990012_Enforcement (Other)_20230811

PLEASE PRINT CLEARLY OR TYPE
STATE OF NORTH CAROLINA IN THE OFFICE OF
COUNTY OF (j)Vadidn
ADMINISTRATIVE HEARINGS
(2) Shady Grove Dairy - )
TmA. SmNremrat _ Tim A. SmAhemran )
(your name) PETITIONER, )
PETITION
V. } FORA
CONTESTED CASE HEARING
(3) North casino Department of Errvironmerrlal Quarrty )
Division of Water Resources
RESPONDENT. )
(The State agency or board about which you are complaining) )
I hereby ask for a contested case hearing as provided for by North Carolina General Statute § 15OB-23 because the Respondent has:
(Briefly state facts showing how you believe you have been harmed by the State agency or board)
It continually reined from winter to Spring. Ground was muddy
C�ffirp of. General Counsel
(4) Amount in controversy $ J / 6 6 /, -7 3 (if applicable)IF AUG 1 1 2023
(If more space is needed, attach additional pages.)
DEPARTMENT OF
(5) Because of these facts, the State agency or board has: (check at least one from each column) ENVIRONMENTAL QUALITY
deprived me of property; exceeded its authority or}urisdiction;
xta ordered me to pay a fine or civil penalty; or xxx acted erroneously;
otherwise substantially prejudiced my rights; AND failed to use proper procedure;
acted arbitrarily or capriciously; or
failed to act as required by law or rule.
(6) Date: August 8. 2o2a (7) Your phone number. ( ) 14ears
(8) Print your full address: 1040 Hoot owl Honow. East Band, NC 27018
(street address/p.o. box) (arty) (state) (zip)
(9) Print your name: Tim a smarrerman
-/
(10) Your signature: _ 1
You must mail or deliver a COPY of this Petition to the State agency or board named on line (3) of this form. You should contact the
agency or board to determine the name of the person to be served.
CERTIFICATE OF SERVICE
I certify that this Petition has been served on the State agency or board named below by depositing a copy of it with the United States
Postal Service with sufficient postage affixed OR by delivering it to the named agency or board:
(1 l) Tim A Smilhennan (12) North Carolina Environmental Quality
(name ofperson served) (State agencyor board listed -online 3)
(13) 1040 Hoot owl Hoibw Fast Bend NC 27018
(street address/p.o. box) (city) (state) (zip code)
(14) This the se, day of August 2023
(15) Tim A. Smithemran I i`
(your signature)
When you have completed this form, you MUST mail or deliver the ORIGINAL to the Office of Administrative Hearings, 1711 New
Hope Church Road, Raleigh, NC 27609.
H-061nstructions (06/21)