NC0041696_LV20150086_20150608

"A
0
MUM,
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Certified Mail # 7014 0510 0000 4466 5948
Return Receipt Requested
June 08, 2015
Jeffery V Morse
Town of Valdese
PO Box 339
Valdese, NC 28690
SUBJECT: Notice of Violation and Assessment of Civil Penalty
for Violations of North Carolina General Statute-(G.S.) 143-215.1(a)(6)
and NPDES Permit No. NCO041696
Town of Valdese
Lake Rhodiss WWTP
Case No. LV -2015-0086
Burke County
Dear Permittee:
Donald R. van der Vaart
Secretary
RECEIVEDIDENROWR
JUN 16 2015
Water Quality
Permitting Section
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $659.26 ($500.00 civil penalty
+ $159.26 enforcement costs) against Town of Valdese.
This assessment is based upon the following facts: -a review has been conducted of the discharge monitoring report
(DMR) submitted by Town of Valdese for the month of January 2015. This review has shown the subject facility to be
in violation of the discharge limitations and/or monitoring requirements found in NPDES Permit No. NC0041696. The
violations, which occurred in January 2015, are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that Town of Valdese violated the terms, conditions or
requirements of NPDES Permit No. NCO041696 and G.S. 143-215.1(a)(6) in the manner and extent shown in
Attachment A.. In accordance with the maximums established' by G.S. 143-215.6A(a)(2), a civil penalty may be
assessed against any Person who violates the terms, conditions or requirements of a permit required by G.S.
143-215.1(a).
Based upon the above findings of fact and conclusions of law, and in accordance with authority provided by the
Secretary of the Department of Environment and Natural Resources and the Director of the Division of Water
Resources, I, G. Landon Davidson, Regional Supervisor, Asheville Regional Office hereby make the following civil
penalty assessment against Town of Valdese:
2090 U S. 70 Highway, Swannanoa, NC 28778
Phone [phone] \ tnternet• www ncdenr gov <http //vvww.ncdetn gov>
An Equal Opportunity \ Aflirntndve Action Employer- Made in part by recycled paper

500.00 1 of the 1 violations of 143-215.1(a)(6) and NPDES Permit No.NC0041696, by discharging
waste water into the waters of the State in violation of the Permit Weekly Average for TSS -
Conc.
500.00 TOTAL CIVIL PENALTY
159.26 Enforcement Costs
659.26 TOTAL AMOUNT DUE
Pursuant to G.S. 143-215.6A(c), in determining the amount of the penalty I have taken into account the Findings of Fact
and Conclusions of Law and the factors set forth at G.S. 143B -282.1(b), which are:
(1) The degree and extent of harm to the natural resources of the State, to the public health, or to private property
resulting from the violation;
(2) The duration and gravity of the violation;
(3) The effect on ground or surface water quantity or. quality or on air quality;
(4) The cost of rectifying the damage;
(5) The amount of money saved by noncompliance;
(6) Whether the violation was committed willfully or intentionally;
(7) The prior record of the violator in complying or failing to comply with programs over which the Environmental
Management Commission has regulatory authority; and
(8) The cost to the State of the enforcement -procedures.
Within thirty (30) days of receipt of this notice, you must do one of the following:
(1) Submit payment of the penalty, OR -
(2) Submit a written request for remission, OR
(3) Submit a written request for an administrative hearing
Option 1: Submit payment of the penalty:
Payment should be made directly to the order of the Department of Environment and Natural Resources (do not
include waiver form). Payment of the penalty will not foreclose further enforcement action for any continuing or
new violation(s). Please submit payment to the attention of.
NPDES Compliance/Enforcement Unit
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
2

