HomeMy WebLinkAboutNC0001899_Permit Issuance_20190507ROY COOPER
(;Me nar
MICHAEL S. REGAN
Sermrary
LINDA CULPEPPER
a'rWW
Certified Mail # 7017-2680-0000223605"
Return Receipt Reauested
Jason Kaplan
Moncure Holdings West LLC
282 Century Pl Ste 2000
Louisville,CO 80027
NORTH CAROLINA
Environmental Quality
May 07, 2019
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 W W Permit No. NC0001899
Moncure Holdings West LLC
Moncure Holdings West WWTP
Case No. LV-2019-0099
Chatham County
Dear Permittee:
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $287.78 ($250.00 civil penalty
+ $37.78 enforcement costs) against Moncure Holdings West LLC.
This assessment is based upon the following facts: a review has been conducted of the Discharge Monitoring Report
(DMR) submitted by Moncure Holdings West LLC for the month of June 2018. This review has shown the subject
facility to be in violation of the discharge limitations and/or monitoring requirements found in NPDES W W Permit No.
NC0001899. The violations, which occurred in June 2018, are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that Moncure Holdings West LLC violated the terms,
conditions or requirements of NPDES W W Permit No. NC0001899 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).
DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT
Violator: Moncure Holdings West LLC
Facility Name: Moncure Holdings West WWTP
Permit Number: NC0001899
County: Chatham
Case Number: LV-2019-0099
ASSESSMENT FACTORS
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;
No known damage to environment, public health or private property
2) The duration and gravity of the violation;
One daily maximum and one monthly average exceeded for BOD.
3) The effect on ground or surface water quantity or quality or on air quality;
Not documented.
4) The cost of rectifying the damage;
Not documented.
5) The amount of money saved by noncompliance;
It is not believed that any money was saved by these violations.
6) Whether the violation was committed willfully or intentionally;
It is not believed that the violations were committed 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
There have been no CPAs in the past year.
8) The cost to the State of the enforcement procedures.
— 'e �le
Rick Bolic , MG., Assistant Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
$37.78
to
PMnaM RNMaalan vaYw 9emamaM
M
RNaYp CFa.<_ _ Fanu
— — —
pm9.Y/ vel.le0 no411one
—
} aenall,.azrsze^. — M
yaHumMr: �fcw9i IIJv flJs�30z6iMJl36
w
N 9ila _ P:qs O
P.f iqn Drya.s... COC
.Coy MonMMp R.qv[
FNIR9HM'. MMq. WMMMP _ Oeyil..
fl.p�on RNwpn CNb'.
OwYa wlu. NMY:p. YM1MLLC
OI.C.CIX��
GnY.KbYLYWIIOW..
C.MRORY coM I
fl.YC M.Q
pIa dWRCRMp
EMortm.nl Canit JYYr 4p.�
�
BYIMpI.Ev
PMWN.Y1.p D. )0O /A1Y
R1MF.IM R.gNY�
EY41MYYg0.Y
i.YeoR.. oso�®iv—I
wm.uY wal..wP.af _._- __
m..w:YwB
pNYIMpYM 3pWOV—
FM.CM CN:�__
dC RYutl R.aYaN
Enlwum.MCort JB
EM1 CM IIYeOO
v.BYanln OMl
raW Cu. P.naly ).3B
FNIII... CodI
MmI..Im MNu[
F.YMft.pMpiBC. .9
iUtlMYW W.. W.W ..._,....•
CY.b CYWne
R.epon.. pp BF OME40Y
T4tl1I.mpXl vyC {y],1B
NemY1R.yM 9
CY.CbN
'9M L
flo
R..q
PM Vt
Q ryPe nYmro Ya�cR p
X
U.S.
