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HomeMy WebLinkAboutWQ0018708_PC-2012-0012_20120521LAKE CREEK R. P 0 P A T 1 ib; fr4, July 7, 2012 M-n Ed Hardee :Aquifer Protection Sectibh Division of Water Quality 1636 MaiiService Center Raleigh, North Carolina 27699:4636: Je;Request ,for RenlissiOri of Civil ,Peopity,Aes:5,rnehtforl?..errnItW4001.8708 (Enforcement Dear Mr. Hardee, Attached please find the 'RequeSt for Remission, Waiver of Rightto Administrative Hearing and: Stipulation Of Facts" fern, related to the Civil Penalty tb, Lake Creelc-:_Carporatiory, in accordance with the remission request, we request that theDiviSion considerthe > One or more of the civil penalty assessment factors in NCGS14313-22.1(b) were wrongfully applied to the detriment ofthe petitioner; arid, > Payment of the -civil penaltywillvrevent payment fort herernairiiing neCesSai-y- remedial actions. Whilee'rerhiSsion request may not be the propermechanism for dispuingfacts,,ihthis letter:We 'would like tti'draW attention in particular to one of the Sikvjolations,.a+rted in the assessrrient. The civil penalty asserts that Lake Creek Corporation did not maintain a suitable year round crop. We respectfully disagree with this statement, We feelas if the Bermuda grss has been properly Maintained in accordance with the permit i; therefore,- with regards to the suitable year round crop ViolatiOn, We: requeSt additiOnal clarificatiOh; so that we rnay:tp'ke ,appropriteaction if neces5ary. As stated above, we request that the Division COntiderthe-tiVii,liehotty assessment factors in isic0S, 1436 282.1(h) Which states'. ThefiriatagencydecisiOn in contestecraises that driSefrOtri CiYitpenblVasSessmerits:Fshall be Made by the ComMisSiOnin the evaluation of each violation, 'the Commission shall recognize that harrn'eqthe natural resources of the State arising from the violation ofstand‘ards or limitations' established to protect those resources may be immediately observed through damaged resources or-mby be incremental or cumulative with no damage that can be :immediatelY observed or documented Penalties up tothe-MaximUm: authorized may be based on any one or 'combinationi ofthe follbWinglattors: (1) The degree and extent of harm tOthe,ncitbral resources of the .Sate, tb-the-0,013iie health; Of to private property reSultihg from the Vidlation; (2) The duration and gravity of the-violatiom (3) The effect on ground or surface water quantity or qualityor on iir quality;. ('4) The cost Of rectifying the clarnage;, (3) The amount of -Money saved by noncomplibnce;- (3).Whether the Violation was committed willfully:or intentionally; (7) The prior record of the violator in complying Orfailing to,complYwith programs over which the' Environmental IVIqn0gement,corritnission has regplatoryiauthority;Jand 0 The costito the State:of:the enforcement 33 WEsTBv RIDGE Rog, HAy*Eus NPIRTFI.OzpuNN 28444 --',91p.581314432(o) 91Q:58A:44340 LAKE CREEK c Q4fltAThlQtJ While it is correct.that Lake Creek :COrpOtation did not employ a certified operator in responsiblechargew 'a,certiffed backup operator in teSpOnsible'dhargefroMSepteMberI,04. through May ,20,12,:fatjaci;O:..w13..ffiik required fnonitoting-repotts;:falled to have a readable)agoon level marker, and have been delinquent in paying -thetequired!annuaLpermit,renewarfee,-we dIdemploy-flon certified personnel to operate and maintain the wastewater system. Further,-theseviolations,didliotresult ih harrnto the natural resources of the State, public:health or private propertyor nave.ah-effedt on ground r surface water quantity or qualityor on air quality: We reqiieStthat thesDiviSibri dcibSidetheSelattors in determining the ternission' request-contained,hereh Additionally, We request that the ,DiVision consider the penalty in the context of the nature, ty0:0otf:ti* of the subject wastewater strain the penalty will have on Lake Creek Corporation's ability to operate and maintain theWattewatersystem,. Lake Creek Corpotation's wastewater system islocated:jn'pladen:Courity, North Carolina and currently .serves 164 residents in the Bay Tree„Lakes:cdmiNnity, ,Abqutfialf-pfthese residents are Second home residents using their property primarily in the summer months and on occasional weekends and holidays' • "duringother. parts Of -the -year. Thedevelopmentserved by this wastewater sYstern-baS been SignifiCahtly.irnpacte:cibythe,20,0g,-,,e-cOhorhic:, downturn, and, as it relates to this community at least, the downturn persists Still,today:. There has been little growth within the development srnte2007. The lack,Of:aCtiVitibas strained Lake CreekCorporation's.; 'financial situatfori, Lake Crpak.corporatiop is -authorized, by -the North Carolina ptiptips1tomm4on, to charge:aflatrate of $40, per resident per month, the same rate established by the Commission.initiallyirv1998: With all current residents,paying, this rate produces a grossrevenue stream ofjust.under $179;poo per -years. As you know, Operation and Maintenance of awastewater utility and spray field in-ftill• compliance withNC D.ENR requirements involves. significant PXpenditureSin roPriage'rheeit, Iabo, electricity, -chOffircalS,Iesting, Maintenande, adrriinistratiVedostSjeeS, and'sb forth. Sinteerriployinga certified OperatOrandtertified: backup, oUr 'fully loaded costs to. operate and thgsystOm:annUaliiies to oypr$80,9001pgr year, Thus, the expenditures for this-senall,'Ondierutilized:systam prasarits-,:a financialiancloperatiOnall strain on Lake Creek Corporation, and, given the ourt_pnt'(a-nO:historic):tateofgrowth in theommunity,we,will not likely experience revenue/operating scale sufficient to alleviate thesituatiOin any time!socin..Additionally, certain pro -forma analyses we have run assuming theabsolthe:fullexterit of NC DENR's requirements projects a Cost to Service at roughly-tWOrtimet.Ourcurrent fully lOaded 'Costs above. :SP,Iinally,:wethankthe DiVision:fdrcOnSidering this remiSsion request ancthooe that th-P„Di.NijSion will consider the fact that these