Option 2: Submit a written request for remission or mitigation including a detailed
justification for such request:
Please be aware that a request for remission is limited to consideration of the five factors listed below' as they' may
relate to the reasonableness of the amount of the civil penalty assessed. - Requesting remission is not the proper
procedure for contesting whether the violation(s) occurred or the accuracy of any of the factual statements contained
in the civil penalty assessment document. Because a remission request forecloses the option of an administrative
hearing, such a request must be accompanied by a waiver of your right to an administrative hearing and a stipulation
and agreement that no factual or legal issues are in dispute. Please prepare a detailed statement that establishes why
you believe the civil penalty should be remitted, and submit it.to the Division of Water Resources at the address listed
below. In determining whether a remission request will be approved, the following factors shall be considered:
(1) whether one. or more of the civil penalty assessment factors in NCGS 143B -282:1(b) was wrongfully
applied to the detriment of the,petitioner;
(2) whether the violator promptly abated continuing environmental damage resulting from the violation;
(3) whether the violation was inadvertent or a result of an -accident;
(4) whether the violator had been assessed civil penalties for any previous violations; or
(5) whether payment of the civil penalty will prevent payment for the remaining necessary remedial actions.
Please note that all evidence presented in support of your request for remission must be submitted in writing. The
Director of the Division of the Division of Water Resources will review your evidence and inform you of his decision
in the matter of your remission request. The response will provide details regarding the case status, directions for
payment, and provision for further appeal of the penalty to the Environmental Management Commission's Committee
on Civil Penalty Remissions (Committee). Please be advised that the ,Committee cannot consider information that
was not part of the original remission request considered by the Director. Therefore, it is very important that you
prepare a complete and thorough statement in support of your request for remission. .
In order to request remission, you must complete' and submit the enclosed "Request for Remission of Civil Penalties,
Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form within thirty (30) days of receipt of this
notice. The Division of Water Resources also requests that -you complete and submit the enclosed "Justification for
Remission Request."
Both forms should be submitted to the following address: _
NPDES Compliance/Enforcement Unit
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

Option 3: File a petition for an administrative hearing with the Office of Administrative
Hearings:
If you wish to contest any statement in the attached assessment document you must file a petition for an
administrative hearing. You may obtain the petition form from the Office of Administrative Hearings. You must file
the petition with the Office of Administrative Hearings within thirty (30) days of receipt of this notice. A petition is
considered filed when it is received in the Office of Administrative Hearings during normal office hours. The Office of
Administrative Hearings accepts filings Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.,
except for official state holidays. The petition may be filed by facsimile (fax) or electronic mail by an attached file
(with restrictions) - provided the signed original, one (1) copy and a filing fee (if a filing fee is required -by NCGS
§1508-23.2) is received in the Office of Administrative Hearings within seven (7) business days following the faxed
or electronic transmission. You should contact the Office of Administrative Hearings with all questions regarding the
filing fee and/or the details of the filing _ process.
The mailing address and telephone and fax numbers for the Office of Administrative Hearings are as follows:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714
Tel: (919) 733=2698
Fax: [phone]
One (1) copy of the petition must also be served on DENR as follows:
Mr. Sam M. Hayes, General Counsel
Department of Environment and Natural Resources
1601 Mail Service Center
Raleigh, North Carolina 27699-1601
Please indicate the case number (as found on page one of this letter) on the petition.
Failure to exercise one of the options above within thirty (30) days of receipt of this letter, 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 may be assessed for violations
that occur after the review period of this assessment.
4

If you have any questions, please contact Janet Cantwell with the Division of Water Resources staff of the Asheville
Regional Office at [phone] or via email at [e-mail].
Since
for S
Director, Division of Water Resources, NCDENR
By G. Landon Davidson, Regional Supervisor
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDENR
ATTACHMENTS
Cc: WQS Asheville Regional Office - Enforcement File (w/attachments)
NPDES Compliance/Enforcement Unit - Enforcement File (w/attachments)
Central Files, Water Quality Section (w/attachments)
61
Iz-