Postal
Service'"
CERTIFIED
MAIL®
RECEIPT
-
Domestic
Mail
Only
For
delivery
information,
visit
our website
at wwwusps.com
M ('artifled Mall Fee
r!J $
ru re rvI= Fees tdadmv, snare. maPpgvrerel
O ❑ Rewm Recepr PwurgPN e
❑Paean Reoe�q (alxvmk) $ Poelrrierkk
C3 ❑ caress Mali Reeetlen L) I $ Here
C3 ❑Atlue Spnesve Reoutraa S
❑M�n Spnanne Rmo-icmE oasreN e
O Postage
CIO $
'11 Total Poste{ IASON RAPLAN
fL MONCURE HOLDINGS WEST LUC
$ 28
Sent To 2 CENTURY PL STE 2000
M1
,� LOUISVILLE, CO 80027
r3 Shoefend-A NOV-LV-2019-0099: NCDO01899: MONCURE HOLDINGS
M1 CHATHAM COUNTY: NOV&ASSESS OF CP
OIty;-$fe7e,: 05/07/19: MAILED: 05/09/19: ZHANG
■ Complete items 1, 2, and 3. A. Signatul ❑ Agent
■ Print your name and address on the reverse 9
❑Address
so that we can return the card to you. Addressee
■ Attach this card to the back of the mallplece, B. Ybo@ved by (Prints le) . Date of Delivery
or on the front M space permits.
1 • A� to: D. is dM*very address dRfelent from Item 1? ❑ Yea
- M YES, enter delivery address below: ❑ No
JASON KAPLAN
8
MONCURE HOLDINGS WEST LLC
282 CENTURY PL STE 2000
LOUISVILLE, CO 80027
NOV-LV-2019-0099: NCOOOIS99: MONCURE HOLDINGS WE
CHATHAM COUNTY: NOV & ASSESS OF CP
05/07/19: MAILED: OS/09/19: ZHANG
3.
s❑
III
IIIIII
IIII
III
I II
III
II
I I
II II
I III
I
I II II
II III
Ad
dulSlg r tare Restricted Delivery
❑ Registered Mall Restricted
❑ CertRed Mall Reelrlcted Delivery
Q'FLReltercnendise far
El Collect on Delivery
Collect on Delivery ResVk1ed Delivery
❑ Si nature CanOrrnatlonTM
D
2. Article Number (Trap- fP h^r^ `^^ram v'r"e--- -
1 Insured Mail
❑ Signature Confin eatbn
Restricted Dell
7017 266D D000 2236 059 nsu Mail Restricted Delivery very
Ps Form 3811, July 2015 PSN 7530-02-DOO-9053 Domestic Return Receipt
ROY COOPER
On ernor
MICHAEL S. REGAN
Srerrfvrr
LINDA CULPEPPER
0111101
Certified Mail # 7017-2680-000022360598
Return Receipt Requested
Jason Kaplan
Moncure Holdings West LLC
282 Century Pl Ste 2000
Louisville, CO 80027
P� r�J'�
x,
� Z�r
NOS;'" LAHOLINA
Environmental Quality
May 07, 2019
SUBJECT: Notice of Violation and Assessment of Civil Penalty
for Violations of North Carolina Genetaal Statute (G.S.) 143-215. 1 (a)(6)
and NPDES W W Permit No. NC0001899
Moncure Holdings West LLC
Moncure Holdings West WWTP
Case No. LV-2019-0099
Chatham County
Dear Permittee:
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $287.78 ($250.00 civil penalty
+ $37.78 enforcement costs) against Moncure Holdings West LLC.
This assessment is based upon the following facts: a review has been conducted of the Discharge Monitoring Report
(DMR) submitted by Moncure Holdings West LLC for the month of June 2018. This review has shown the subject
facility to be in violation of the discharge limitations and/or monitoring requirements found in NPDES W W Permit No.
NC0001899. The violations, which occurred in June 2018, are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that Moncure Holdings West LLC violated the terms,
conditions or requirements of NPDES W W Permit No. NC0001899 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
,Secictary of the Department of Environmental Quality and the Director of the Division of Water Resources, I, Rick
Bolich, L.G., Assistant Supervisor, Raleigh Regional Office hereby make the following civil penalty assessment against
Moncure Holdings West LLC:
$0.00 0 of 1 violations of G.S. 143-215. 1 (a)(6) and Permit No. NC0001899, by discharging waste water
into the waters of the State in violation of the Permit Daily Maximum for BOD. 5-Day (20 Dee. C)
- Concentration
250.00 1 of 1 violations of G.S. 143-215.1(a)(6) and Permit No. NC0001899, by discharging waste water
into the waters of the State in violation of the Permit Monthly Average for BOD. 5-Day (20 Dee.