vicilatIons,d4;ffot;resOltip harm to the public healthor any private property the Division to consider further that 'pphaly of $.:',72$,...60vio'rorly exacerbate Lake Creek Corporation's already challenging operational and rhaintenancp situation at currprt. rates ---'and further cornOiieptes Oayrn,Ont:t0Warci any remedilalpoti.ons. Thank you. And, please fpet free to contact me with any question,s: Steve Jones, Lake Creek Corporation cc: D. Stephen Jones, President, Lake:Creek Corporation Michael Myers, PteSident, Envirolink 33 WES(BAYMOGEROAD - HARRELL§ NORTH c.AROLINA 218444,-910.588.4432(o) 910.5,80.44321(f) AVA NCDENR North Carolina Department of Environment and Natur6I Resources Division of Water Quality Beverly Eaves Perdue Charles Wakild P. E. • Dee Freeman Governor Director Secretary February 16, 2012 CERTIFIED MAIL -76/ t / u -70 0 00 3 \. l -1 LI —2 RETURN D. Stephen Jones Lake Creek Corporation 33 West Bay, Ridge Road Harrells, NC 28444 Re: Notice of Violation NOV-2012-PC-0051 Lake Creek Corporation Permit No. WQ0018708 Bladen County Dear Mr. Jones: You are hereby notified that, having been issued a permit for wastewater disposal for the subject facility, Lake 'Creek Corporation was found to be in violation of the following permit conditions. Violation 1: SECTION III OPERATION AND MAINTENANCE REQUIREMENTS (2) Upon classification of the wastewater treatment and irrigation facilities by the Water' Pollution Control System Operators Certification Commission (WPCSOCC), the Permittee shall designate and employ a certified operator to be in responsible charge (ORC) and one or more certified operator(s) to be back-up ORC(S) of the facility in accordance with 15A NCAC 08G .0200. The ORC shall visit the facilities iri accordance with 15A NCAC 08G .0200 or as specified in this permit and shall comply with all other conditions in these rules. The facility has had no ORC or back-up ORC on record since the resignation of Bill !Stafford on 07 September 2011.The facility also failed to report the loss of both the ORC and back-up ORC to the Certification Commission (WPCSOCC) as required within seven calender days of the vacancies. Required Corrective Action for Violation I: If you have not already done so, immediately take measures to hire operators with the appropriate certifications to manage and ensure proper facility operation. AQUIFER PROTECTION.SECTION 225 Green St.; Ste. 714 Fayetteville, North Carolina 28301 Phone: 910-433-33001 FAX : 910-086-07071 Customer Se:vice:1-877.623-6748 Internet: www.h20.enr.state.nc.us An Equal Opportunity \ Affirmative Action Employer No ihCarolina Naturally D. Stephen Jones Page 2 February 16, 2012 Violation 2: SECTION Ill OPERATION AND MAINTENANCE REQUIREMENTS (3) A suitable year round vegetative cover shall be maintained such that crop health is optimized, allows for even distribution of effluent and allows inspection of the irrigation system. On 03 November 2011 a site visit was conducted by Jim Barber, a member of the Fayetteville Regional Office's Aquifer Protection Section. Irrigation of sections of the spray field was in progress with lino indications of a suitable seasonal winter crop to uptake nutrients being applied. Required Corrective Action for Violation II: If you have not already done so, immediately take actions to establish a suitable seasional winter crop. Violation 3: SECTION III OPERATION AND MAINTENANCE REQUIREMENTS (5) Irrigation shall not be performed during inclement weather or when the ground is in a condition that will cause ponding or runoff. On 21 December 2011 a site visit was conducted by Tony Honeycutt and Jim Barber, members of the Fayetteville Regional office's Aquifer Protection Section. Irrigation of the disposal field was taking place at the time of the visit with no supervision on site. Rainfall was observed while traveling to the site, while on site (approximately 30 minutes) and upon leaving the site. Required Corrective Action for Violation III: If you have not already done so, hire appropriate personnel to manage and operate the facility or install a rain break devise that stops the irrigation process with the on -set of rain. Violation 4: Section IV MONITORING AND REPORTING REQUIREMENTS0) Any monitoring (including groundwater, surface water, soil or plant tissue. analysis)' deemed necessary by the Division to ensure surface and groundwater protection will be established and an acceptable sampling reporting 'schedule shall be followed: Individual reporting requirements are references by IV (2), (3), (4), (5), (6), (8), (9) and (10). From the date of the ORC resignation, 07 September 2011, no monitoring data has been submitted from the facility. (NDMR, NDAR or GW-59) Required Corrective Action for Violation 4: • If you have not already done so, hire appropriate personnel to manage, operate and sample as required. Violation 5: Section III OPERATION AND MAINTENANCE REQUIREMENTS (13) A waste -level gauge, to monitor waste levels in the storage lagoon and daily holdingljbasin, •shall be provided. The gauge shall have readily visible permanent markings indicating the maximum liquid level at the top of the temporary liquid storage volume, minimum liquid level at the bottom of the temporary liquid storage volume, and the lowest point on top of the dam elevation. Caution must be taken not to damage the integrity of the liner when installing the gauge. Lagoon marker was not readable (numbers were washed away at water line at the 6' mlark). Lagoon marker was not reset per site visit and information provided to the facility by e-mail and US Postal Service (September 2010). Required Corrective Action for Violation 5: If you have not already done so, use the supplied information to make the freeboard marker readable and accurate. D. Stephen Jones Page 3 February 15, 2012 Violation 6: Section VI GENERAL CONDITIONS (8) The Permittee must pay the annual fee within thirty (30) days after being billed by the Division. Failure to pay the fee accordingly may cause the