NC0062278_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, jr jatn S` tIoriQns (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 e -1[ It i/ 00 Ks f-I Da- (Owner/Organization Name).
By submitting this application, 1, B rjah s hp,yi S (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.
.....-.17Y(441--)
Submitter Signa
ljr jc e21A CESkIn�C(•Ccirl
Email Address
O per -al -or 1- 19 - 27._
Title Date
980-339-I1o5
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 ld:
User Id
Subscribed and sworn to before me this i c) day of 614 vcv/ , 2011
utiinutiroo e 2///0044:,‘,
SO4i
O
NototV MV
public
Gaston Cou
TNC Nit
\.��.
(SEAL)
Signature of Notary Public
At:910,,-,
Printed Name of Notary Public
My Commission Expires:
LI/Chock
NCDWR Electronic Submittal Agreement Version 1 Page 5

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.
(printed name), am authorized by the Responsible Official
name in this doc nt, who does have the authority under the applicable standards, to enter into this
agreement for Oreg. M.47 (t Jfis
(Owner/Organization Name).
By submitting this application, I, groyt/L, idols (printed name), have read,
understand, and accept the terms and conditions of this Electronic Signature Agreement. 1 certify under
penalty of law that 1 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
1011r1%eigt /- Iq - 2�
Title Date
geinchnii)-4e1460Askt4-4-ei;Car, 'I0y-3sl'Llo`!1
Email Address 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:
Subscribed and sworn to before me this
"GM O RR/SO /�i,�.
�o
s
Noto'v CO'0111
Gosto� Q =
2:
ti0
qoitR i.mCcP \\‘\
(SEAL)
15
User Id
day of Jaflvy , 20
Signature of Notary Public
Alcr, £ /14ex-rc►
Printed Name of Notary Public
My Commission Expires: L/ 6 )ztz
NCDWR Electronic Submittal Agreement Version 1 Page 5

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 eDMRadmi nett ncdenr.eov.
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 eDMRadmin(u ncdenr.gov within
ten working days if my duties change and 1 no longer need to interact with eDMR on behalf of my
organization.
17. Agree to notify the NCDWR eDMR Administrator via email at eDMRadmintu 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 identi fled
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
Submittter�
2 (ifapplicable)
X en6 2 r1 K
$eA 1Yr y O /Te
i q 5rrert Lrv. 6140;06 /14.4
2 t fa
,frill... 5.11-9•LA-5
1 You may only include perrmts associated WI U QtLe owner. If more space is needed for additional permits or submitters you
may attach separate pages. A supplemental sheet is available at httns://dea.nc.eov/about/divisions/water-
resourccs/cdmr/forms-and-renortt
2. 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

N.C. Department of Environmental Quality
Division of Water Resources
Electronic Signature Agreement
Federal regulations require that electronic documents must have valid electronic signatures if Title 40 of
the Code of Federal Regulations requires handwritten signatures on the paper documents they replace.
Valid electronic signature refers to an electronic signature on an electronic document that has been
created with an electronic signature credential.
This Electronic Signature Agreement, when finalized and approved, will allow the individuals with
electronic signature credentials to sign electronically a variety of required permit documents in lieu of the
submittal of signed paper copies. The submittal of Electronic Discharge Monitoring Reports (eDMR)
will be available once your electronic signature credentials are in place. Some agreements for document
submittals or acceptance, as noted in the Agreement Conditions (Section B.), are not currently available
electronically but are included here to have the agreements in place and to avoid the need to complete
future submittal of agreement forms when these systems are initiated.
A. Owner / Organization Information
Owner/Organization Name:
rxr%1 p pt,rg 10off r
Responsible Official:
(as identified in accordance with 40 CFR 122.22)
^
Fi iii.fh-- m, ,h, c it
Street Address:
l Oaf a</1u. LA/
City:
(,s,`.t.`.. 9
State/Zip:
,$'t
ZS!OSL
Phone Number:
(6/c) 65-3-/SY3
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
eke, & 6,/one+vwnLapALl . Com.
B. Agreement Conditions
To receive and accept the required electronic signature credential, consisting of a user name and
password, issued by the North Carolina Division of Water Resources (NCDWR) in order to sign
electronic documents submitted to NCDWR's Electronic Document Systems and to receive electronic
documents from NCDWR's systems;
The Responsible Official and Submitter (if applicable) named in this form do herby:
1. Understand that this Electronic Signature Agreement requires me to submit electronic documents to
NCDWR'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 NCDWR. This
authorization will not become effective until NCDWR establishes a system for processing electronic
documents; I am notified in writing from NCDWR 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.
NCDWR Electronic Submittal Agreement Version 1 Page 1

January 18, 2022
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Signature Authority
BERKLEY OAKS WWTP
NPDES Permit Number NC0062278
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 213.0506.
Individual #1
Individual #2 (ef applicable)
Name:
Charles Brandon Long
Brian Willard Stephens
Title:
Orc
Backup
Mailing Address:
5600 Lakeview Rd
Charlotte Nc.28269
5600 Lakeview Rd
Charlotte Nc.28269
Physical Address:
(ifdierent)
Email Address:
[e-mail]
[e-mail]
Office Phone:
704 - 741 - 7867
704 - 741 - 7867
Mobile Phone:
704 - 351 - 4049
980 - 339 - 1105
If you have any questions regarding this letter, please feel free to contact me at Enter Email or Phone
Number.
Sincerely,
Authorized Signing Official's Name A&M Authorized Signing Signing Official's Title pz
Mailing Address 12„v S . Cal a -cc c o G kx►dkxk t) CO aaZy b
Email Address eLmcg S}urc‹-4. Capio , • c cry
Office Phone 30'5''I O"1- 3 O O
Mobile Phone
cc: Mooresville Regional Office, Water Quality Permitting Section