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Home My WebLink AboutNC0056863_Signature Authority 2014_20140924September 23, 2014 Wastewater Branch Water Quality Permitting Section Division of Water Resources 1617 Mail Service Center Raleigh, NC 27699 -1617 Subject: Delegation of Signature Authority Town of Rose Hill NPDES Number NC 0056863 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 Town of Rose Hill 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. Bobby Cavenaugh Public Utilities Director Talmadge Grubbs Pretreatment Coordinator/Water /Sewer Technician And Backup ORC Beniamin Hillard ORC Angela Smith Customer Service Rep./Deputy Tax Collector If you have any questions regarding this letter, please feel free to contact me at 910 -289- 3159. Sincerely, RECEIVED /DENR/DWR ary .Boey SEP242014 Mayor Water Quainy Permitting Section cc: Wilmington Regional Office, Water Quality Permitting Section Itow 1ln.i. 7rHwi.,Iar.d I)i TOWN OF `' RosE HILL NORTH CAROLINA flomr of the Wor!&.i bugear I iy:ng Pan September 23, 2014 To Whom It May Concern: Mayor Clarence Brown, Sr. passed away on April 23, 2013, delegating authority to Mayor Pro - Tempore Gary L. Boney. Mayor Gary L. Boney (elected November 2013) is now the responsible official, effective the above said date. T*�—) Thomas G. Drum Town Administrator RECEIVED 0ENRIDWR 103 SE Railroad Street, P.O. Box 8, Rose Hill, N.C. 28458 Telephone 910 - 289 -3159 -- Fax 910 - 289 -4461 Email: rosehill(cDembargmail.com www.townofrosehilinc.com SEP 2 4 z i i4 W4tel U anti Section Permitting DWR DIA&S n of Water Resoures North Carolina (NC) eDMR Reports eDMR Registration Form EDMR is an electronic reporting system, which will provide a facility Owner the ability to submit discharge monitoring reports via the internet. EDMR is only currently available to facilities that have an NPDES Wastewater permit issued by the Division of Water Resources. Registration for eDMR must be completed by the legal Owner of the facility(s), and this legal Owner must be the same Owner to which the permit(s) have been issued. Once an Owner is registered for eDMR, all permits held by the Owner will also be registered and able to submit reports via eDMR. NOTE: Before completing and submitting the registration form, the legal Owners as specified above should verb the permit facility, Owner, and ORC designations for all permits. This information can be verified using the eDMR Owner Information Search provided on the eDMR website. This information is maintained in the DWR data management system, as provided by the permittee, and contained in the permit issued to the Owner. Should any discrepancies with this information be determined, the appropriate DWR contact should be notified so information can be corrected prior to registration. It is important that the permit information be correct prior to eDMR registration. Please provide all information in Parts A, B, C and D. An Owner signature is required for eDMR registration. Should the registration information be incomplete, the registration process may be delayed. Part A: Owner Registration — Permit/Facility Information Please provide a Permit Number and the associated facility information. Only a single permit number is needed for registration. If multiple permits are involved, the permit number provided will be used to identify the Owner and all associated permits. All associated permits issued to the Owner will be registered for eDMR. NC eDMR Registration Form (Revision 3.1) Page 1 of 5 N1 C 1010156863 _ Film' Town Of Rose Hill r` : 4_ Rose Hill Wwtp 287 Charlie Teachey Road L4 Rose Hill NC , # tea 28458- NC eDMR Registration Form (Revision 3.1) Page 1 of 5 Submitter User Details Permit No. (s): NC0056863 NC00 NC00 NC00 NC00 First Name: Talmadge Middle Name: Keith Last Name: Grubbs Phone Number: 910 - 289 -2000 Email: rosehillpw_grubbs @embarq mail.com Uset' lD: (Assigned by DWR eDMR Administrator) Submitter User Details Permit No. (s): 1 NC0056863 NC00 NCOO ��- NC00 NC00 First Name: Bobby Wayne Cavenaugh Middle Name: Last Name: Phone Number: 910- 289 -1461 Email: ro m sehillpwOembargmaiLco User ID: (Assigned by DWR eDMR Administrator) Submitter User Details Permit No. (s): NCO056863 NC00 LNCOO NC00 NC00 Joseph First Name: Middle Name: Benjamin Hilliard Last Name: Phone Number: 910- 2894498 Small: rhtownclerk(a embargmail.c � Om User ID: (Assigned by DWR eDMR Administrator) Submitter User Details Permit No. (s): NC0056863 NC00 NC00 NC00 NC00 First Name: Angela Savage Middle Name: Last Name: Smith Phone Number: 910- 289 -3159 Email: rosehill @embargmail.com UseC ID: (Assigned by DWR eDMR Administrator) NC eDMR Registration Form (Revision 3.1) Page 3 of 5 I ' Part B: Owner Registration - Owner User Details: Please provide the following information which is needed for creating the Facility Owner in eDMR. The Owner is the legal entity to which the permit(s) have been issued and may be an organization or individual. For an organization, the information provided for the owner details should be the official contact