C)- Concentration
250.00 TOTAL CIVIL PENALTY
37.78 Enforcement Costs
287.78 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.I (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 Environmental Quality (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:
Wastewater Branch
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 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:
Wastewater Branch
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 maybe 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 §150B-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:
6714 Mail Service Center
Raleigh, NC 27699 6714
Tel: (919) 431-3000
Fax: (919)431-3100
One (1) copy of the petition must also be served on DEQ as follows:
Mr. William F. Lane, General Counsel
Department of Environmental Quality
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.
If you have any questions, please contact Cheng Zhang with the Division of Water Resources staff of the Raleigh Regional
Office at (919) 791-4200 or via email at cheng.zhang@ncdenr.gov.
Sincerely,
Rick Bolich, L.G., Assistant Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
ATTACHMENTS
Cc: WQS Raleigh Regional Office - Enforcement File
NPDES Compliance/Enforcement Unit - Enforcement File
ATTACHMENT A
Moncure Holdings West LLC
CASE NUMBER: LV-2019-0099
PERMIT: NC0001899
FACILITY: Moncure Holdings West WWTP
REGION: Raleigh
COUNTY: Chatham
LIMIT VIOLATION(S)
SAMPLE LOCATION:
Outfall 001 - Effluent
Violation Report
Unit of Limit Calculated %Over Violation
Penalty
Date Month/Yr
Parameter
Frequency Measure Value Value Limit Type
Amount
6/13/2018 6-2018
BOO, 5-Day (20 Deg.
Weekly mg/I 10 11.7 17.0 Daily
$0.00
C) - Concentration
Maximum
Exceeded
6/30/2018 6-2018 BOD, 5-Day (20 Deg. Weekly mg/I 5 6.45 29.0 Monthly $250.00
C) - Concentration Average
Exceeded
Case Number:
Assessed Party:
Permit No.:
NSTIFICATION FOR REMISSION REQUEST
LV-2019-0099
Moncure Holdings West LLC
NC0001899
County: Chatham
Amount Assessed: 2$ 87.78
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. § 14313-282. 1 (c), remission of a civil
penalty maybe 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. 14313-282.1(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 (i.e., explain the
steps that you took to correct the violation and prevent figure 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
COUNTY OF CHATHAM
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST
Moncure Holdings West LLC
Moncure Holdings West WWTP
PERMIT NO. NC0001899
DEPARTMENT OF ENVIRONMENTAL QUALITY
WAIVER OF RIGHT TO AN
ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
CASE NO. LV-2019-0099
Having been assessed civil penalties totaling $287.78 for violation(s) as set forth in the assessment document of the Division
of Water Resources dated May 07, 2019, 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 20
SIGNATURE
ADDRESS
TELEPHONE
ROY COOPER
0'r4Ur
1r11CHAEL S. REGAN
&•: Wa'v
LINDA CULPEPPER
13" tnr
Certified Mail # 7017-2680-000022360598
Return Receipt Requested
Jason Kaplan
Moncure Holdings West LLC
282 Century PI Ste 2000
Louisville, CO 80027
ai:17i
h, r t ..
`O::'! Aq0LJNA
Environmental Quality
May 07, 2019
r
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 WW Permit No. NC0001899
Moncure Holdings West LLC
Moncure Holdings West WWTP
Case No. LV-2019-0099
Chatham County
Dear Permittee:
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $287.78 ($250.00 civil penalty
+ $37.78 enforcement costs) against Moncure Holdings West LLC.
This assessment is based upon the following facts: a review has been conducted of the Discharge Monitoring Report
(DMR) submitted by Moncure Holdings West LLC for the month of June 2018. This review has shown the subject
facility to be in violation of the discharge limitations and/or monitoring requirements found in NPDES WW Permit No.
NC0001899. The violations, which occurred in June 2018, are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that Moncure Holdings West LLC violated the terms,
conditions or requirements of NPDES WW Permit No. N00001899 and G.S. 143-215.l(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
$eeretary-oLthe.Department of Environmental Quality and the Director of the Division of Water Resources, I, Rick
Bolich, L.G., Assistant Supervisor, Raleigh Regional Office hereby make the following civil penalty assessment against
Moncure Holdings West LLC:
$0_00 0 of 1 violations of G.S. 143-215.1(a)(6) and Permit No. NC0001899, by discharging waste water
into the waters of the State in violation of the Permit Daily Maximum for BOD. 5-Day (20 Dee. C)
- Concentration
250.00 1 of 1 violations of G.S. 143-215.1(a)(6) and Permit No. NC0001899, by discharging waste water
into the waters of the State in violation of the Permit Monthly Average for BOD. 5-Dav (20 Dee.
