WQ0035576_NDARR_20210604

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
May 21, 2021
To: ARO-WQROS: Landon Davidson / Daniel Boss
From: Chloe Lloyd, Water Quality Permitting Section - Non-Discharge Branch
Permit Number: WQ0035576 Permit Type: Distribution of Residual Solids (503 Exempt)
Applicant: Broad River Water Authority Project Type: Renewal
Owner Type: Organization Owner in BIMS? Yes
Facility Name: Broad River Water Authority DCAR Facility in BIMS? Yes
Signature Authority: Maria Hunnicutt Title: Manager
Address: PO Box 1269, Rutherfordton, NC 28139 County: Rutherford
Fee Category: Non-Discharge Minor Fee Amount: $0 - Renewal
Comments/Other Information: [e-mail]; [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: BEB6AD7C-18B9-4FFB-AF14-2F09597969ED
6/4/2021