JUSTIFICATION FOR REMISSION REQUEST
Case Number: LV -2015-0086 County: Burke
Assessed Party: Town of Valdese
Permit No.: NC0041696 Amount Assessed: $659.26
Please use this form when requesting remission of this civil penalty. You must also complete the 'Request For
Remission, Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form to request remission of
this civil penalty. You should attach any documents that you believe support your request and are necessary for the
Director to consider in evaluating your request for remission. Please be. aware that a request for remission is limited to
consideration of the five factors listed below as they may relate' to the reasonableness of the amount of the civil penalty
assessed. Requesting remission is not the proper procedure for contesting whether the violation(s) occurred or -the
accuracy of any of the factual statements contained in the civil penalty assessment document. Pursuant to N.C.G.S. §
143B -282.1(c), remission of"a civil penalty may be granted only when one or more of the following five factors apply.
Please check each factor'that you believe applies to your case and provide a detailed explanation, including copies of
supporting documents, as to why the factor applies (attach additional pages as needed).
(a) one or more of the civil penalty assessment factors in N.C.G.S. 143B -282.1(b) were wrongfully applied to
the detriment of the petitioner (the assessment factors are listed in the civil penalty assessment document);
(b) the violator promptly abated continuing environmental damage resulting from the violation (Le., explain the
steps that you took to correct the violation and prevent future occurrences);
(c) the violation was inadvertent or a result of an accident (i.e., explain why the violation was unavoidable or
something you could not prevent or prepare for);
(d) the violator had not been assessed civil penalties' for any previous violations;
(e) payment of the civil penalty will prevent payment for the remaining necessary remedial actions (i.e., explain
how payment of the civil penalty will prevent you from performing the activities necessary to achieve
compliance).
EXPLANATION:

STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
COUNTY OF BURKE
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
Town of Valdese )
Lake Rhodiss WWTP 1
PERMIT NO. NCO041696 ) CASE NO. LV -2015-0086
Having been assessed civil penalties totaling $659.26 for violation(s) as set forth in the assessment document of the
Division of Water Resources dated June 08, 2015, 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 720
ADDRESS
TELEPHONE
SIGNATURE

C
ATTACHMENT A
Town of Valdese
CASE NUMBER: LV -2015-0086
PERMIT: NCO041696 FACILITY: Lake Rhodiss WWTP COUNTY: Burke REGION: Asheville
Limit Violations
MONITORING OUTFALL I VIOLATION UNIT OF CALCULATED % OVER
PENALTY REPORT PPI LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE LIMIT VIOLATION TYPE
$500.00 1-2015 001
9
Effluent TSS - Conc
1/10/15 5 X week
a
mg/l 45 61.00 35.6 Weekly Average Exceeded

DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT (FILE)
Violator: Town of Valdese/ NCO041696
(January 2015 DMR)
County: Burke
Case Number: LV -2015-0086
8 ASSESSMENT FACTORS
As required by G.S. 143-214.6A(c), in determining the amount of the penalty I considered the factors
set out in G.S. 143B -282.1(b), which are:
1) The degree and extent of harm to the natural resources of the State, to the public health, or to
private property resulting from the violation;
All effluent violations may be detrimental to the receiving stream but may not
be immediately quantified.
2) The duration and gravity of the violation;
One Weekly Average TSS, exceeded the permit limit by 35.6 %.
3) The effect on ground or surface water quantity or quality or on air quality
All effluent violations may be detrimental to the receiving stream but may not
be immediately quantified.
4) The cost of rectifying the damage;
The cost is unknown.
5) • The amount of money saved by noncompliance;
The amount of money saved would include the cost of excess solids removal.
6) Whether the violation was committed willfully or intentionally;
It does not appear to be either.
7) The prior record of the violator in complying or failing to comply with programs over which
the Environmental Management Commission has regulatory authority; and
There have been no civil penalty enforcements in the twelve months prior to
this violation.
8) The cost to the State of the enforcement procedures.
$159.26.
g /5 Y�
ate G. La or
06/08/2015
r
idson, Regi6nal Supervisor
Regional Operations Section
mal Office, NCDENR

