NC0024945_DV-2022-0142_20221228 (5)

STATE OF NORTH CAROLINA
COUNTY OF MECKLENBURG
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST
CHARLOTTE WATER
IRWIN CREEK WWTP
DEPARTMENT OF ENVIRONMENTAL
QUALITY
WAIVER OF RIGHT TO AN
ADMINSTRATIVE HEARING AND
STIPULATION OF FACTS
CASE NO. DV-2022-0142
Having been assessed civil penalties totaling $1,105.05 for violation(s) as set forth in the
assessment document of the Division of Water Resources dated January 6, 2023, the undersigned,
desiring to seek remission of the civil penalty, does hereby waive the right to an administrative hearing in
the above -stated matter and does stipulate that the facts are as alleged in the assessment document. The
undersigned further understands that all evidence presented in support of remission of this civil penalty
must be submitted to the director of the Division of Water Resources within thirty (30) days of receipt of
the notice of assessment. No new evidence in support of a remission request will be allowed after (30)
days from the receipt of the notice of assessment.
This the day of , 2022.
SIGNATURE
ADDRESS
TELEPHONE