C) - Concentration
250.00 TOTAL CIVIL PENALTY
37.78 Enforcement Costs
287.78 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.l(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 conmtitted 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 Environmental Quality (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:
Wastewater Branch
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 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 thlty (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:
Wastewater Branch
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Option 3: File a aetition 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 maybe 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 § 15013-23.2) 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
6714 Mail Service Center
Raleigh, NC 27699 6714
Tel: (919) 431-3000
Fax: (919) 431-3100
One (1) copy of the petition must also be served on DEQ as follows:
Mr. William F. Lane, General Counsel
Department of Environmental Quality
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.
If you have any questions, please contact Cheng Zhang with the Division of Water Resources staff of the Raleigh Regional
Office at (919) 791-4200 or via email at cheng.zhangCncdenr.gov.
Sincerely,
Rick Bolich, L.G., Assistant Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
ATTACHMENTS
Cc: WQS Raleigh Regional Office - Enforcement File
NPDES Compliance/Enforcement Unit - Enforcement File
Centpl Files
ATTACHMENT A
Moncure Holdings West LLC
CASE NUMBER: LV-2019-0099
PERMIT: NC0001899
FACILITY: Moncure Holdings West WWTP
REGION: Raleigh
COUNTY: Chatham
LIMIT VIOLATION(S)
SAMPLE LOCATION: Outfall 001 - Effluent
Violation Report Unit of Limit Calculated % Over Violation Penalty
Date Month/Yr Parameter Frequency Measure Value Value Limit Type Amount
6/13/2018 6-2018 BOD, 5-Day (20 Deg. Weekly mg/I 10 11.7 17.0 Daily $0.00
C) - Concentration Maximum
Exceeded
6/30/2018 6-2018 BOD, 5-Day (20 Deg. Weekly mg/I 5 6.45 29.0 Monthly $250.00
C) - Concentration Average
Exceeded
Case Number:
Assessed Party:
Permit No.:
JUSTIFICATION FOR REMISSION REQUEST
LV-2019-0099
Moncure Holdings West LLC
NC0001899
County: Chatham
Amount Assessed: S287.78
Please use this form when requesting remission of this civil penalty. You must also complete the 'Request For Remission,
Maiver 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. 4 14313-282. 1 (c), remission of a civil
penalty maybe 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. 14313-282.1(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 (i.e., 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
COUNTY OF CHATHAM
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST
Moncure Holdings West LLC
Moncure Holdings West NVWTP
PERMIT NO. NC0001899
DEPARTMENT OF ENVIRONMENTAL QUALITY
WAIVER OF RIGHT TO AN
ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
CASE NO. LV-2019-0099
Having been assessed civil penalties totaling $287.78 for violation(s) as set forth in the assessment document of the Division
of Water Resources dated May 07, 2019, 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 20
SIGNATURE
ADDRESS
TELEPHONE
■ Complete Items 1, 2, and 3.
■ 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 maiipiece,
or on the front if space permits.
1. n,npla Addressed to:
JASON KAPLAN
MONCURE HOLDINGS WEST LLC
282 CENTURY PLSTE 2000
LOUISVILLE, CO 80027
NOV-LV-2019-0099: NCOOOIS99: MONCURE HOLDINGS
CHATHAM COUNTY: NOV & ASSESS OF CP
05/07/19: MAILED: 05/09/19: ZHANG
❑ Agent
Date of Delive.
