WQ0031131_NDARR_20210419

State of North Carolina
Department of Environmental Quality
Division of Water Resources
WATER QUALITY REGIONAL OPERATIONS SECTION
NON-DISCHARGE APPLICATION REVIEW REQUEST FORM

FORM: WQROSNDARR 09-15 Page 1 of 1
April 9, 2021
To: ARO-WQROS: Landon Davidson / Daniel Boss
From: Chloe Lloyd, Water Quality Permitting Section - Non-Discharge Branch
Permit Number: WQ0031131 Permit Type: Single-Family Residence Wastewater Irrigation
Applicant: Michael Ricker Project Type: Change of Ownership
Owner Type: Individual Owner in BIMS? No
Facility Name: Catawba Falls Lot #195 SFR Facility in BIMS? Yes
Signature Authority: Michael Ricker Title: Owner
Address: 14236 Mailer Blvd., Orlando, FL 32828 County: McDowell
Fee Category: Single-Family Residence Wastewater Irrigaton Fee Amount: $0 - Minor Mod
Comments/Other Information: [e-mail]
Attached, you will find all information submitted in support of the above-referenced application for your review, comment,
and/or action. Within 45 calendar days, please take the following actions:
Return this form completed. Return a completed staff report.
Attach an Attachment B for Certification. Issue an Attachment B Certification.
When you receive this request form, please write your name and dates in the spaces below, make a copy of this sheet, and
return it to the appropriate Central Office Water Quality Permitting Section contact person listed above.
RO-WQROS Reviewer: ___________________________________________ Date: _____________________
DocuSign Envelope ID: AA0FBC8C-1F20-4AD5-9DFE-B196C46D3815
4/19/2021