ao
D�
m
m
O
M
co
(D
LO
O
n
O
N
M
M
M
m N
y y
_
U
co
—
C-
1l
W
W
N
- G
m m
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
x CL a
z
z
z
z
z
z
z
z
z
z
z
z
z
z
z
z
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
us
0
vs
0
to
0
us
0
urs
0
av
0
u4
0
O
0
0
0
6%
0
u9
0
u4
0
urs
0
w
0
19
0
w
N tm1
W G
A
10 0
O
CD
0
co
(D
(D
co
O
O
0
O
a
v
v
V
st
O
0
v
O
O
O
O
o
('M
O
•-
Di
O
0
Di
C�
O
(N
M
Di
N
W
Di
N
M
O
O
O
O
O
O
O
0
Of
N
N
O
O
Ir -_A
to- a
61),
d,
v,
vi
w
is
O
(D
C)Den
0»
O
w
64
-
vs
vs
M
w
M
yr
w
m E
Q
m
c
0
N C
0
E
E
O
c
0
- � c
i m E
G
c
w m m
W x S
d
C o
3 G
O
O
y
Q
O
O
O
O
CA
603,
.Q W
N
M
M
yr
N
w
eo
N
(D
N
(D
o v
�
d d $ m
� rc z rc
m
� m
W E
w, o
•
Y m
a m
7
m`
0
(D
7
(D
V
(D
Q
(D
V.
(D
V'
O
O0
O
O
O
o
V
O
O
O
O
O
M
0
n
mfl-
0
m
O
r
N
v
N
a
n
M
t`
M
r
M
'c p
»
r0-
6%
0)
vs
ug
6%
0)
uY
&9�
Vs
Ln
!A
H
N
w
6�1
e9
6S.
t4
•• W U
G
G •'
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
U C7 p
O
O
O
OO
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
m E
O
o
O
C
O
o
N
N
N
r
In
N
O
0
0
O
O
0
O
0
0
C
ci
O
C
O
0
a Q
0
In
,n
N
m
N
0
u]
N
0
Ln
N
N
W
(R
64
!A
K
Ys
CA
69
(A
u4
M
u4
Ks
Ns
CA
Vs
C
m
W
0
O
to
=
r
r
O. E
(O
T
O
O
O
O
M
O
M
O
M
O
O
(D
(�
m
-W
t(1
fA
00
N
V
N
O
N (0 m
Of
(�
(p
N
VC
d G'y O
'a Nn. Q Q
N
cc 'O m
O f0
Cl)
O
M
O
<n
O
_
N
N
y
O
O
O
O
O
N
-
N
N
N
N
N
N
N
Y L
N
r
N
r
MCC)
fl.
r
o U y
F- J Z Q
V
O)
(D
O)
co
Cl)
st
I—
OD
N
(p
(D
U7
m
N
N
V
V
M
fA
01
O
O
h
O
Cl)
O
O
O
N
O
O
a
O
N
O
M
O
Cl)
O
MO
O
O
N
O
N
O
N
O
N0
O
O
r
coa)
O
O
m
Cl)
0
Ui
D - o a
O
rn
O
rn
O
o
N
O
o
N
O
O
N
O
o
N
O
o
N
O
O
N
O
o
N
O
0
N
O
N
0
N
0
N
0
N
0
N
0
N
•V € m y E
T
D
'-
U
i
i
i
V2 LL d U 2
J

PC -2014-0001 1/6/14 $1,250.00 $137.00
6/8/2015
2
$1,387.00 $0.00 No 2/5114
LV -2014-0041 12-2013 4/24/14 $2,000.00 $147.50 5/15114 6/3/14 $1500 $647.50 $0.00 No 7/2/14
LV -2008-0247 1-2008 $1,550.00 $145.00
$1,69500 No
Total Cases: 19 Total Penalty Amount: $25,050 Total Enforcement Cost: $2104.28 Sum Of Total Paid: $19,859.28 Total Balance Due. $2,295.00
Sum of Total Case Penalties. $27,154.28 Total Penalties After Remissions: $22,154.28