Division to initiate action to revoke this permit pursuant to 15A NCAC 02T..0105(e). Required Corrective Action for Violation 6: If you have not already done so, immediately pay all past due fees and/or penalties to bring your account back into good standing. The Division of Water Quality requests that in addition to the specified correctiveaction above; please submit a timeline to address any item that cannot be immediately rectified. A written response to each of the above violations is to be submitted on or before March 16, 2012. Please be advised that the Division of Water Quality has the authority to levy a civil penalty of not more than $25,000 per day per violation. Information submitted will be reviewed and Lake Creek Corporation will be informed if a civil penalty is to be issued. Please be advised that nothing in this letter should be taken as removing you from the responsibility or liability for failure to comply with any State Rule, Regulation, State Statue or permitting requirement. If you have any questions concerning this matter, please do not hesitate to contact either Tony W. Honeycutt (910-433- 3339) or myself at (910- 433-3336). Sincerely, t-� Stephen.amhardt, L.G. Regional Aquifer Protection Supervisor NCDENR/DWQ/FRO cc: APS Central Office File ;AFS FR Fir6 `: : Bay Tree Lakes POA, Inc. 640 Bay Tree Drive Harrells, NC 28444 Attn: Clark Wooten, President Barber, Jim From: Barber, Jim Sent: Thursday, July 19, 2012 4:08 PM To: Hardee, Ed; Barnhardt, Art Cc: Honeycutt, Tony Subject: RE: NC DENR Civil Penalty Assessment Letter: Lake Creek Corporation Ed; After reading Mr. Jones' letter requesting penalty remission, I provide the following reibuttal: 1). Two permit modifications for upgrading the infrastructure at Baytree Lakes/Lake Creek Corp have been submitted in the past and approved to increase flow. Baytree/Lake Creek Corp has been cited for flow violations in the past and most recently paid the penalty for those violations. Neither modification has been constructed at this time due to cost issues cited by past Baytree/Lake Creek Corp staff. It was pointed out to Baytree/Lake Creek Corp staff at a meeting in Fayetteville, several years ago, that up- grades to infrastructure could be made and a petition filed with the Utilities Commission to request a rate increase to recoup the expenditures that Baytree/Lake Creek Corp incurred. To our knowledge neither occurred; 2). As far as the issue of a year round crop being at the site, Fayetteville doesn't contend that bermuda isn't at the site. The violation was for irrigating on bermuda when it was dormant during the months of November and December without a winter cover crop of small grain (i.e. rye or oats), therefore a suitable year round crop was not in existence; 3). In conjunction with the lack of a suitable year round crop; when site visits where made in November and December the irrigation system was in operation with no operator on -site and a steady rain was fallinig; 4). According to statements from officers of the Baytree Lakes Homeowners Association and information provided by Public Water Supply Section in Fayetteville (and from Bladen county personnel and the local newspaper), Baytree/Lake Creek Corp sold their water system to Bladen County in December 2011. With that Baytree Lakes homeowners are receiving a monthly utility bill from both Baytree and Bladen County. According to a office of the HOA I spoke with earlier this year (when trying to find a telephone number to reach Steve Jones), the residents are/where still paying Lake Creek Corp $40/month for utility services and approximately $20/month to Bladen County. Baytree/Lake Creek Corp is still receiving ii evenue and only providing half of the services to the residents; 5). Since Baytree/Lake Creek Corp hasn't had a back-up ORC for over a year and a ORC for nine months, performed no analytical testing on wastewater, and performed no analytical testing on groundwater, it would seem that money has been saved by not paying for these services while receiving monthly utility bill payments from residents; 6). With the issues described in item #5, the claim that "these violations did not result in harm to the natural resources of the State, public health, etc" cannot be substantiated without any evidence being supplied and is only the opinion of a non -certified, nor trained individual in wastewater treatment technology; 7). Baytree/Lake Creek Corp did not respond to the Notice of Violation issued by the Division by the deadlines outlined in the NOV. Therefore the issuance of the Enforcement with administrative penalty was warranted. Baytree/Lake Creek Corp did not respond to the Division (either by phone, email or written correspondence) by the required deadlines in the Enforcement and only submitted a response (after the statutory deadline) after hiring a contract operations company to assist with preparing a response to the Enforcement; 8). In reviewing BIMS today concerning the annual permit administration fee of $1310/year ($2620 total for 2010 & 2011) does not appear to be have been paid; 9). Lastly, in reviewing past records from the Surface Water Protection Section files; Baytree/Lake Creek Corp applied for a Non - Discharge permit in 2000 to remedy problems/violations that could only be corrected by upgrading the treatment infrastructure at the site to maintain their NPDES permit. The facility was cited with violations while under the NPDES permit and a no tap moratorium was instituted with the last NPDES permit issued to the facility. The spray irrigation system was put into service in 1 the sumfmer of 2005 and since that time has had numerous violations relating to site operations, hence the NOV's and ersforcement actions with penalties. With all of the above, I feel that the remissions request should not be considered or a lowed and that the penalty assessment be upheld. Furthermore, there are no facts to dispute. Baytree/Lake Creek Corp didn't have certified operators at the facility, hasn't