NC0071897_Delegated Authority_20180214

State of North Carolina | Environmental Quality | Water Resources
2090 U.S. 70 Highway, Swannanoa, NC 28778
828-296-4500
February 14, 2018

Robert Crummie
Mizpah Healthcare Inc
74 Lotus Lane
Hendersonville, NC 28792

SUBJECT: Delegation of Signature Authority
Facility: Henderson’s Assisted Living WWTP
Permit No: NC0071897
County: Henderson

Dear Mr. Crummie:
A review of our records indicates your facility’s Delegation of Signature Authority Form on file
or those forms submitted by your operator are either invalid or outdated. 15A NCAC
2B.0506/2T.0106 requires a valid form granting third parties signatory authority to submit permit
applications, monitoring reports and other information relating to the operations at the subject
facility on your behalf. To maintain continued compliance, the Division of Water Resources
requests you submit an updated form to the Water Quality Permitting Section. A copy of the form
is enclosed with this letter.

If you no longer wish to delegate your signatory authority, please notify the appropriate Regional
Office and the Water Quality Permitting Section in Raleigh.

Additionally, please review all registered EDMR users, ORC designations and Responsible
Official listings to insure the Division has the most accurate and up-to-date information for your
facility. If you have any questions, please feel free to contact Janet Cantwell or myself at the ARO
at 828-296-4500.

Sincerely,

Daniel Boss
Environmental Specialist
Asheville Regional Office
Division of Water Resources