NC0086142_NOV NRE 2012-LV-0025_20120131

ATTACHMENT A
CASE NO. LV-2012-0015
Outfall Date Parameter Reported Value Permit Limit
001 10/14/2011 TSS *72.0 mg/1 45.0 mg/1 (daily maximum)
001 10/2011 TSS *44.25 mg/l 30.0 mg/1 (monthly average)
*Denotes civil penalty assessment
The Aqua North Carolina, Inc. response to NOV/NRE-2012-LV-0025 was reviewed by
DWQ staff. Mitigating factors were not found that resulted in a reduced civil penalty
amount.

STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
COUNTY OF GASTON
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTY AGAINST ) ADMINISTRATIVE HEARING AND
AQUA NORTH CAROLINA INC. } STIPULATION OF FACTS
PERMIT NO. NCO086142 )
FILE NO. LV-2012-0015
Having been assessed civil penalties totaling $ 494.67 for violation(s)as set forth in the assessment
document of the Division of Water Quality dated January 31, 2011, the undersigned, desiring to seek remission
of the civil penalties, 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 Quality within 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 , 2012
BY
ADDRESS
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