paid their annual permit fee for two years, hasn't submitted valid monthly monitoring reports for nine months and hasn't submitted two groundwater monitoring events as specified by the permit. If additional information is needed or clarification of the above information provided, please don't hesitate to call me at 910- 433-3340 or email. I will be more than willing to participate in a meeting at the Fayetteville Regional office, if requested by Baytree/Lake Creek Corporation to clarify any items or permit issues that Baytree/Lake Creek Corporation may have. Sincerely Jim Barber From: Hardee, Ed Sent: Thursday, July 19, 2012 9:35 AM To: Barnhardt, Art Cc: Barber, Jim; Honeycutt, Tony Subject: FW: NC DENR Civil Penalty Assessment Letter: Lake Creek Corporation Case PC-2012-0012 Lake Creek Corp. The 30 day time to respond for this case was by 6-21-12. On 6-25-12 Mike Myers, Envirolink, called and said he had just received a copy of the case from Lake Creek. Mr. Myers want to know if it was ok to submit a remission request and I told him the deadline had past, but if he wanted to submit information it would be ok. I also to d him I made no promise that information submitted would be used in a remission request as the deadline had past. On 7-18-12 I received the attaches letter from Mr. Steve Jones, Jr. The request was not submitted within 30 days and a signed waiver has not been submitted. I believe this case should not be considered for remission. From: Steve Jones [mailto:sjones©Iakecreekcorp.com] Sent: Wednesday, July 18, 2012 11:20 AM - To: Hardee, Ed Cc: 'Michael Myers' Subject: NC DENR Civil Penalty Assessment.Letter: Lake Creek Corporation , Dear Ed - In follow up regarding the subject and earlier communication from Mike Myers with Envirolink concerning same, please see attached. And, please feel free to contact me any time. Regards, Steve Steve Jones 704.576.8462 (m) 704.973.7936 (f) sjones@lakecreekcorp.com 2 ROY COOPER: ATroRNEY GENERAL . • STATE OF NORTH CAROLINA ! DEPARTMENT' OF JUSTICE P.O. Box 629 RALEIGH, NC 27602 'May 20, 2013 D. Stephen Jones, Sr.,,Registered Agent Lake Creek Corporation PO Box-1029 Clinton, NC 28328 UL lI-FRS% IUN l 201. " DWG REPIX I O: PHIIl11'T. RF.YNOIDSr . ENVIRONMENTAL DIVISION TEL: (919) 716-6600 FAX: (919) 716-6766 Re: Civil Penalty Assessment,Caldwell County ! , DWQ PC 2012-0012, $6, 728.60, plus interest $306 01, total l$7,034.61 Bladen Dear Mr. Jones: A civil penalty was assessed against you by the N.C. Department of Environment and Natural Resources, Division of Water Quality, on May 21, 2012, and became due and owing on June 21, 2012, in the current amount of seven thousand thirty-four dollars and sixty-one cents ($7,034.61), which includes investigation costs and accrued interest. As' of the date of this letter, no payment has been received. In order to avoid the filing of a civil action against you, the civil penalty assessment must be paid. Payment should be made by check or money order payable Ito "N.C..Department of Environment and Natural Resources" or "DENR", and sent to my attention at the above address. If payment is not made within ten (10) days of receipt of this letter, the State will file a legal actiortin Bladen County Superior Court to collect the civil penalty, plus court costh, and interest at the legal rate. If you have any questions, please contact me immediately at (919) 716-6600. Sincerely, Phi lip T. Reynolds Assistant Attorney General cc: Vanessa Manuel, DENR, DWQ PTR/brc 0 0 NC ENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue _Charles Wakild, P.E. Dee Freeman Governor Director Secretary August 3, 2012 CERTIFIED MAIL # 7008 1300 0000 1106 5994 RETURN RECEIPT REQUESTED Mr. D. Stephen Jones, President Lake Creek Corporation 33 West Bay Ridge Road Harrells, NC 28444 SUBJECT: Past Due Notice of Civil Penalty Assessment Lake Creek Corporation Permit Number: WQ0018708 Case Number PC-2012-0012 Bladen County County RECEIVED AUG - 7 2012 DENR-FAYETTEVILLE REGIONAL OFFICE Dear Mr.Jones: On May 12, 2012, the Division of Water Quality assessed a civil penalty of $6,728.60, including $1,128.60 in enforcement costs, against Lake Creek Corporation in violations of the subject permit conditions. The assessment was sent via certified mail to Lake Creek Corporation and was accompanied by a list of available options that included: payment of the penalty, request for remission of the penalty, or request for an administrative hearing. The assessment stated that failure to exercise one of these options within thirty (30) days after the receipt of a civil penalty will result in this matter to be referred to the North Carolina Attorney General's Office, to institute a civil action in Superior Court to recover the amount of the assessment. Records from our Division reveal that the assessment document was delivered on May 22, 2012. A response was due by June 21, 2012. On June 25, 2012 I received a phone call from, Mr. Michael Myers, Envirolink, Inc. stating he had received a copy of the assessment from Lake Creek Corporation and Wanted to submit a remission request. Mr. Myers was informed that the response due date had passed, and if he wanted to submit information he could, but it would not be considered for remission. Mr. Myers stated he would submit information within the next couple of days. Mr. Myers sent an email the same day relating that information would be sent within the next couple of days On July 18, 2012 I received an email from Mr. Steve Jones, Jr. with attached letter, requesting remission. In addition to being received after the due date the request was incomplete as, there was no signed waiver form submitted. AQUIFER PROTECTION SECTION 1636 Mail Service Center, Raleigh, North Carolina 27699-1636 Location: 512 N, Salisbury Si,.Raleigh, North Carolina 27604 Phone: 919-807-64641 FAX: 919-807-6496 Internet: www.ncwaterouality.orq One NorthCarolina An Equal Opportunity ; Affirmative Action Employer Mr. D. Stephen Jones August 3, 2012 Page2of3 North