summarizing actions
taken in accordance with the�Corrective Action Plan.
5. Achieve compliance with Totalopper and Total Zinc limits specified in Section A. (2.)by .
Upon approval of the Corrective Action Plan by the Division,the report and actions become an enforceable part
of this permit.Any modifications to the schedule shall be requested to the Division at least ninety(90) days
before the deadline.Modifications to the schedule in excess of four months will be subject to public notice.
Page 4 of 8

NPDES Permit NC0089834
A. (3.) USE OF BIOCIDES - SPECIAL CONDITION
[G.S. 143-215, 143-215.1]
The Permittee shall obtain authorization from the Division prior to using any biocide in discharge from that
may be toxic to aquatic life. The Permittee shall notify the Director in writing no later than 90 days prior to
using any biocide not already approved for this facility. The Permittee shall provide such notification by
completing a Biocide Worksheet, Form 101 to include a map indicating the receiving stream and the effluent
discharge point. Concentrations of additives to biocides such as chromium, copper, or zinc shall not exceed
applicable water quality standards in the receiving stream, as determinedi y calculations using the Biocide
Work Sheet, Form 101 and the Supplemental Analysis Worksheet.
A (4.) CHRONIC TOXICITY PERMIT LIMIT (QUARTERLY)
[15A NCAC 02B .0200 et seq.]
The effluent discharge shall at no time exhibit observabl ' 'ibiti, on of r production or ignificant mortality to
Ceriodaphnia dubia at an effluent concentration of 57%.
'The permit holder shall perform at a mini um',�quarterly monitoring using test procedures outlined in the
"North Carolina Ceriodaphnia Chronic Effflluent Bioa ss ay Procedure"Revised December 2010, or subsequent
versions or"North Carolina Phase II Chronic` Vhole Effluent toxicity Test'Procedure"(Revised-December
2010) or subsequent versions.-T-he-t�sts will be performed du ni g.the months,of January,April,July and
October.These months s gasify the first month of'each threemonth oxicitytesYing quarter assigned to the
facility. Effluent sampling for this test g\must be obtaiped during repro e9tative effluent discharge and shall be
performed at the NPDES\permitted final effluent discharge'below all treatment processes.
If the test procedure perf�med•as the first�test of\single quarter results in a failure or ChV below
the permit limit,then multiple concentration testing stall be performed at a minimum,in each of the two
followingmonths`as'described in`:`North Caroli a Phased l)Chronic Whole Effluent Toxicity Test
Procedure"(Revised-December 201'0)or subsequ nt ve sions.
All toxicity results required as art of this ennit condition will be entered on the Effluent Discharge
Y g q \p � .P g
Monitoring Form(MR-1)for the m,onths in which tests were performed,using the parameter code TGP3B for
the pass/fail resultsand THP3B for\the Chronic Value.Additionally,DWR Form AT-3 (original)is to be sent
to the following address
Attention: North\�a Division of Water Resources
Water Sciences Section/Aquatic Toxicology Branch
1621 Mail Seice Center
Raleigh,NC 27699-1621
Completed Aquatic Toxicity Test Forms shall be filed with the Water Sciences Section no later than 30 days
after the end of the reporting period for which the report is made.
Test data shall be complete, accurate,include all supporting chemical/physical measurements and all
concentration/response data, and be certified by laboratory supervisor and ORC or approved designate
signature. Total residual chlorine of the effluent toxicity sample must be measured and reported if chlorine is
employed for disinfection of the waste stream.
Page 5 of 8

NPDES Permit NC0089834
Should there be no discharge of flow from the facility during a month in which toxicity monitoring is required,
the permittee will complete the information located at the top of the aquatic toxicity(AT)test form indicating
the facility name,permit number,pipe number, county,and the month/year of the report with the notation of
"No Flow"in the comment area of the form. The report shall be submitted to the Water Sciences Section at the
address cited above.
Should the permittee fail to monitor during a month in which toxicity monitoring is required,monitoring will be
required during the following month.Assessment of toxicity compliance is based on the toxicity testing quarter,
which is the three month time interval that begins on the first day of themonth in which toxicity testing is
required by this permit and continues until the final day of the third mo nth.
Should any test data from this monitoring requirement or tests performed by the North Carolina Division of
Water Resources indicate potential impacts to the receiving stream,tlus,permit maybe re-opened and modified
to include alternate monitoring requirements or limits.,/-\r
NOTE: Failure to achieve test conditions as specified/m the cited document, s ch as minimum control
organism survival,minimum control organism reproduction,and appropriate envi'ro �mental controls, shall
constitute an invalid test and will require immediate follow-up testing to be completed no later than the last day
of the month following the month of the initial monitoring, '\�
V"-..
A. (5.) ELECTRONIC REPORTING O DISCIIARGE\`�M\ONITORING REPORTS
[G.S. 143-21/:Y(b)] \�'
Federal regulations require electrom submittal of all disc arge monitoring reports (DMRs) and program
reports.The final NPDE�S Electronic Reporting Rule'was <adopted and became effective on December 21, 2015.
NOTE: This special condi�nupple `ents or-supersedes the following sections within Part II of this permit
(Standard CO ditioi for NPDES Permits):
• Section B. 11) at\Requirements
( \ \. \
• S c D. (2.) Reporting
• Section D. (6.) Records Retentio
• Section (5') Monitoring1Reports
\\\
) I
1. Reporting Requirements/(Supersedes Section D. (2.) and Section E. (5.) (a)1
The permittee shall reporttdischarge monitoring data electronically using the NC DWR's Electronic
Discharge Monitoring Report(eDMR) internet application.
Monitoring results obtained during the previous month(s) shall be summarized for each month and
submitted electronically using eDMR.The eDMR system allows permitted facilities to enter monitoring
data and submit DMRs electronically using the internet.Until such time that the state's eDMR application
is compliant with EPA's Cross-Media Electronic Reporting Regulation(CROMERR),permittees will be
required to submit all discharge monitoring data to the state electronically using eDMR and will be required
to complete the eDMR submission by printing, signing, and submitting one signed original and a copy of
the computer printed eDMR to the following address:
Page 6 of 8

NPDES Permit NC0089834
NC DEQ/Division of Water Resources/Water Quality Permitting Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
If a permittee is unable to use the eDMR system due to a demonstrated hardship or due to the facility being
physically located in an area where less than 10 percent of the households have broadband access,then a
temporary waiver from the NPDES electronic reporting requirements may be granted and discharge
monitoring data may be submitted on paper DMR forms (MR 1, 1.1,2,,3)or alternative forms approved by
the Director.Duplicate signed copies shall be submitted to the mailing address above. See"How to Request
a Waiver from Electronic Reporting"section below. / ‹/
Regardless of the submission method,the first DMR is due on the lastday of the month following the
issuance of the permit or in the case of a new facility, on-thelast daINof the month following the
commencement of discharge.
Starting on December 21,2020,the permittee must electronically report the ollowing compliance
monitoring data and reports,when applicable:
• Sewer Overflow/Bypass Event Reports;
• Pretreatment Program Annual Reports;
• Clean Water Act(CWA) Section 3\ 6(b),Annual Reports.
The permittee may seek an electronic reporting waive from the Division\ see How to Request a Waiver
from Electronic Report.ngg"section below).
2. Electronic Submissions
In accordance with 40 R 1'22.4L(1)(9);the permittee must identify the initial recipient at the time of each
electronics bu mis`sion. The permittee should use the B A'�s website resources to identify the initial recipient
for the electronic-submission.
on.
Initia recipient of electron NPDES 'nformation from NPDES-regulated facilities means the entity(EPA
or the state authorized by EPA to\implementthe NPDES program)that is the designated entity for receiving
electronic NPDES data[see 40 CPR 127.2(b,)]�
EPAplans to esta lishha website that will also link to the appropriate electronic reporting tool for each type
\ \ / i p g
of electronic submission and for each state. Instructions on how to access and use the appropriate electronic
reporting tool will be mailable as/well.Information on EPA's NPDES Electronic Reporting Rule is found
at: http://www2.epa.gov/compliance/final-national-pollutant-discharge-elimination-system-npdes-
electronic-reporting-rule.
Electronic submissions must start by the dates listed in the"Reporting Requirements"section above.
3. How to Request a Waiver from Electronic Reporting
The permittee may seek a temporary electronic reporting waiver from the Division.To obtain an electronic
reporting waiver, a permittee must first submit an electronic reporting waiver request to the Division.
Requests for temporary electronic reporting waivers must be submitted in writing to the Division for written
approval at least sixty(60) days prior to the date the facility would be required under this permit to begin
submitting monitoring data and reports. The duration of a temporary waiver shall not exceed 5 years and
Page 7 of 8

