NCS000312_Email re Electronic Signature Agreement_20201211

McCoy, Suzanne
From: McCoy, Suzanne
Sent: Friday, December 11, 2020 1:27 PM
To: [e-mail]
Subject: Stormwater eDMR Electronic Signature Agreement
Attachments: ESA for First Batch of NCS Permits-FI LLABLESAVABLE_20201209.pdf
Importance: High
Good afternoon.
Attached please find a form that was inadvertently left out of the initial Step 2 instructions for eDMR registration.
Please complete and send the original signed and notarized form to:
NC DEQ DEMLR Stormwater Program
Attn: Suzanne McCoy
1612 Mail Service Center
Raleigh NC 27699-1612
Thank you,
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
Department of Environmental Quality
512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
1612 Mail Service Center, Raleigh, NC 27699-1612
919-707-3640
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has adjusted operations to protect the health and
safety of the staff and public. Many employees are working remotely or are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are
limiting public access to appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your requests by phone or
email. We appreciate your patience as we continue to serve the public during this challenging time.
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Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

Stormwater Electronic Signature Agreement Form
A. Delegation of Signature Authority Letter
=> Attach a Stormwater Delegation of Signature Authority Letter on official company
letterhead that lists every Facility Administrator included on your Stormwater Electronic
Registration Form. This letter must be signed by the Responsible Official to request
that the User(s) be allowed to submit electronic reports.
B. Electronic Signature Agreement Conditions
To receive and accept the required electronic signature credential, consisting of a User ID and password,
issued by the North Carolina Division of Water Resources (NCDEQ) in order to sign electronic documents
submitted to NCDEQ's Electronic Document Systems and to receive electronic documents from
NCDEQ's systems;
The Responsible Official and Submitter(s) (if applicable) named in this form do herby:
1. Understand that this Electronic Signature Agreement requires me to submit electronic documents to
NCDEQ's approved eDMR system under the authorized program in lieu of paper submissions.
2. Understand that this Electronic Signature Agreement requires me to accept electronic transmissions,
in lieu of paper transmissions of all permits, permit modifications, authorizations to construct, and
any other correspondence related to reviewing and processing permits from NCDEQ. This
authorization will not become effective until NCDEQ establishes a system for processing electronic
documents; I am notified in writing from NCDEQ that use of the electronic systems has officially
been initiated; and North Carolina rules and statutes are changed to allow the implementation of
electronic submittal and acceptance of documents.
3. Understand that this Electronic Signature Agreement requires me to submit electronic all necessary
information for processing of NPDES application including information for renewal of existing
permits, modification to existing permits, and applications for new discharge permits. The submittals
may include all necessary applications and supporting documentation to NCDEQ's approved system
for electronic submittals in lieu of paper submissions. This authorization will not become effective
until NCDEQ establishes a system for processing electronic documents; I am notified in writing from
NCDEQ that use of the electronic systems has officially been initiated; and North Carolina rules and
statutes are changed to allow the implementation of electronic submittal and acceptance of
documents.
4. Understand that this Electronic Signature Agreement requires me to accept electronic submissions,
in lieu of paper submissions, of all Notices of Deficiency, Notices of Violation, Civil Penalty
Assessments, and any other correspondence related to compliance with federal and state water
quality laws and regulations that might be sent by NCDEQ. This authorization will not become
effective until NCDEQ establishes a system for processing electronic documents; I am notified in
writing from NCDEQ that use of the electronic systems has officially been initiated; and North
Carolina rules and statutes are changed to allow the implementation of electronic submittal and
acceptance of documents.
5. Agree to protect both the electronic signature credential, consisting of my User ID and password,
and security questions and answers, from compromise and from use by anyone except me.
Specifically, I agree to maintain the secrecy of my electronic signature credential and security