person or the person with delegated signatory authority for the Owner. Boney Leamon Gary 910- 289 -3159 e N r mfsi�; resg310 @yahoo.com k'hda (Assigned by DWR eDMR Administrator) Part C: User Account Information — Submitters Please provide the users, in addition to the Owner, who will need Submitter permissions. Submitter permissions can only be assigned by the DWR eDMR Administrator. The Owner specified above will be given full eDMR permissions including Submitter permissions. The Submitter is equivalent to the individual who signs the certification statement on the back o the discharge monitorin rgport. In most cases, the Submitter will be the Owner but may be other delegated individuals. The Submitter must be an individual with delegated signatory authority. If individuals other than the duly authorized person for the Owner have been delegated signatory authority, the Division of Water Resources must be notified in writing of such delegations. A delegation of authority form is available from the eDMR website. In addition to the User Details, please specify the permit(s) that each user will be associated with for eDMR submittal. Should additional space be needed for users and/or permits, please make additional copies of the Submitter User Details page and complete as needed. NOTE: The Owner will be responsible for creating all facility users except those with Submitter permissions. In addition to the Owner and Submitter user, there are four additional user types identified by user permission level: Facility Administrator, Certifier, Data Entry and View Only. The Owner and Facility Administrator will have the ability to manage facility users. The Facility User Administration Guide will provide the appropriate procedures for facility user management. NC eDMR Registration Form (Revision 3.1) Page 2 of 5 Part D: Registration Certification: I request the facility identified above be allowed to submit DMR data using the NC DWR eDMR system. 1 understand that electronic submittal of the DMR does not fully satisfy US EPA's electronic signature requirements and as a result, 1 understand I will be required to print, sign, and submit hardcopies (one signed original and a copy) of the eDMR to NC DWR under the same reporting requirements as paper -based DMRs as specified in Part II, Condition D (2) of the NPDES Permit. 1 agree to protect the security of my user ID and password from compromise and shall take all necessary steps to prevent its loss, disclosure, modification, or unauthorized use. Gary Leamon Boney Owner (Permittee) Name (type or print) Mayor Official Title (type or Print) -A 97�_, Lc-�� September 22, 2014 Owner (Perini e) Signature k3 Date Please return the completed Registration Form to the NC Division of Water Resources Fax: or Email: or Mail to: (919) 807 -6498 eDMRadminAncdenr.gov Information Processing Unit Attn: eDMR Registration 1617 Mail Service Center Raleigh, NC 27699 -1617 NC eDMR Registration Form (Revision 3.1) Page 4 of 5 Rost: I 1 tu. trx:npaiar..! 1R "� TOWN OF `, ROSE HILL NORTH CAROLINA Home off he b mrd'.S Largcar 1-iy.-ng Nan September 23, 2014 To Whom It May Concern: Mayor Clarence Brown, Sr. passed away on April 23, 2013, delegating authority to Mayor Pro - Tempore Gary L. Boney. Mayor Gary L. Boney (elected November 2013) is now the responsible official, effective the above said date. T� y Thomas G. Drum Town Administrator RECEIVED /DP SEP 2 4 : Water Quaut; Permitting Sertio 103 SE Railroad Street, P.O. Box 8, Rose Hill, N.C. 28458 Telephone 910- 289 -3159 - Fax 910 - 289 -4461 Email: rosehil1(a?embargmail.com www.townofrosehilinc.com DWR Dlvisloe of W atu Resowses North Carolina (NC) eDMR Reports eDMR Registration Form EDMR is an electronic reporting system, which will provide a facility Owner the ability to submit discharge monitoring reports via the internet. EDMR is only currently available to facilities that have an NPDES Wastewater permit issued by the Division of Water Resources. Registration for eDMR must be completed by the legal Owner of the facility(s), and this legal Owner must be the same Owner to which the permit(s) have been issued. Once an Owner is registered for eDMR, all permits held by the Owner will also be registered and able to submit reports via eDMR. NOTE: Before completing and submitting the registration form, the legal Owners as specified above should verb the permit facility, Owner, and ORC designations for all permits. This information can be verified using the eDMR Owner Information Search provided on the eDMR website. This information is maintained in the DWR data management system, as provided by the permittee, and contained in the permit issued to the Owner. Should any discrepancies with this information be determined the appropriate DWR contact should be notified so information can be corrected prior to registration. It is important that the Permit information be correct prior to eDMR registration. Please provide all information in Parts A, B, C and D. An Owner signature is required for eDMR registration. Should the registration