450007_PC-2021-0032 RR Waiver of Rights_20211115

STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL
QUALITY
COUNTY OF HENDERSON
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST
MICHAEL R. CORN
PERMIT NO. NCA345007
WAIVER OF RIGHT TO AN
ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
FILE NO. PC-2021-0032
Having been assessed civil penalties totaling $5,050.38 for violation(s) as set forth in the
assessment document of the Division of Water Resources dated July 6, 2021, the undersigned,
desiring to seek remission of the civil penalty, does hereby waive the right to an administrative
hearing in the above -stated matter and does stipulate that the facts are as alleged in the assessment
document. The undersigned further understands that all evidence presented in support of remission
of this civil penalty must be submitted to the Director of the Division of Water Resources within
thirty (30) days of receipt of the notice of assessment. No new evidence in support of a remission
request will be allowed after thirty (30) days from the receipt of the notice of assessment.
This the 8 day of No gv , 2021
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SENDER: COMPLETE THIS SECTION
1 COMPLETE THIS SECTION ON DELIVERY
El Complete items 1, 2, and 3.
le Print your name and address on the reverse
so that we can return the card to you.
to Attach this card to the back of the mailpiece,
_ or on the front if space permits.
1. Article Addressed to:
Michael R. Corn
735 Butler Bridge Rd.
Fletcher, NC 28732
11111111111
111111111
HOLM
9590 9402 3951 8060 0164 09
2. Article Number (Transfer from service label)
017 0190 0000 1635 4686,
PS Form 3811.,, Juiy 2015 PSN 7530-02-00649053
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Adult Signature Restricted Delivery
6Certified Mail®
Certified Mail Restricted Delivery
0 Collect on Delivery
R Cotgct on Delivery Restricted Delivery
Insud Mail
f, .,fpisjj edd Mail Restricted Delivery
ver $500)
A.. Signgture
El Agent
Addressee
ame) . C. Date of Delivery
D. Is delivery address different from item 1? 0 Yes
If YES, enter delivery address below: p No
❑ Priority Mail Express®
❑ Registered Mail",
❑ Registered Mail Restricted
Delivery
Return Receipt for
Merchandise
❑ Signature ConfirmationrM
❑ Signature Confirmation
Restricted Delivery
Domestic Return Receipt

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USPS TRACKING #
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9590 9402 3951 8060 0164 09
United States
Postal Service
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First -Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4® in this box•
NCDEQ - DWR
AFO Program
ATTN: Heath Robinson
1636 MAIL SERVICE CENTER
RALEIGH, NC 27699-1636
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