questions and answers; I will not divulge or delegate my credential or security questions and
answers to any other individual; I will not store my credential or security questions and answers in an
unprotected location; and I will not allow my electronic signature credential or security questions and
answers to be written into computer scripts to achieve automated log -in.
6. Understand and agree that I will be held as legally bound, obligated, and responsible for the use of
my electronic signature as I would be using my hand-written signature.
7. Understand that I will be informed through my registered email address whenever my User ID or
password has been modified.
8. Understand that eDMR reports the last date my User ID and password were used immediately after
successfully logging into eDMR.
9. Agree to contact the NCDEQ SW-eDMR Administrator via email at SW-eDMR(c_ncdenr.gov as soon
as possible, but no later than 24 hours, after suspecting or determining that my User ID and/or
password have become lost, stolen or otherwise compromised.
10. Agree that I will review the contents of all electronic submissions prior to submission.
11. Understand that I will automatically receive an email receipt at my registered email address from the
NCDEQ's SW-eDMR system for any submission that contains a valid electronic signature,
identifying the document received, the signatory, and the date and time of receipt.
12. Agree to contact the NCDEQ SW-eDMR Administrator via email at SW-eDMR(a)_ncdenr.gov if I do
not receive an email receipt as specified above within five (5) business days for any electronically
signed submission using my credentials.
13. Agree that if I received an email notification for an activity that I do not believe that I performed, I will
notify the NCDDEQ SW-eDMR Administrator via email at SW-eDMR(a)ncdenr.gov as soon as
possible, but no later than 24 hours, after receipt.
14. Agree to report, within 24 hours of discovery, any evidence of discrepancy between any electronic
document I have signed and submitted and what the NCDEQ eDMR has received from me by
contacting the NCDEQ SW-eDMR Administrator via email at [e-mail].
15. Understand that the NCDEQ eDMR's system will automatically reject any electronic document
submitted without a valid electronic signature if such signature is required.
16. Agree to contact the NCDEQ SW-eDMR Administrator via email at SW-eDMR(a)_ncdenr.gov within
ten working days if my duties change and I no longer need to interact with eDMR on behalf of my
organization.
17. Agree to notify the NCDEQ SW-eDMR Administrator via email at SW-eDMR(c�ncdenr.gov if I cease
to represent the regulated entity specified above as signatory of that organization's electronic
submissions as soon as this change in relationship occurs.
18. Understand that the NCDEQ may contact the Organization's Responsible Official, who signs below
to authorize me as a signatory for the Owner/Organization, in order to verify my identity.
19. Agree to retain a copy of this signed agreement as long as I continue to represent the regulated
entity specified above as signatory of the Organization's electronic submissions.
20. Certify that I have the authority to enter into this Agreement on behalf of the Organization identified
above, and I am a signatory authorized to represent that Organization, and I am able to sign and
submit reports and other information on behalf of that Organization in the capacity required by
statute and/or regulation.

C. Responsible Official Signature
The Responsible Official, as identified in accordance with 40 CFR 122.22, is the appropriate
individual with the authority to sign and submit reports for the organization.
this Agreement for
(printed name), have the authority to enter into
(Owner/Organization Name).
I request the NCDEQ the Submitter(s) named in Part B of this form an electronic signature
credential to submit and accept documents electronically on behalf of my organization.
I acknowledge that the Submitter(s) named in Part B of this form work at/for my organization
and have authority to submit and accept electronic documents and act as a signatory for
purposes of the NCDEQ's electronic document systems.
By submitting this application,
(printed name),
have read, understand, and accept the terms and conditions of this Electronic Signature
Agreement. I certify under penalty of law that I have personally examined and am familiar with
the information submitted in this application and all attachments and that, based on my inquiry
of those persons immediately responsible for obtaining the information contained in the
application, I believe that the information is true, accurate and complete. I am aware that there
are significant penalties for submitting false information, including the possibility of fine and
imprisonment.
Responsible Official Signature
Email Address
Subscribed and sworn to before me this
Title
Phone Number
day of
Signature of Notary Public
Printed Name of Notary Public
(SEAL) My Commission Expires:
Date
eDMR User Id
20

D. Facility Administrator Signature
=> Provide a separate page for every Facility Administrator listed on your Stormwater
Electronic Registration Form.
Facility Administrators are users other than the Responsible Official who submits this agreement
to request to sign reports electronically and other information and to accept electronic
documents.
(printed name), am authorized by the Responsible
Official named in this document, who has the authority under the applicable standards, to enter
into this agreement for
(Owner/Organization Name).
By submitting this application, I, (printed name),
have read, understand, and accept the terms and conditions of this Electronic Signature
Agreement. I certify under penalty of law that I have personally examined and am familiar with
the information submitted in this application and all attachments and that, based on my inquiry
of those persons immediately responsible for obtaining the information contained in the
application, I believe that the information is true, accurate and complete. I am aware that there
are significant penalties for submitting false information, including the possibility of fine and
imprisonment.
Submitter Signature
Email Address
Subscribed and sworn to before me this
Title
Phone Number
Date
eDMR User Id
day of , 20
Signature of Notary Public
Printed Name of Notary Public
(SEAL) My Commission Expires: