NC0049620_Remission Request (LV-2023-0292)_20231229

DocuSign Envelope ID:CDD2OCBE-35E6-4CF2-AD15-D194CCE4BFBE
STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
COUNTY OF MADISON
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINISTRATIVE HEARING AND
) STIPULATION OF FACTS
Town of Marshall )
Marshall WWTP )
PERMIT NO.NC0049620 ) CASE NO. LV-2023-0292
Having been assessed civil penalties totaling$496.29 for violation(s)as set forth in the assessment document of the Division
of Water Resources dated December 4,2023,the undersigned,desiring to seek remission of the civil penalty,does hereby
waive the right to an administrative hearing in the above-stated matter and does stipulate that the facts are as alleged in the
assessment document. The undersigned further understands that all evidence presented in support of remission of this civil
penalty must be submitted to the Director of the Division of Water Resources within thirty(30)days of receipt of the notice
of assessment. No new evidence in support of a remission request will be allowed after(30)days from the receipt of the
notice of assessment.
This the A is I— day of Dcccni/Jt✓ ,20.73
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RECEIVEDSIGNATURE
DEC 2 9 2023 ADDRESS
NCDEQ/DWR/NPDES Po goo sK$
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TELEPHONE
($.28) GYg -3b3/