Carolina General Statute 143-215.6A (d), (f), and (g) which provide the law on contested cases and remission request is copied. below. § 143-215.6A. Enforcement procedures: civil penalties (d) The Secretary shall notify any person assessed a civil penalty of the assessment and the specific reasons therefor by registered or certified mail, or by any means authorized by G.S. 1A-1, Rule 4. Contested case petitions shall be filed within 30 days of receipt of the notice of assessment. (f) Requests for remission of civil penalties shall be filed with the Secretary. Remission requests shall not be considered unless made within 30 days of receipt of the notice of assessment. Remission requests --must-be accompanied by a waiver of the right to a contested -case hearing pursuant to Chapter 150B and a stipulation of the facts on which the assessment was based. Consistent with the limitations in G.S. 143B-282.1(c) and (d), remission requests may be resolved by the Secretary and the violator. If the Secretary and the violator are unable to resolve the request, the Secretary shall deliver remission requests and his recommended action to the Committee on Civil Penalty Remissions of the Environmental Management Commission appointed pursuant to G.S. 143B-282.1(c). (g) If any civil penalty has not been paid within 30 days after notice of assessment has been served on the violator, the Secretary shall request the Attorney General to institute a civil action in the Superior Court of any county in which the violator resides or has his or its principal place of business to recover the amount of the assessment, unless The violator contests the assessment as provided in subsection (d) of this section, or requests remission of the assessment in whole or in part as provided in subsection (f) of this section. If any civil penalty has not been paid within 30 days after the final agency decision or court order has been served on the violator, the Secretary shall request the Attorney General to institute a civil action in the Superior Court of any county in which the violator resides or has his or its principal place of business to recover the amount of the assessment. Such civil actions must be filed within three years of the date the final agency decision, or court order was served on the violator. The request for remission letter and any contacts requesting remission were not submitted within the required thirty days of receipt of the assessment, and cannot be considered. Please submit payment of the civil penalty to the address below within fifteen days of receipt of this notice. Make check payable-to-NCDENR. - Mr. Ed Hardee NCDENR, Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Stephen Jones August 3, 2012 Page 3 of 3 Should you have any questions or desire to setup a payment plan, please contact me at (919)-807-6319. Sincerely, E.D. Hardee Aquifer Protection Section cc: Enforcement File #: PC-2012-0012 (Fayetteville Regional Office, Aquifer Protectiori.Section Permit File WQ0018708 Mr. Michael Myers, Envirolink, Inc. ;CERTIFIED M!. ILT,, RECEIPT', E (Domestic Mail Only; No Insurance Coverage Provided) For delivery Information visit our website at www.usps.como FIFICI L USE Postage Certified Fee Retum Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees Sent To (n • Street, Apt. No.; or PO Box No. ss City, State, ZIP+4 - A4 Y42 • WC_ 42.N. Post `'ark Here n edified Mail Provides: A mailing receipt A unique identifier for your mailpiepe A record of delivery kept by the Postal Service for two years rrportant Reminders: - Certified Mail may ONLY be combined with First -Class Mail® or Priority Mail, Certified Mail is not available for any class of international mail. NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. Fo valuables, please consider Insured or Registered Mail. For an additional fee, a Retum Receipt may be 'requested to provide proof o delivery. To obtain Return Receipt service, please complete and attach a Retun Receipt (PS Form 3811) to the article and•add'applicable postage to cover the fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver foi a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is required. For ' an additional fee, delivery may be restricted to the addressee o addressee's authorized agent. Advise the clerk or mark the mailpiece with thi endorsement "Restricted Delivery". if a postmark on the Certified Mailreceipt is desired,.please present the arti cle at the post office. for postmarking: If a postmark on the Certified Ma receipt is not needed, detach and affix label with postage and mail. NPORTANT: Save this'receipt and'present it when making an inquiry. 5 Form 3800, August 2006 (Reverse) PSN 7530-02-000-9047 - ENDER: COMPLETE THIS SECTION tr J • Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired:, • Print your name and address on the reverse so that'we can return the card to you. • Attach this card to the back of the mailpiece, oron the front if space permits. tD SIT rtirdo7ONES LAKE CREEK CORPORATION 33 WEST BAY, RIDGE ROAD HARRELLS, NC 28444 COMPLETE THIS SECTION ON DELIVERY t 0 Agent In ddresse C. Date of Deliver ..fir 22 - D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type - - - Certified Mail 0 Express Mail °Registered'. , :XRefdrn Receipt for Merchandis( ❑ Insured Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number fi (Transfer from servicelabel) •7Itl ]h1 1 d 1� C1Sl 1 7 4 �. b �e Gr,rr„ r4Sti i roi,rr ter„ onnn Qe+11r., Qeroir,+ nano, n,..,�� UNITED.. STATES P.OST4, .PERV,icF • • • - • "5rst7G1qp'§'Mail.••••''. -,•=Ptmitflb,.•47 • Sender: Please print your name, address, and ZIP-14 in this box • NC DEPT OF ENVIRONMENT & NATURAL RESOURCES DIVISION OF WATER QUALITY ATTN: ART BARNHARDT DENR-FRO 225 GREEN ST, SUITE 714 FAYETTEVILLE NC 28301-5043 MAY 2 2 2012 OWQ IIiIiJllIlI1IllJI Nortil CarolinaDivtsioiif Departmehtf„6. Beverly Eaves Pei.clue Ofia4e, GOvernor CERTIFIED MAIL RETURN RECEIPTREQUESTED D. Stephen Jones Lake Creek Corporation 33. WestBay, Ridge Road Harrells; NC :28444 SUBJECT: Assessment of Civil.Penalties for Violation(s) 6f NCGS 143-143,215:1 8 Permit No.WQ0018108: Bladen County Enforcement File #: PC-2012-0012 , . - Dear Mr. Jones: This letter tfansInitofiotiee of 4:eivil penalty assessed againstLake aniOU • • . . and $ 1118:60. in investigative costs, for a. tbtal. 