EFFLUENT r
t
NPDES PERMIT NO.: NCO041696 DISCHARGE NO.: 103 MONTH JANUARY YEAR: 2015
FACILITY NAME: LAKE RHODHISS WASTEWATER TREATMENT PLANT CLASS: IV COUNTY: BURKE
OPERATOR IN RESPONSIBLE CHARGE (ORC): GREG PADGETT GRADE: IV PHONE:
CERTIFIED LABORATORIES W W T P #230 MERITECH #165 BLUE RIDGE LABS # 275
CHECK 80X IF ORC HAS CHANa prY' e., ER, .N(S) COLLECTING SAMPLES: CHRIS BORTNICK & NORMAN COOK
Mail ORIGINAL and ONE COPY to: FEB 2 015
ATTN: CENTRAL FILES x \�✓/ ,.�
DIVISION OF WATER QUALITY c (SIGNATURE OF 0 BATOR IN RESPON IBL ARGE) FY THAT T�WREPCRT IS J a /
BY THIS
N,DMAILSERVICE CENTER GEI j ' RAI, FILES ACCURATE AND COMPLETECERTIOTHE BEST OFMYYKNOWLEp7���,
RALEIGH, NC 27699.1617 DY' R SE MON"'MR 05 201g
828-879-2131
DATE
m
-
*u u
uu41u
uublu
00530
39616
00300
00600
00665
32730
TGP38
c
E
`
FLOW
EFF
W
=) (j)
-j U1
QW
JO W
Jai
W Z
J W
O
?
a�
o
«
H
INF ❑
a?
�y
=
��
0
O
U
Qo
OO
ZC7
O
7
QZp
~ W-
a0 `
U W..
>W
JO
O
QO
I --O
J�
a0
F -x
j
-/
O
Z
F
U
o aN
CL
O
C
��
W -I
�U
Q
W=
CO C4
��
00)W
LLoE
NX
O�
F-
z
Q
O
p9
V
QZ
��
(1 W
7O
Z
z
CL
a
a
HRS
HRS
YINI MGD
° C
S.U.
I </>
UGIL
</
MG/L
<P
MGIL
MGIL
q A/1100ML
MG/L
MGIL
MGIL
1 800
5
H
1.402
2 600
16
Y
1.321
15
7.0
21
2.54
5.00
6
9,0
;a/FP
3 800
4
1.255
4 800
5 600
16
Y
2.526
13
677
<
20
i
33.7
268
20
8.8
6 000
16
Y
1.958
13
6.9
32
1
18.5
16.3
1
8.7
7 600
16
Y
2.139
14
6.9
41
1
3.03
7.00
24
89
8 600
16
Y
1.912
12
7.1
23
3.31
<
0.50
1 8.60
6
9.4
S44
0.55
9 600
1.6
Yj
1.717
12
7WT
26
3.02.
5.20
16
9A
0 800
4
1.365
600
16
Y
1.587
10
6.9
22
1
4.26
7.40
3
101
n,
3 600
16
Y
1.998
12
7.0
<
20
1
12.0
8.00
6
9.3
4 600
16
Y
T 114
15
6.9
31
1
2.59
<
0.50
<
5.00
-6----0-.5
7.34
0.53
5 600
16
Y
1.960
15
7.0
25
<1
2.00
1
<
5.00
1
89
6 600
16
Y
1.185
15
7.0
23
<
2.00
<
5.00
1
8.8
7 800
4
0.818
9 800
5
H
1.686
_..... _._
.._.
0 600
16 1
Y 1
1.788
12
7.0
<
20
3.82
8.40
17
9.2
PASS
1 600 1
16
Y
1.726
13
71
24
4.05
5.80
2
8,6
2 600 1
16
Y
1.611
15
7,0
34
2.63
6.40
1
8.7
PASS
3 600
16
Y
1.697
16
71
<
20
2.96
<
0.50
<
5.00
I1
8.6
8.27
1.29
4 800
4
1.273
5 800
5 600
16
Y
1.660
12
7.1
28
<
2.00
<
0.50
<
5.00
3
9.5
9.46
1.09
7 600
16
Y
1.554
12
71
20
2.56
5.20
3
4.2
3 600
16
Y
1.899
13
7.0
24
2.34
<
5.00
< 1
8.9
1 600
16
Y
1.925
14
7.2
32
<
2.00
<
5.00
2
9.0
600
16
Y
1.351
15
6.8
<
20
2.06
<
5.00
10
8.8
I
AVERAGE
1.599
1
21
5.44
<
0.50
18.5
4
9.1
7.75
0.87
#i#W
ASS
N1AXD"
3.37
16
7.2
41
33.7
<
0.50
268
24
10.1
10.
1.29
0.000
PASS
NDNDIU-M
0.683
10
6.7
<
20
<
2.00
<
0.50
<
5.00
< 1
8.6
5.44
0.53
4.000
PASS
mp. (C) I Grab (G)
j
(G)
(G)
(G)C)
(C)
(C)
(G)
(G)
(C}
O
(G,)
Monthly Limit
1.6
to 9
30.01
30.0
200
Test Blank Out of QC. (H) Denotes Observed Holidays: 1/1 New Year's Day & 1/19 Martin Luther King, Jr.
LL REPORTED DATA ASSOCIATED WITH FLAGGED CONDITIONS ARE VALID NUMBERS. - WEEKLY TSS VIOLATION: 115 THROUGH 119.
DWQ � fC� 0 `tvxe Lv- 0 a 5- �.d- ;5016--oa8�
s