information be incomplete, the registration process may be delayed. Part A: Owner Registration — Permit/Facility Information Please provide a Permit Number and the associated facility information. Only a single permit number is needed for registration. If multiple permits are involved, the permit number provided will be used to identify the Owner and all associated permits. All associated permits issued to the Owner will be registered for eDMR. NC eDMR Registration Form (Revision 3.1) Page I of 5 :d NICIOIOI56863 ;Faet133r Over• >: Town Of Rose Hill Rose Hill Wwtp =: 287 Charlie Teachey Road Rose Hill NC 1 28458 t�►d+lt1 NC eDMR Registration Form (Revision 3.1) Page I of 5 Part B: Owner Registration - Owner User Details: Please provide the following information which is needed for creating the Facility Owner in eDMR. The Owner is the legal entity to which the permit(s) have been issued and may be an organization or individual. For an organization, the information provided for the owner details should be the official contact person or the person with delegated signatory authority for the Owner. Last Name: Boney Middle Name: Leamon First Name: Gary Phone Number: 910- 289 -3159 Email: resg310 @yahoo.com User Id: (Assigned by DWR eDMR Administrator) Part C: User Account Information — Submitters Please provide the users, in addition to the Owner, who will need Submitter permissions. Submitter permissions can only be assigned by the DWR eDMR Administrator. The Owner specified above will be given full eDMR permissions including Submitter permissions. The Submitter is eauivalent to the individual who suns the certification statement on the back of the discharge monitoring report. In most cases, the Submitter will be the Owner but may be other delegated individuals. The Submitter must be an individual with delegated signatory authority. If individuals other than the duly authorized person for the Owner have been delegated signatory authority, the Division of Water Resources must be notified in writing of such delegations. A delegation of authority form is available from the eDMR website. In addition to the User Details, please specify the permit(s) that each user will be associated with for eDMR submittal. Should additional space be needed for users and /or permits, please make additional copies of the Submitter User Details page and complete as needed. NOTE: The Owner will be responsible for creating all facility users except those with Submitter permissions. In addition to the Owner and Submitter user, there are four additional user types identified by user permission level: Facility Administrator, Certifier, Data Entry and View Only. The Owner and Facility Administrator will have the ability to manage facility users. The Facility User Administration Guide will provide the appropriate proceduresforfacility user management NC eDMR Registration Form (Revision 3.1) Page 2 of 5 Submitter User Details Permit No. (s): NC0056863 NC00 NC00 NC00 NC00 First Name: Talmadge Middle Name: Keith Last Name: Grubbs Phone Number: 910 -289 -2000 Email: rosehillpw_grubbs @embarq maiLcom User ID: (Assigned by DWR eDMR Administrator) Submitter User Details Permit No. (s): NCO056863 NC00 NC00 NC00 NC00 First Name: Bobby Wayne Middle Name: Last Name: Cavenaugh Phone Number: 910- 289 -1461 Email: rosehillpw @embargmail.co m User ID: (Assigned by DWR eDMR Administrator) Submitter User Details Permit No. (s): NC0056863 NC00 NC00 NC00 NC00 First Name: Joseph Middle Name: Benjamin Last Name: Hilliard Phone Number. 910- 289 -4498 Email: rhtownclerk @embargmail.c Om User tD: (Assigned by DWR eDMR Administrator) Submitter User Details Permit No. (s): NC0056863 NC00 NC00 NC00 NC00 41rst Name: Angela Middle Name: Savage Last Name: Smith Phone Number: 910 -289 -3159 Email: rosehill @embargmail.com User ID: (Assigned by DWR eDMR Administrator) NC eDMR Registration Form (Revision 3.1) Page 3 of 5 Part D: Registration Certification: I request the facility identified above be allowed to submit DMR data using the NC DWR eDMR system. 1 understand that electronic submittal of the DMR does not fully satisfy US EPA's electronic signature requirements and as a result, I understand I will be required to print, sign, and submit hardcopies (one signed original and a copy) of the eDMR to NC DWR under the same reporting requirements as paper -based DMRs as specified in Part 11, Condition D (2) of the NPDES Permit. I agree to protect the security of my user ID and password from compromise and shall take all necessary steps to prevent its loss, disclosure, modification, or unauthorized use. Gary Leamon Boney Owner (Permittee) Name (type or print) Official Title (type or Print) —A 9��7, 10� September 22, 2014 Owner (Permi e) Signature k3 Date Please return the completed Registration Form to the NC Division of Water Resources Fax: or Email: or Mail to: (919) 807 -6498 eDMRadmin(i ,ncdenr.gov Information Processing Unit Attn: eDMR Registration 1617 Mail Service Center Raleigh, NC 27699 -1617 NC eDMR Registration Form (Revision 3.1) Page 4 of 5