WQ0013200_Signature Authority_20240701

7/20/24, 6:50 AM
Veolia Mail - Southeast Brunswick Sanitary District Submittal 7/19/2024
Q VEOIIA
Morris, Lisa <[e-mail]>
Southeast Brunswick Sanitary District Submittal 7/19/2024
1 message
[e-mail]<[e-mail]>
To: [e-mail]
Attached is a copy of the Non Discharge form submitted on 7/19/2024.
Non -Discharge Branch Upload_Submittal Form.pdf
110K
Fri, Jul 19, 2024 at 2:59 PM
https://maii.g000le.com/mail/u/0/?ik=d52ba2l 675&view=Dt&search=all&permthid=thread-f:1805035060985265671&simpl=msq-f:18050350609852656... 1 /1

July 1, 2024
Division of Water Resources
Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Subject: Signature Authority Designation
To Whom It May Concern:
As an appropriate signing official for Southeast Brunswick Sanitary District 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
N a ni her
Administrative
Asst
Lisa Morris
WQ0013200
Area Manager
Nadine
Blackwell
WQ0013200
If you have any questions, please contact me at the following:
Permittee/Applicant name (please print): Brian N.
Title: District Manager
Complete mailing address:
4240 Committee Drive Southeast
City: Southport State: NC Zip: 28461
Telephone number: [phone] Email: \ [e-mail]
Sincerely,
Alf
signature

Project Contact Information
Please provide information on the person to be contacted by Nos Staff regarding electronic submittal, confirmation of receipt and other con espondwrprt.
Name' Lisa Morris
Email Address*
lisa.morris@veolia com
Project Information
Application/Document Type*
Phone Number"
3364869547
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Signature Authority Delegate
Permit Type: `
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Permit Number: *
WQ0013200
Has Current Existing permit number
Applicant/Pennittee*
Bryan N McCabe
Applicant/Permittee Address*
4240 Committee Drive Southeast
Facility Name*
Southeast Brunswick Sanitary District
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1.
N DAR-2
Residual Annual Report
Change of Ownership
High -Rate Infiltration
Reclaimed Water
Residuals
Other

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
[e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, calculations, Etc.)
Sign Delgt Form.pdf 45 91 KB
Upload only 1 PDF document One than 250 Me). 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"
Submission Date 07/19/2024
Is filled in automatically once submitted.