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Home My WebLink AboutWQ0034715_Signature Authority Designation_20230309Initial Review Reviewer nathaniel.thornburg Is this submittal an application? (Excluding additional information.) * Yes No If not an application what is the submittal type?* Annual Report Residual Annual Report Additional Information Other Signature Authority Designation Permit Number (IR) * W00034715 Applicant/Permittee Concert 12 Oaks, LLC Email Notifications Does this need review by the hydrogeologist? * Yes No Regional Office CO Reviewer Admin Reviewer Submittal Form Project Contact Information Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence. Name* Sundria R Ridgley Email Address* sridgley@concertgolfclubs.com Project Information ......................... Application/Document Type* New (Fee Required) Modification - Major (Fee Required) Renewal with Major Modification (Fee Required) Annual Report Additional Information Other Signature Authority Designation Phone Number* 2025383252 Modification - Minor Renewal GW-59, NDMR, NDMLR, NDAR-1, N DAR-2 Residual Annual Report Change of Ownership We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form. https:Hedocs.deq.nc.gov/Forms/NonDischarge Monitori ng_Report Permit Type:* Wastewater Irrigation High -Rate Infiltration Other Wastewater Reclaimed Water Closed -Loop Recycle Residuals Single -Family Residence Wastewater Other Irrigation Permit Number:* WQ0034715 Has Current Existing permit number Applicant/Permittee Address* 300 International Parkway, Suite 150, Lake Mary, FL 32746 Facility Name* The Club at 12 Oaks Please provide comments/notes on your current submittal below. At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg at nathaniel.thornburg@ncdenr.gov. Please attach all information required or requested for this submittal to be reviewed here. (Application Form, Engineering Plans, Specifications, Calculations, Etc.) Signature-authority-designation-letter-200129 CGP.pdf 727.28KB Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger than upload limit. * By checking this box, I acknowledge that I understand the application will not be accepted for pre -review until the fee (if required) has been received by the Non -Discharge Branch. Application fees must be submitted by check or money order and made payable to the North Carolina Department of Environmental Quality (NCDEQ). I also confirm that the uploaded document is a single PDF with all parts of the application in correct order (as specified by the application). Mail payment to: NCDEQ — Division of Water Resources Attn: Non -Discharge Branch 1617 Mail Service Center Raleigh, NC 27699-1617 Signature t5i"lt"J1 ?1'?P41* Submission Date 3/9/2023 ROY COOPER Governor MICHAEL S. PEGAN Secretary S. DANIEL SMITH Director Division of Water Resources Non -Discharge Branch 1617 Mail Service Center Raleigh, North Carolina 27699-1617 To Whom It May Concern: NORTH CAROLINA Environmental Quality March 9, 2023 Subject: Permit No. WQ0034715 Signature Authority Designation The Club at 12 Oaks Other Non -Discharge Wastewater System Wake County As an appropriate signing official for The Club at 12 Oaks, Holly Springs, NC (city/town or business name) as designated by 15A NCAC 2T .0106, I hereby delegate authority to sign and certify all permit applications, reports or other permit related documents to the following staff for the following permit types (sewer, spray, land application) and/or permit numbers: Position Person Currently in Position Permit Type or Permit Number SVP of Agronomy Danny Gwyn W00034715 Authorized Person Walter Bogumil WQ0034715 If you have any questions, please contact me at the following: Permittee/Applicant name (please print): Sundria R. Ridgley Title: Authorized Person Complete mailing address: 300 International Parkway, Suite 150 City: Lake Mary State: Florida Zip. 32746 Telephone number: ( 202 ) 538-3252 Facsimile number: ( 407 ) 588-4818 Sincerely, signature D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617 NORTH CAROLINA Department of Environmental Quality /`� 919.707.9000