D. Is delivery address different from Rem 19 V Yet
If YES, enter delivery address below: ❑ No
e
Type
Pill
aid
II
IIIIIII
IIII
IIII
II IIIIII
II
II
IIIIII
II
II'I�
Aduft
=.rrSM®Restricted Delivery
edressi
El RRl�lstMailRestr
9590 9402 3222 7196 3536 67
Delivery
try
Receipt for
❑ Certified MaRestricted
❑ Collect on Delivery
Merchandise
2. Article Numbar ?rnnshu earn ta.ae-e rarest
❑ Collect on Delivery Restricted Delivery
sored Mail
'itior
❑ Signature ConRnnatio,
Ogeshrcteedre
7017 266t( D000 2236 0598
nured Mall Restricted Delvery
D llvery
(over$500)
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Recall
Domestic Mail Only
For delivery information, visit our website
■r 1
G ❑Return Rai PerdwPN $
C3 ❑ Return Pei (elecwmd $ Postmark
O ❑ Certified Mal Restruned Delivery $ Here
C3 ❑ Adult Signature Reeuired $
(]Adult Slenature Restricted Delhrery $
i3 Postage
1:0 $
—9 Total Postal JASON KAPLAN
ru MONCURE HOLDINGS WEST LLC
$ 282 CENTURY PL STE 2000 —
r SBnf To i LOUISVILLE, CO 80027
p $p,jgl anifA NOV-LV-2019-0099: NC0001899: MONCURE HOLDINGS Ill
171 CHATHAM COUNTY: NOV &ASSESS OF CP __
7Aly, Stele,: 05/07/19: MAILED: 05/09/19; ZHANG
r
V /
Permit Enforcement History by Permit
Permit
NC0001899
Facility:
Moncure Holdings West iAWTP
Owner:
Moncure Holdings West LLC
Region:
Raleigh
County:
Chatham
Penalty
Remission Enforcement EMC
Collection
Has
Assessment
Penalty
Enforcement
Request Conference Hearing
Memo Sent
Payment
Case
Cate
Approved
Amount
Costs
Damages Received Held Held
To AGO
Total Paid
Balance Due
Plan
Closed
TX-2001-0012
04/23/O1
$1,000.00
$39.24
$1,039.24
$0.00
No
05/11/01
LV-2002-0248
07/03/02
$1.000.00
$53.07
$1,053.07
$0.00
No
07/26/02
LV-2010-0178 06/16/10 $100.00 $47.54 $147.54 $0.00 No 07/07/10
Total Cases: 3
$2.100.00 $139.85
$2,239.85
$0.00
Total PerwMles:
$2.239.85
Total PenalBas after
$2,239.85
NPDES PERMIT NO.: NC0001899
FACILITY NAME: Moncure Holdings West W WTP
OWNER NAME: Moncum Holdings West LLC
GRADE: W W-2
eDMR PERIOD: 06-2018 (June 2018)
PERMIT VERSION: 5_0
CLASS: WW-2
ORC: Lawreace D. Mumay
ORC HAS CHANGED: No
VERSION: 1.0
j� PERMIT STATUS: Active
R F C; F I V E DoUNTY: Cliat6am—
A U U A 1 2019 ORC CERT NUMBER: 25810
CEN l RAL FILES STATUS: Prmeased
DWR SECTION
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
"" No Reporting Reason ENFRUSE -No Flow-ReuselRwycle; ENV WTHR= No Visitation - Adverse Wmgwu , NOFLOW =No Flow; HOLIDAY -No Visitation- Holiday
INC Dept of Environmental QW4
AUG - 6 2018
Raleigh Regional OM@p
ARMIT NO.: NC0001899
iLITY NAME: Moncure Holdings West W WTP
.9WNER NAME: Moncure Holdings West LLC
GRADE: WW-2
eDMR PERIOD: 06-2018 (June 2018)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 5.0
CLASS: WW-2
ORC: Lawrence D. Murray
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: 9196222901
PERMIT STATUS: Active
COUNTY: Chatham
ORC C19RT NUMBER: 25810
STATUS: Processed
SUBMISSION DATE: 07/262018
07/26/2018
/Cer er ignat e: F a v 1 Real E-Mail:aba•ei@withersravenel.com Phone #:3176-2Z -T73V Date
.Cay ruAir• 4 (wturrny@u •flws ,wl •4nti 419—622.29tol
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially 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
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, 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.
Permittee/Submitter Signature:*** Earl Beal E-Mail:ebeal@withersravenel.com Phone #:336-266-1254 Date
Permittee Address: 338 Pea Rdg Rd New MII NC 27562 Permit Expiration Date: 07/31/2021
I certify, under penalty of law, that this document and all attachments were prepared under my direction 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Pace Analytical
CERTHUD LAB #: NC Wastewater Certification #12
PERSON(s) COLLECTING SAMPLES: Lawrence "Larry" Murray
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit (919) 807-6300 or by visiting httpd/portal.nodem.org/weh/wq/swp/pstnpdes/forms,
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge 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 entire monitoring period
" ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority most be on file with the state per 15A NCAC 2B
.0506(bx2)(D).