6',:128,60',;-;:Atta.efied is a copy of the AgeOffeilt..dOCUfgens explainhig thiS:pen'aity. This sa-ction Ay45 taken ppdertlwaufhoriiy vested in: me,by 'delegation provided b the Secretary of thelaepartnient of Envirofinielit alid,:gattutal Res0PEPOAnycontinuing viplatiOn(s).'may be the ;subjett,of a new .enforeePlent action, including an additional penalty: Within thirty days .of receipt of this notice, you nit* de op.e.Ofthe f6.116Wing: 1. Subinitpaynient of the perialtyz: ,1 PappentAoulct 1)e-410e-directly 00e:elder:of the Department. Of Environment_ and.,Natural Resources (do not include, waiver. foriii). Pomba.of the penalty will not foreclose : flu!Ithe!. enforcement Action. for any continuing.ornewviolatioa(s). Please:submit:payment to,the attention.:ol: Ed Hardee Aquifer Protection Section Division of Water Quality 1636 Mail Service Center Raleigh, North Carolina 27699-1636 1617 Mail Service Center, Raleigh, North Carolina 276994 617 Location: 512 N, Salisbury St:: Raleigh, Nofth Carol itirt 27604 Phone: 919-807-6,300FA).C:-9) 9-807-6492 Customer Service: 1-877-63.-6748 Internet www:ncwateratiality.org An Equal Opportunity \ Affirmative Action, Employee One NorthCarohna aturally Assessment.of Civil Penalty L4e.Creek Corporation Enforcement File 4PC-2012-0012 5/11 /20 12 Page2 of 3 OR . ... .... •-.,:•:,:::: . 1 Submit a written request-1'o- rentiSsiOn.inatiding,-11:: did e ... .. , ...... —.. for such Please be aware that &request for remissionis•lirnitatoyconsideration o ..,,i191.4,ekqet\orsiiiiSte below,14 they may . . May relate to the reasonableness ofth,d_arnOurit of ilid-Cylltiqiiii,;*404-,,ii-4., pggigiiittl47 sPtatoPme:nts contained in the civil'penalty assessment.1914)994*(1*41e g6tta6Y*4IVq1914. •,,,- ,,,,,„ • --1.0 er procedure ..for oontesting: whether the:ViOl."' ...., option of an aifiiilitistrative: hearing; such • • •-• •":#1090444‘...0§4ia iimlianiieii• 1-1'6194441*1 it to the Division of Water Quality at the addrefiS- prepare a detailed statement thatestablishes why :•...Op;'":lto#1*6T4TriSFil411j;:tliiik);111)1':'.it.t..itilbeilmriessil administrative' hearing and.a stipulation:ail 'reAii.4`11*§Itb*4.cediAigiV10,13-k'-,14441'%1"* the a**6iilffi**'**la.',r:;lle:!.:r::::::::::.;.-:.:9:,f:::Y:.::?::::"if::1:::ti: an ...v .:••,..:- below In A2. •,-:- - ,„... --., will be approved, the following -factors. shalt be-considefe -,-: '- .:;• - .:•• If -......: -.---,i, • :,-... .---- (1) whether one or more of the civil penalty aSSesSirientlketerS S. '1431:82i.,1.(b)...Were;.-WIF•ongftilly. , . ,, •,• . . , applied to the detriment of thdVidlator,, . • - ,,- , . • .. , :...,..,,,,;.;.,,,c,....--•-,_..)... -, • ,,•,...,.;..,,,,, ....-..- ,, ..,• (2) whether the violator promptlyabated Contintiin.g..01Vitolifoio oti,a•-g-e000igivo.ifittivioutidif; . ,... (3) whether the violation was inadvertent or a-reSult OftihfieCiddnt;••-_•:. .. • ...;.-... . • • • , - ' _ - ,,„ • ._, (4) whether the violator has been assessed civil penaltiOgnallY:ingyidUS Violations; or . . • . , (5) whether payment of the civil penalty will prevent for ifie:itiiiaiiiingiieCeSSary•feirredialAetions., .. . , . .,....,..„ . . .. . Please note that All.evidencdsp•resentdd in supfort.o.f.yotii,:yegue407.r.::.ternissiori;ifi,00:•:b0-§olifititted.-itt writing. , The Director of the Division of the Division of Water -'-..QijalitY.,*illi•ieVid.w your evidence. and inform you of their decision in the matter or your remission.request.T4ito0000,Wilis.proVide details regarding the case status, directions for payment; and provisiont :Or.:ftilifier::APPOt: of 'the• penalty to :the Environmental Management Commission's -Committee on-CivilTenatfyleittiSsiMiSXCommittee.)„, Pleasebe.adVise'd-sthatthe Coirunittee cannot consider inforrnatiOn that was not part "Offite'-6i.jgiiialreMisSiOnyecittat.eptiSidered 1,--y..the Director. TherefOre,-, it is very important that you prepare a -COMPlite. and thorough State:Pent in support of yovrrequestfor. remission.. In order to request remission, you must complete and submit • the .enelosecl"Request :for RemiSsion..of:CiVil Penalties, Waiver of Right to an Administrative Hearing, -and -Stipulation of Facts" form Within thirty (3,10) days of receipt of this The Division of Water Quality also requests• that you complete and submit-the•. enclosed "Justification for.Reinission Request." Both forms skit:hi-be submitted to the following address: Ed Hardee Aquifer Protection Section Division Of -Water Quality 1616 Mail Service center Raleigh, North Caroliiia 21699.-1636 OR 3. File a petition for an administrative hearing with the Office of Administrative Hearings: - Assessment of Civil. Penalty Lake: Creek, Corp -oration Enforcement .File.#.PC 2012=001.2 :5/21/201`2 Page 3,90 If; you wish to contest:any statement' in the attached assessmen administrative:hearing:, eaiwg:, You may obtain thepetition forin fi nt must file the petition:with the: Office: of Administrative eaungs w notice. A petition 'is.considered filed'when it is reeeiyed?in the Off normaloffice l u s., The Office of Administrative Hearin the hours of 8:00;'a.m. and 500 p.m., exceptfer officiallstat, (fax)9r'electronic snail by an attached file (wiih restrictions a> fiting:;fee (if:a::filing fee is:reguired by NCGS § 15013, Hearings within. seven (7) business days following the» axe $ ,f the Office of: Adiiaimstrative 1learnigs,°with all.questtonssregaru process: The mailing. address: and telephone and fax°nui ibers> follows: r :Office of Adiniiistrative Hearings 6714.Mai 1; Service Center Raleigh,. NC 27699,6714. Tel: (91.9):431-3000 Fax: (91'9).43:.1-31.00 One (1): copy of the petition. iriust. also: be served on:DE Mary:Penny. Thompson, General Counsel DENR I601.