NC0028827_Electronic Reporting Requirements_20181126

APPLICATION FOR
B .'' Water Resources
EY•✓tern sou Temporary Electronic Reporting Waiver
011Alil"
NPDES Permit Number N I C s CIC I •.2 I l XI 7i
DATE RECEIVED:
(AGENCY USE ONLY)
Electronic Reporting Waiver Number:
(AGENCY USE ONLY)
Federal regulations require electronic submittal of all discharge monitoring reports (DMRs)and other
program reports and specify that,if a state does not establish a system to receive such submittals,then
permittees must submit monitoring data and reports electronically to the Environmental Protection
Agency(EPA). The fmal NPDES Electronic Reporting Rule was adopted and became effective on
December 21,2015.
A permittee may be granted a temporary waiver from the NPDES electronic reporting requirements if the
reporting facility:
1. Is physically located in a geographic area(i.e.,zip code or census tract)that is identified as under-
served for broadband internet access in the most recent National Broadband Map
(http://www.broadbandmap.gov/)from the Federal Communications Commission(FCC);or
2. Demonstrates that such electronic reporting of the monitoring data and reports would pose an
unreasonable burden or expense to the NPDES-permitted facility.
Approved waivers from electronic reporting are temporary and will include an expiration date. The
permittee may re-apply for a new waiver if the conditions above are met. Re-application should be
submitted to the Division no Pater than sixty(60)-days-prior to the electronic reporting waiver's - - -
expiration._Approved,electronic-reporting-waivers are not transferrable. _
Upon the electronic reporting waiver's expiration,if the permittee did not re-apply for and receive a new -
temporary waiver,then the permittee must report the required NPDES monitoring data and reports
electronically using the state's web-based electronic reporting tool(for DMRs use the eDMR system)or
EPA's web=based electronic reporting tool(for the CVA§316(b)Annual Reports only).
Electronic reporting waivers are waivers fromelectronicreporting only. An NPDES-regulated permittee
receiving an electronic reporting waiver must provide the required monitoring data on paper forms or
formats approved by the Director. Failure to report is an enforceable violation of the NPDES permit.
To apply for a temporary waiver from electronic reporting,please provide the following information:
1. Contact Information:
Designated Facility Representative"(as identified in accordance with 40 CFR 122 22)
Name ©S•t��j , � Ige.a`
Position/title 0 A r,
Mailing address - 1) 'j. Rd'
,City; - - •-.- , (/ - CU4 4.-i
•State./-Zip Code. . • /‘) C • ��/ - - . ,
.Telephone number: (;Zn) 11;2,5 , L 171
_Email.address:-° ; :. -
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2. Facility Location Information: ,
Owner name
Facility name SA%AI /46...43e.)--t- G ,-1 ,IV e Lse,,t ( ' y
Street address or state road i t.}Y 7 (7 e.-s 4
City J ee._ .4-e.cd e-I l
State/Zip Code AdIC A'r i 7
County (CA t.-+C P
3. Brief Explanation for Waiver Request:
If the space provided is not sufficient, attach the explanation on a separate sheet of paper.
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4. Copy of the Relevant FCC Information
If applicable,attach a copy of the relevant FCC information,from the most recent FCC report
addressing such issues,identifying the zip code or census tract where the facility is located as being
under-served for broadband internet access.The FCC web page is found at the following address:
http://www.fcc.gov/.
5. Applicant Certification
I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system,or
those persons directly responsible for gathering the information,the information submitted is,to the best of my
knowledge and belief,true,accurate,and complete. I am aware that there,are significant penalties for
submitting fal information,including the possibility of fine and imprisonment for knowing violations.
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Si of Designated FacilityRepresentative Dat
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North Carolina General Statute§ 143-215.6B provides that:
Any person who knowingly makes any false statement representation, or certification in any application,
record, report, plan, or other document filed or required to be maintained under this Article or a rule
implementing this Article; or who knowingly makes a false statement of a material fact in a rulemaking
proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this
Article or rules of the Commission implementing this Article,shall be guilty of a Class 2 misdemeanor which
may include a fine not to exceed ten thousand dollars ($10,000). 18 U.S.C. Section 1001 provides a
punishment by a fine or imprisonment not more than 5 years,or both,for a similar offense.
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RETURN COMPLETED APPLICATION TO:
NC DEQ/DWR/Water Quality Permitting Section—Wastewater Branch
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Note: The submission of this document does not guarantee the e-reporting waiver will be granted.
You should receive a response from the Division within 15 business days of application receipt.
If you have questions,or to check the status of your application,contact: Vanessa Manuel,919-807-6392
AGENCY USE ONLY
Electronic Reporting Waiver:
❑ Approved Effective date: Expiration Date:
❑ Denied
The US EPA shall have the authority to review and disapprove the state's decision regarding the granting
of all temporary waivers from NPDES electronic reporting.
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