Permit NC0001899
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Water Quality
Commission, and the Federal Water Pollution Control Act, as amended,
Moncure Holding West, LLC
is hereby authorized to discharge wastewater from a facility located at the
Moncure Holding West, LLC WWTP
338 Pea Ridge Road, New HIII
Chatham County
to receiving waters designated as the Haw River in the Cape Fear River Basin in
accordance with the discharge limitations, monitoring requirements, and other applicable
conditions set forth in Parts I, II, and III.
This permit modification shall become effective December 1, 2017.
This permit and the authorization to discharge shall expire at midnight on July 31, 2021
Signed this day November 10, 2017.
Signed by Julie Grzub
for Linda Culpepper, Interim Director
Division of Water Resources
By the Authority of the Environmental Management Commission
Page 1 of 11
Permit NC0001899
Part I
A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS (Outfall 001)
[15A NCAC 02B .0400 et seq., 02B .0500 et seq.]
During the period beginning on the effective date of the permit and lasting until expiration, the
Permittee is authorized to discharge treated process, domestic, and filter backwash wastewater from
Outfall 001. Such discharges shall be limited and monitoreds by the Permittee as specified below:
Effluent
Characteristics
Limits
Monitoring Requirements
Monthly Average
Daily Maximum
Measurement
Frequency
Sample
a
Sample
Location 1
Flow
0.244 MGD
Continuous
Recording
Influent or
Effluent
pH 2
6.0 < pH s 9.0
Continuous
Recording
Effluent
BOD, 5 day (20°C)
5.0 mg/L
10.0 mg/L
Weekly
Composite
Effluent
Total Suspended Solids
30.0 mg/L
45.0 mg/L
Weekly
Composite
Effluent
NH3-N
1.0 mg/L
2.0 mg/L
Weekly
Composite
Effluent
Oil and Grease
55.67 lbs/day
210.92 lbs/day
Weekly
Grab
Effluent
Temperature, °C
Monthly
Grab
Effluent
Temperature, "C
Monthly
Grab
Upstream &
Downstream
Conductivity, pmohs/cm
Monthly
Grab
Effluent
Conductivity, pmohs/cm
Monthly
Grab
Upstream &
Downstream
Dissolved Oxygen, mg/L
Monthly
Grab
Effluent
Dissolved Oxygen, mg/L
Monthly
Grab
Upstream &
Downstream
Total Nitrogen3.7
4.48 lb/day
Quarterly
Composite
Effluent
Total Phosphorus?
1.0 lb/day
Quarterly
Composite
Effluent
Total Cadmium
62.9 pg/L
284.7 pg/L
Monthly
Composite
Effluent
Chronic Toxicity 4
Quarterly
Composite
Effluent
CWT 5
Quarterly
Grab
Effluent
Cyanide6
178.0 mg/L
500.0 mg/L
Quarterly
Grab
Effluent
Footnotes:
1. Upstream: valve at Permittee's river water pump house. Downstream: nearest accessible point
at least 100 yards below the outfall and above the confluence of the Deep and Haw Rivers.
Instream monitoring is provisionally waived due to the permittee's participation in the Upper
Cape Fear River Basin Association. Instream monitoring shall be conducted as stated in this
permit should the permittee end its participation in the Association.
2. The pH shall be monitored continuously at the effluent.
3. TN = TKN + NO3-N + NO2-N, where TN is Total Nitrogen, TKN is Total Kjeldahl Nitrogen, and
NO3-N and NO2-N are Nitrate and Nitrite Nitrogen, respectively.
4. Chronic Toxicity (Ceriodaphnia) Chronic P/F at 0.94%, January, April, July, and October, see A.
(4.).
5. Refer to A. (2.) regarding CWT monitoring.
6. CWT — based limitation.
7. Please see Special Condition A. (7.).
8. The permittee shall submit Discharge Monitoring Reports electronically using NC DWR's eDMR
application system. Please See Special Condition A. (6.).
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN
TRACE AMOUNTS.