= Mail Service Center Raleigh, NC 2769.9-160:1 urmg !{between, faestimle "cony and. Failure. to exercise one of the.pptions above within :thirty (3:0) .days of receipt of this notice, as evidenced by an. internal date/time received stamp. (not a postmark), will result in this matter being referred to the Attorney General's Office for collection of the penalty through a civil action. Please be advised that:additional.penalties maybe assessed for violations thatocent after the:review periodof this assessment, lfyou have any questions, please contact Stephen Barnhardt at:(9.10)'433-333'6,, Enclosures cc: Sincerely;; STATE OF NORTH CAROLINA ;COUNTY Of BLADEN IN THE. MATTER OF: LAKE CREEK CORPORATION FOR VIOLATIONS OF.: Permit No.WQ0018798 arid N:C.G.S. 143-215.1 ASSESSMF ST OF CIVIL PENi\ Acting pursuant to North Carolina General delegation provided by the Secretary of theliet*t*iltr..0 TV101-..3t0#t*iNatural I, Charles Wakild P.E., Director. of the Division of Water Quality.:0)*(M''ii:41,the,' 1. FINDINGS OF FACT: A. Lake Creek (.'orporation (hereinaftcr re1rrcdto as reek, is a`-OriltiraltiOn; organized and existing under the laWS'of4014*o.fNorth operates a 20,000 gallon per day waSteWaiet_SAtfaCe,i:Irrigation.Systeni:af'l2415..:NC Highway 41 EaSt; llarrells, NottlirCarblitikIlladen10*-ty, B. The Lake Creek Corporation's -wastewater facility OffststS, Of .an infInert.'flewmimitor, barscreen, storage lagoon with (30) days storage, hypo -chlorite injection and spray irrigation system. C, Lake Creek as issued Permit NO. WQ0018708, On February 3, 2009 With an expiration date of J„une 30, 2013 for operation of the wastewater ,disposar system: D. On February 16, 2012, the Division issued .a Naffed. of Violation (NOV).to Lake Creek identifying violations Of Perrint NO.WQ00.18108. The violations Were as f011OwS: (1). Failure to employ and designate a Certified operator -in:responsible charge (ORC) and 0110 01.* more certified operator(s)• to. be the back-up ORC(s) Permit. Section la (2), (2). Failure to maintaimasuitable year round vegetative crop. Permit Section III (3). (3). Conducting, spray.irrigation OperatiOns during inclement weather. Permit Section In (5). (4). Failure to submit required monitoring information. Permit Section IV (1) (5). Lagoon marker was not readable nor was it reset to'reflect correet levels with the information provided following a:site visit Permit Section III (i 3). (6). Failure to pay the required annual permit teriew4lfee(s). Permit SeCtiOn.Y1 ($.), E. The NOV was sent by Certified Mail, Return Receipt Requested and received on February 25, 2012. .s; F. 04 M4tett .2012 a Notice of .Intent:tonoe4ietex, violation of NI:Q.0.$, j4 --7'2j 5.1 G. ThO Notice of Intent to enforce was •sdk, and recievied on March 27, 2012. 1-1 Staff costs Ancl'Pcpe.11Pes ••associated with del arid extent and bringing enforcernen(dOiOfil 1$4.se4itipo4th0 aboVe;Finding :Of Fad, I rilake.the,:. 11. .CONCLUSIONS,OF LAW. •A. kake,Creekis mpasohli within the l'ilearting.; , B. Permit NO. WQ401.810$ is.reqi,iedhy1tC: Creek oil -February 2011 and 0pites.JUne4 C. Lake Creekviolated N C G S 143-21.5.4. and Perrni • extentastiesdyibed in Petrnit WQ0018708:13Y:theI6 5 k is perfnit Wa§,jss c,maifect44 Pr -,• (f). Failure te:einplOy,and desighate:h:cortifiedOfferaTO00840iisiblolifte7(0K arid:Otie or niote cotified„opetatO1:0:to 01;(2)., (2): failure to maintain a (3): .cohchictihg:spra)1fligation opetationS.duiini:1n0*4*eatblet, Permit Section .1II‘ (5), (4): Failure to ,submitrequired,monioring infdinatiOn;40#pofts. Permit Section TV - (1). (5). Lagoon marker was not readable nor Wa'§it:t.60-ettAO-Oiket correct levels information provided following a site:Visit..PO-hilt SWioh.III • (6). Failure to pay-thoreoirod arihp.1 permit tetiew41 fcC44f!Crthit$ectiO04 ($),, GentratStaihte 143,21-5:0A (h),:(2) provides that a civil penalty of ildt.inotelhao $490 (), 00 per violation a pergdii. who violatesor failsto.adt#1aeetidaiic;With, . the t60:8„ conditions, or requiteinefits ofopettnit„roqWtd4 14.342151... • B. Generalgfatufe :141215•.,3(a).:(9)':proyides,tattne. teasonOlp;costs -of .any. investigation, inspection or -monitoring:survey may I)e,a§se§cd.Aga-ih-ft,a person who' violates : any: kegiaations, glanciatc%bt lithitationadOpted'bylilt. Environmental Managenient COrronis.8ioivot0014tos,Ahy.torm§ or conditions 01:111:421Sslied 143-245.1, or special ord,cr or. -other documenti$suOTUrsuantto 14.3415.2.. Based upon the aboveFindings of.Fact and Conclusions fLaw, 1 inalj'e the f011bwing. III. DECISIONS Pursuant to N.C.G.S. 143 2.15,6A iri:detertritmn into account the Findings of Fact and Conclusions p N.C.G.S:14313282.1, = Accordingly, Lake Creek Corporation shall be, $ '1,600,:00 $ 200.00 " $ 20000 $ 3,200.00 $ 200.00 20000 $ 5600.00 for violaticinsf , Section III (2),.:firai in ern operator in,reSpOliSite'vefe(( operators(s)_ tp:be:f 1, .01.;Z e amoun:o for violations Of Section .111 (3)i•vbY:failtri the spray irrigatidn fie assessed 43215 and Permit No. , sto4rianitatn`a,SUttapp•y941:-TpRuuto era for violations of C.G.S. and NO:: 708, -", Section by conducting. spray irrigation operations during inclement weather. (21 ,ebenibef 2-011) for violations arid Permit No. wool ros Section (1),, by submit information and itep6it..:(01-.::**13br 2911 -,,-May=1,- 2012) for violations 0: and Permit NO. W00618108 Section 111(.13), by not haVing:a readable lagoon level marker and failure to reset the level inarkey:fq reflect ccirrectleyels with information provide after a site visit. for violations ofN.C.O.S. 143215 and Permit No. WQ001870.8 Section VI (8) by failure to pay the:required 'annual permit renewal fees. (2010 and 2011.of $1310:00 per year) TOTAL CIVIL PENALTY which is 0.44 percent of the, maximum p,enaltyauthortzed by N.O.G.S. 1437215.6A. $ 1,128,.60 Investigation 'costs assessed $ 6'728.60 TOTAL AMOUNT DUt which penalties have not yet beep assessed. V. TRANSMITTAL: Pursuant:to. G. S. 143 •21 .6A(p), in 400014011 into account the Findings,ofFaCt and ConcbiSiOnk'S 282. 