NPDES Permit NC0089834
shall thereupon expire.At such time,monitoring data and reports shall be submitted electronically to the
Division unless the permittee re-applies for and is granted a new temporary electronic reporting waiver by
the Division.Approved electronic reporting waivers are not transferrable. Only permittees with an approved
reporting waiver request may submit monitoring data and reports on paper to the Division for the period
that the approved reporting waiver request is effective.
Information on eDMR and the application for a temporary electronic reporting waiver are found on the
following web page:
http://deq.nc.gov/about/divisions/water-resources/edmr
4. Signatory Requirements [Supplements Section B. (11. (b).and Supersedes Section B.(11.) (d)1
(( �
All eDMRs submitted to the permit issuing authority sl allbe7signed uy a person described in Part II,
Section B. (11.)(a)or by a duly authorized representative of that person'ass des ribed in Part II, Section B.
(11.)(b).A person,and not a position,must be delegated signatory authority for eDMR reporting purposes.
For eDMR submissions,theperson signingand submittin the DMR must ob��eDMR user account
� erg .�
and login credentials to access the eDMR system.For\more infor i��n on North Carolinas eDMR system,
registering for eDMR and obtaining an-e MR user account,p ease visit the following eb page:
http://deq.nc.gov/about/divisions/water,-resources/edmr
Certification. Any person submitting an e ectronic DMR using the s?tecs eDMR system shall make the
following certification[ 0-6F 122.22].NO OTHER TE ENTS OF\CERTIFICATION WILL BE
ACCEPTED:
"I certify, under penalty of It th's docume andrall attachments were prepared under my direction
or supervision in accor ance with a system design too assure that qualified personnel properly gather and
evaluate the in ormatio bmiJt d.Based on my in q`ry\of the person or persons who manage the system,
or thoserpersons directly res onsible-for-gatheering the nformation, the information submitted is, to the best
of m 'lino�wledge and belief, true,,a rate,aTzdcomple e..il am aware that there are significant penalties
for submitting false information, including the possitty of fines and imprisonment for knowing
viol ons "
5. Records a ention [Suppl ments Section D.(6.)1
The permittee shall"retain records o all Discharge Monitoring Reports,including eDMR submissions.
These records or c pies shall be)maintained for a period of at least 3 years from the date of the report.This
period may be extended request/of the Director at any time [40 CFR 122.41].
Page 8 of 8

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', < ��\, r `J /!•BYW4 f-' . 40 40 r �r Ii irk,'^
. f• %,N4roltiRk.,,ViiPpilei oc- ' If
... ? „.,-.7i
:,
ar--.-. .
--u,
ti % •�. _ - 4 deo . 1 ))), Hominy Creek - �� -''Ai ,
A l” as _ t ai, ,,,,al [flows east]
=' - Approximate _ <,.-� l ' 4 `"~1VI .
.V Facility Boundary �• ' i�4-. `�; — - -s V
ire �>
1 r�/, ��"• Outfa11001 N
, . ,,,,0-04,- .. .......i... t.,,,, . I -..... 0;
.thVii-100‘-___,07-c. Aer, `1t.
1� <
�' I� �f 3,' �� (flood gate) ` !r"IA1,111441111"
' [flows north] _
.. � �, Of
y
f>40, 4.-
'-).,; - ';Ai9" 1:P.I.,_____.4.71, obi..._ -...fist° ..:7App. ill - e -
: Sandhill Rd `''`� : `" 0 . ,-.1-c9 I
, \ „N. vti �c
5''',h i t :0 1 fr
UT to HominyCreek '`.•
0
> �- '� \
,P1 'r\1� ,0 . �� '� ► [flows north] __�=\�
6/'1s t r , 1.�1 l,i.\ ) 1� Enka ;i • •!" acd` 1r , �" ..- -`\
/ .,.-
r� lit UT to Hominy Creek r
. .
J.�„ [flows north]
.— East Ditch • _
1 00,1
--...---k.' aill , -. ' -.1 ' - -..--4'
Flood Gate a-,
-- !, Plitiglitit .diki
torpows-wii ,
,,,? ......... ii i
p. Source Esri,Did [Globe,GeoEte Earthstar Geographies,
• - Cam=Ai bus DS DA. USGSner„oGRID IGN, andt ( �1f
� ��/((///1J !=111 Community ' `
Low & Bonar, Inc. N
NPDES Permit NC0089834 A -
1301 Sandhill Road, Enka 28728 t150�°°°
Receiving Stream:UT to Hominy Creek Stream Class:C
Stream Segment:6-76 Sub-Basin#:04-03-02 35.543097°N, -82.649147°W
River Basin:French Broad HUC:060101050503 SCALE NC Grid:
County:Buncombe 1:24,000 USGS Quad:Enka,NC

ROY COOPER
a (;orrrnor
MICHAEL S. REGAN
LINDA CULPEPPER
Water Resources
ENVIRONMENTAL QUALITY
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NC00 / / / / or NCG5 / / / /
1. Facility Name:
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
c. Other(please explain):
2. New owner's name(name to be put on permit):
3. New owner's or signing official's name and title:
(Person legally responsible for permit)
(Title)
4. Mailing address: City:
State: Zip Code: Phone: (
E-mail address:
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
919 807 6300 919-807-6389 FAX
https://deq.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

NPDES Name&Ownership Change
Page 2 of 2
Applicant's Certification:
, 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.
Signature: Date:
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

Date:
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Signature Authority
Facility Name:
NPDES Permit Number: NICI I I I I I I I
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:
Title:
Mailing Address:
Physical Address:
(if different)
Email Address:
Office Phone:
Mobile Phone:
If you have any questions regarding this letter,please feel free to contact me at either the phone
number or email address below.
Sincerely,
Authorized Signing Official's Signature
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cc: Regional Office,Water Quality Permitting Section
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