NC0068705_Signature Authority_20220120

E. Submitter Signature
The Submitter (electronic signature applicant) is a user other than the Responsible Official who submits
this agreement to request to sign reports electronically. The Submitter is given signatory authority by an
individual identified as the Responsible Official by the Owner/Organization to sign reports and other
information and to accept electronic documents.
I, -e)r ar< Sj I\S (printed name), am authorized by the Responsible Official
name in this document, who does have the authority under the applicable standards, to enter into this
agreement for y larir -s \lark en kA (Owner/Organization Name).
By submitting this application, 1, 'an SA-ep\'Ln 5 (printed name), have read,
understand, and accept the terms and conditions of this Electronic Signature Agreement. 1 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
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Email Address
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Title Date
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Phone Number
*email will be the primary method of contact for the electronic submittal process so it is important to have an accurate email
available at all times
If you are a current eDMR submitter please provide your User Id:
User Id
day of Tart/ , 20 2z
ate— AAL
Signature of Notary Public
Subscribed and sworn to before me this /g
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My Commission Expires:
NCDWR Electronic Submittal Agreement Version 1 Page 5

NCDWR Electronic Submittal Agreement Version 1
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Subscribed and sworn to before me this
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If you are a current eDMR submitter please provide your User Id:
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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 NCDWR eDMR has received from me by
contacting the NCDWR eDMR Administrator via email at eDMRadtnin(a),ncdenr.gov.
15. Understand that the NCDWR 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 NCDWR eDMR Administrator via email at eDMRadminAncdenr.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 NCDWR eDMR Administrator via email at eDMRadmin a 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 NCDWR 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. Permit/Facility Information
Approval under this Electronic Signature Agreement is applicable to the following permits and if
applicable to the Submitters, if noted here and in Section E:
Permit
Number'
Facility Name
Facility Address
Submitter2 (if applicable)
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2.
You may only include permits associated with One owner. If more space is needed for additional permits or submitters you
may attach separate pages. A supplemental sheet is available at: httns://deq.nc.gov/about/divisions/water-
resources/edmr/forms-and-reports
A separate Section E must be included for each Submitter in order to obtain a hard copy signature and notarization for all
entities. If more than one individual will have submitter permissions for the same permit, then indicate this on separate
rows.
NCDWR Electronic Submittal Agreement Version 1
Page 3

NCDWR Electronic Submittal Agreement Version 1
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The Responsible Official and Submitter (if applicable) named in this form do herby:
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Email Address:
*email will be the primary method of contact for the electronic
submittal process so it is important to have an accurate email
available at all times
Phone Number:
State / Zip:
Street Address:
Responsible Official:
(as identified in accordance with 40 CFR 122.22)
Owner/Organization Name:
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December 15, 2021
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Signature Authority
MARINERS WATCH WWTP
NPDES Permit Number NC0068705
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 (f applicable)
Name:
Title:
Charles Brandon Long
Orc
Mailing Address:
5600 Lakeview Rd
Charlotte Nc.28269
Physical Address:
(if different)
Email Address:
Office Phone:
Mobile Phone:
[e-mail]
704 - 741 - 7867
704 - 351 - 4049
Brian Willard Stephens
Backup
5600 Lakeview Rd
Charlotte Nc.28269
[e-mail]
704 - 741 - 7867
980 - 339 - 1105
If you have any questions regarding this letter, please feel free to contact me at
[e-mail] or 704-609-3883.
Sincerely,
Dwayne Reedy
Hoa President
16317 Mariners Watch Ct
Charlotte, Nc 28278
[e-mail]
704-609-3883
cc: Mooresville Regional Office, Water Quality Permitting Section