Page 3 of 11
ROY COOPER vc k
Goienmr Environmental Quality
\1ICHAEL S. REGA-N
sscret0Y
LLVDA CL-LPEPPER
Interim Director
Certified Mail # 70172680000022360277
Return Receipt Requested
October 17, 2018
Jason Kaplan
Moncure Holdings West LLC
282 Century PI Ste 2000
Louisville, CO 80027
SUBJECT: NOTICE OF VIOLATION & INTENT TO ASSESS CIVIL PENALTY
Tracking Number: NOV-2018-LV-0726
Permit No. NC0001899
Moncure Holdings West VA TP
Chatham County
DearPermittee:
A review of the June 2018 Discharge Monitoring Report (DMR) for the subject facility revealed the violation(s)
indicated below:
Limit Exceedance Violation(s):
Sample
Location Parameter
Limit Reported
Date Value Value Type of Violation
001 Effluent BOD, 5-Day (20 Deg. C) - 6/13/2018 10 11.7 Daily Maximum Exceeded
Concentration (C0310)
001 Effluent BOD, 5-Day (20 Deg. C) - 6/30/2018 5 6.45 Monthly Average Exceeded
Concentration (C0310)
North Carolina Department of Environmental Quality I Division of Water Resources
1628 Mail service Center, Raleigh. NC 27699-1628
A Notice of Violation/Intent to Issue Civil Penalty is being issued for the noted violation of North Carolina General
Statute (G.S.) 143-215.1 and the facility's NPDES WW Permit. Pursuant to G.S. 143-215.6A, a civil penalty of
not more than twenty-five thousand dollars ($25,000.00) may be assessed against any person who violates or
fails to act in accordance with the terms, conditions, or requirements of any permit issued pursuant to G.S.
143-215.1.
If you wish to provide additional information regarding the noted violation, request technical assistance, or
discuss overall compliance please respond in writing within ten 10) business days after receipt of this Notice. A
review of your response will be considered along with any information provided on the submitted Monitoring
Report(s). You will then be notified of any civil penalties that may be assessed regarding the violations. If no
response is received in this Office within the 10-day period, a civil penalty assessment may be
prepared.
Remedial actions should have already been taken to correct this problem and prevent further occurrences in the
future. The Division of Water Resources may pursue enforcement action for this and any additional violations of
State law. If the violations are of a continuing nature, not related to operation and/or maintenance problems,
and you anticipate remedial construction activities, then you may wish to consider applying for a Special Order by
Consent.
Reminder: Pursuant to Permit Condition 6 in Section E, the Permittee is required to verbally notify the Regional
Office as soon as possible, not to exceed 24 hours, from first knowledge of any non-compliance at
the facility including limit violations, bypasses of, or failure of a treatment unit. A written report may
be required within 5 days if directed by Division staff. Prior notice should be given for anticipated or
potential problems due to planned maintenance activities, taking units off-line, etc.
If you have any questions concerning this matter or to apply for an SOC, please contact Cheng Zhang of the
Raleigh Regional Office at 919-791-4200.
Sincerely,
Danny Smith, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Cc: WQS Raleigh Regional Office - Enforcement File
NPDES Compliance/Enforcement Unit - Enforcement File
Central Files
North Carolina Department of Environmental Quality i Division of Water Resources
1628 Mail service Center, Raleigh, NC 27699-1628
ROY COOPER
Gowrr r
\IICiiaEL S. REG_-N
Saneen
LD1D A CULPEPPER
Ir-:arim D:rtsrir
Certified Mail # 70172680000022360277
Return Receipt Requested
Jason Kaplan
Moncure Holdings West LLC
282 Century PI Ste 2000
Louisville, CO 80027
ILM
k_ ZK I a
NOP71h CAw^•LINA
Environmental Quality
October 17, 2018 t0l �
Z,
LJ/
r
SUBJECT: NOTICE OF VIOLATION & INTENT TO ASSESS CIVIL PENALTY
Tracking Number: NOV-2018-LV-0726
Permit No. NC0001899
Moncure Holdings West WWTP
Chatham County
DearPermittee:
A review of the June 2018 Discharge Monitoring Report (DMR) for the subject facility revealed the violation(s)
indicated below:
Limit Exceedance Violation(s):
Sample
Location Parameter
Limit Reported
Date Value Value Type of Violation
001 Effluent BOD, 5-Day (20 Deg. C) - 6/13/2018 10 11.7 Daily Maximum Exceeded
Concentration (C0310)
001 Effluent BOD, 5-Day (20 Deg. C) - 6/30/2018 5 6.45 Monthly Average Exceeded
Concentration (C0310)
North Carolina Department of Environmental Quality I Division of Water Resources
1628 Mail Service Center, Raleigh, NC 27699-1628
A N6tl 6 atlo a t to Issue Civil Penalty is being issued for the noted violation of North Carolina General
St nd the facility's NPDES WW Permit. Pursuant to G.S. 143-215.6A, a civil penalty of
not more than twenty-five thousand dollars ($25,000.00) may be assessed against any person who violates or
fails to act in accordance with the terms, conditions, or requirements of any permit issued pursuant to G.S.