1 (b), which are: (I) Thc 'degree and extent of .hat-ii••••16..the!,.ra w altresonkeSO health, or ' ' • to pnyatepropertyyegglthri:Oin- -...•''''''''•'-''''''-'•'-'-'''-7---- ' . ,V;io 42,,.4:- • (2)- The duend gravityoft14.-.ViOlaiib ,''''' • -'"•-1-9w '. (31).- Theefiect on ground:or surlaceAvatW Vann effect - - • • - •-, , • —•-...-. ,..:•... (4) The cost of r'OttfYingthe•.daini''sr4''' (5). The amount cif ilva,savgd-. Acmcon1 p L(6):: Whether-0.0,1.4000n was';ciiiri-f 4 ' i11fi11yV4199,44#4, (7) Thoprior recordofthe'violatO6it aiii or failing to ., over 'which:theEnvironmental TaWin),Wti, Commission has and. ,...-. (8) The cost to:the.:glatcolthe.otitOrCoiiichtt roc! u:ro - ' - .,,,,....:, ._..... IV. NOTICE:: lic I reserve the right to assess civil penalties and investigative costs for any continuing violations occurring after the assessment period indicated, above. Each day o'fa continuing violation may be considered a separate violation Subjed to a maximum $25;000i6O:per-day penalty. Civil - penalties and itivestigOVe-cosuriwy be assessedfor any othor rules and.statutesfor These, Ftading of Fact Conelusions. of Law and De**, shall be transmitted to,Lai.o crook in gccordance with 3I w-At./ (Pale) STATE OF NORTH CAROLINA COUNTY OF BLADEN IN THE MATTER OF ASSESSMENT OF CIVIL PENALTIES AGAINST LAKE CREEK CORPORATION 33 WEST BAY, RIDGE .ROAD BARRELS, NORTH CAROLINA, 0444 PERMIT NO:WQ0018708 EPA T •s' Fi Having been .assessed civil penalties totaling the assessment4ocurnent of -the Division Of Whiet';044' desiring to seek remission of the civil penalty, does hearing in the above -stated .matter and assessment document. The undersigned ftirthei.,44.dOW' of remission of thiscivil penalty must be submitted to.. Quality within thirty (30) days of receipt of the. notice support of iremission request will be alloWed"dttefiliitty,`, of assessment. This the day of edee'restrii&e--4F-- su ort e Director of thc Division of Water f assessmcnt. No new evidence in 0) clays fr�m lhe receipt of the notice • : Signature ADDRESS TELEPRQNE N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699=101 (919)733-7015 EtrA •OENfi ciisyirila,seiqce• • )477-623-6748' JUSTIFICATION`ROW APS Case Nun:16er: PC,2012-0012 Assessed Party; Lake.Creek:C.OrnOrdtleik*:j; Permit NO.. 'W000187.08 Amount diSe-siedr.676( Please Use:this:form -When, requesting reirtiSSiiM•.b .,.. rs,eivi e '''a li3Opqt,410,00n) 10031i0 Request For Remission, Waiv& Of Right-16 .: dii-Allig;I:VP-.05:f1:„..di l'i :11::kir6;fit _tS jailed eia rii Tig ifin:b gf' Facts" form to request .remission of this You' e irep 42 r.._ :,...:. 1-41:••4-- . q ap ar: opumentsAhat you believe .support your request and.are rie.PeSiiiirJoi ciVil:penal ,,..Tghotldtrli:i::::::::::41; ji"--6. ,, :.,,,_,,,;• year request for ,:reirfiSSion: Please : be: aware that a consideration of the five factors fisted belii*-.as4..,,e may.re a e.,..,o amount of.,fho: Civil penalty- assessed, leiltl:-.04iii*-41eWkigh,44not the ' ,:;t:,•Ir202 CO1:1S::ti::e;.crj::t, 1,:lx:r'11:::::1:i:iill::f:,: or .1 request'i".forr ea proper- rsoce contesting 'whether the violation(s) pc.cored.6;.:. eI`,attei-tefof any of the Iactua1r§taterrients. contained iiithe ciVil:ponalty assessment:dairriten Bv[NCGS,-- :, • --, ...4..•&,0Q5,...,,,tv,... ; -• ...., 'remission ? a d civil penalty:may be g.riatited When.. one te'frieirth fiVO act° aka tqsd ease• ,-v-zo7.,,ir, vs!•15.t• : cheelc.. eac,ll faelof that :you :4:61iop:appitiog:e.tii:;vour 9N4lei, 4. Omni . 4,.' - i001:actirig; copies of ..supporting:cfpgutiehis::sti- ,_. tor applies (attacittOffia a es: `•-.' 7. - - T. ',: ;.: , • as needed). • • _ • -one or inure of the eivil,pet4ity.?-a§§8§1-iiaif.faefotgin -gdOg:;14011.-*;2g1',IKb)46r wrongfully applied to 'thedetriment bEthelibtitiorier (the assessinentfactoi s are included in the plkichc.d penalty listed ifl the civil penaily • .(h) the violator proitiptly libated boritifiiiiiig:efMtdiiiiittit61 darilkeleSilliititTrorrifthe violation (i.e,, txplatitfh.e- steps that you took coetept the 70folatioit.dhcipiteMit: fuhtrevee prren:e0); • 1 • ,•. I . . (e), the violation, was inadvertent or ,:a result. of 'a.ti accident (Le.i. explain 'Iii.Iiii. the violaii.on'wdj unavoidable or • jeiiiiething you &mid noiplevent br.:pkopafoi)„.. . (d) the violator had not been assessed civil penalties for any previousviolations; (e) payment Of the civil penalty Will prevent pm/Merit for the retnaihifig iieo6§sary rethddial. actions 6.6.„ .exptaii.th pq.prho'nt,.9f th0 ,0111,1711-,#,eneil0 wzllprevent you frfip) pOfoeming :the OetiVitigheee.Odiytd:qchfeve cpnygiafiee). EXPLANATION:. \Rem. req. ( ( rR 0 n.l co N N m 0 D D N to rR O ra Postage Certified Fee Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Feel Sent Map Street, Apt. No.; n or PO Box No. Lam. City, State, ZIP+.1 Lai .UNITED.STATES P.OS.T:3L5ERVIQE „d f b•'%:'p' c..:. '' +"�:ti_+T. .s:t�'s.:t+: SrK •. i Postmark Here 514/A- ° Sender: Please print your name, address, and ZIP+4in this box • NC DEPT OF ENVIRONMENT & NATURAL RESOURCES DIVISION OF WATER QUALITY ATTN: ART BARNHIARDT 225 GREEN ST, SUITE 714 FAYETTEVILLE NC 28301-5043 • ENR F :u'12 j 1,3131.133111,1,1,11 t3 !il31,311313i1313,i.17331 SENDER: COMPLETE THIS SECTION - e Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. • Print your name and address on the reverse so that we can return the card to you. e Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article r o D. STtirN 70NES LAKE CREEK CORPORATIONE OAD 33 WEST BAY, RID HARRELLS, NC 28444 CONIP,LETE THIS SECTION ON DELIVERY ❑ Agent ddressee ri C. Date of Delivery, S'r. 22 D. Is delivery address different from item 1? 0 Yes If YES, eriter delivery address below: ❑ No 3. Service Type Cegied Mail 0 Express CI Registered urn Receipt for Merchandise ❑ Insured Mail ID C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number (Transfer from service label) 4R11 Fahrttary 2004 7010 18'70. 0003 4774 8201 Domestic Return Receipt 102595-02-M-IE