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements -
• Noncompliant
T' a ermittee shall report to the Director or the, appropriate Regional Office anynoncompliance thatpotentially
. P � _ aPP oP- - ld P
threatens public health or the environment: Any information shall be provided orally within 24 hours from the time
the permittee became aware of, the circumstances: A written submission shall also be providedwithin 5 days of the
time the permittee.becomes aware of the circumstances.
Tm
If the facility &non6tapliant, please attach a., list of corrective -actions being taken and a time table for
improvements to be.made as required by Part ILE.6 of.the NPDES permit.
-i cerary, unuer penalty of law, teat tnrs aocument and au ,aitactiments=were preparea unser my (irection or
;
supervision in accordance' with a system designed to assure that qualified personnel properly gather and evaluate the
'
-;information submitted. Based on:my inquiry of the person or persons who managed the system, or those persons
i
_
a', :directl ie ' onsible for atherin the informatio the information;submitted is to the best of knowledge and
Y sP g g n, mY g
5
.
belief, ti ue, accurate, and complete.: I am aware that there are significant penalties for submitting false information, ' :.
_ •:
includiixg the possibility of fines and imprisonment for knowip violations.°'
- .. Perini e r type)
of P *** Date
_ unless submitted electronically).
s a
_Town -of Valdese _
r.::::
-
:------ •-PO;Box 339;Valdese, NC 28690 828-879=2117 - :.' jmorse�ci.valdese.nc.us ;Febrtiaiy:28;;2015
Pemuttee Address' Phone Niunber ' e-mail address Permit E cation Date
i
i . _..'..•.- . ._. - , r ADDITIONAL CERTIFIED LABORATORIES -
Certified Laboratory (2) : - . Certification No:
Certified Laboratory. (3) Certification No.
Certified: Laboratory -(4) Certification No.
_Certified,Labo'ratory (5) Certification No.
,
.PARAMETER CODES -
Parameter -Code assistance may be obtained by. calling the NPDES Unit at [phone] or by_visiting the'Surface
" ::Water'Protection Section's web site at*h2d.'b& state:nc:usJwas-and linking to the unit's information pages.
-Use only unit§ of measurement designated in thereporting facility's NPDES permit for reporting data
No FlowANscharge From Site:. Check, this,box if no discharge occurs and, -as a•result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
ORC On Site?: ORC must visit facility and doeument'visitation of facility as required per 15A NCAC 8G.0204.
Signature of Permittee: If signed by.btlier_ than the permittee, then the delegation of tho�gignatory authority must be
V : : file,with•ihe state per '15A NCA, C 2B :05(i6(h�(2)(D)•
Page 2