143-215.1.
If you wish to provide additional information regarding the noted violation, request technical assistance, or
discuss overall compliance please respond in writing within ten (10) business dam after receipt of this Notice. A
review of your response will be considered along with any information provided on the submitted Monitoring
Report(s). You will then be notified of any civil penalties that may be assessed regarding the violations. If no
response is received in this Office within the 10-day period, a civil penalty assessment may be
prepared.
Remedial actions should have already been taken to correct this problem and prevent further occurrences in the
future. The Division of Water Resources may pursue enforcement action for this and any additional violations of
State law. If the violations are of a continuing nature, not related to operation and/or maintenance problems,
and you anticipate remedial construction activities, then you may wish to consider applying for a Special Order by
Consent.
Reminder: Pursuant to Permit Condition 6 in Section E, the Permittee is required to verbally notify the Regional
Office as soon as possible, not to exceed 24 hours, from first knowledge of any non-compliance at
the facility including limit violations, bypasses of, or failure of a treatment unit. A written report may
be required within 5 days if directed by Division staff. Prior notice should be given for anticipated or
potential problems due to planned maintenance activities, taking units off-line, etc.
If you have any questions concerning this matter or to apply for an SOC, please contact Cheng Zhang of the
Raleigh Regional Office at 919-791-4200.
Sincerely,
Danny Smith, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
Cc: WQS Raleigh Regional Office - Enforcement File
NPDES Compliance/Enforcement Unit - Enforcement File
Central Files
North Carolina Department of Environmental Quality i Division of Water Resources
1628 Mail Service Center, Raleigh, NC 27699-1628
Is Complete items 1, 2, and 3.
■ 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,
or on the front If space permits.
JASON KAPLAN
MONCURE HOLDINGS WEST LLC
282 CENTURY PL STE 2000
L.OUISVILLECO 80027
N logg. -0728
lei BBV-0726 RE HOLDINGS WEST VJNf11'
18 MAILEDA 0/17118.ZHANG
�IIIIIII'I I'III'lllIIIIIIIIIIIIIIIIIIIII IIIIIII
9590 9402 3411 7227 5726 63
7017 2680 0000 2236 0277
PS Form 3811, July 2015 PSN 7530-02-000-9053
A. Signature
x
B. R'eceived 6
❑ Agent
❑ Address
C. Date of DeiivE
i--)L_,
D. Is delivery address different from item 17 ❑ Yes
If YES, enter delivery address below: ❑ No
3. Servioe Type
0 Priority Mal FiwressC.
❑Adult Signature
❑ Registered Mail*"
❑ Aydd It Signature Restricted Delivery
❑ R11stered Mail Restn.
BLera"ried Mail®
❑ Certified Mail Restricted Delivery
Delivery
-01,Retum Recelpt for
❑ Collect on Delivery
Merchandise
El Collecton Delivery Restrcted Delivery
O SignatureConfirmation.
Aall
O Signature Confirmato
Restricted Delivery
Restricted Delivery
-_ _Aafl n)
Domestic Return Recei
rr`
Domestic
u
•
C3
O
p
F I C
a''
rn
Certified Mail Fee
nl
$
f1J
Extra Services & Feee (c boa, add roe as Vprvp^ale)
C3
❑ Relum Recspi(hardmpY) $_.
C3
❑A..R Pt (elecwnic) $
Postmark
C3
❑oseeed elal Ree "a cerireN $
Here
C3
pMrswwe -ire $
QROII!{jl,erlR eesvicteO OeiiveN $
C3
Postage
CO
$
"O Tote JASON KAPLAN
fU MONCURE HOLDINGS WEST LLC
$ 282 CENTURY PL STE 2000
t` Seni
ra LOUISVILLE CO 80027
C3 Sjjg, NOV-2018-LV-0726
rM1 NC000189B.MONCURE HOLDINGS WEST W WTP
?Sid10/22/18 MAILEDA 0/171182HANG