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Home My WebLink AboutWWATR RegistrationSigned_102221WATER WITHDRAWAL AND TRANSFER REGISTRATION Keporting Year _ 1: FACILITY INFORMATION NCDEQ Division of Water Resources 1611 Mail Service Center Raleigh, NC 27699-1611 Tel: (919) 707-9021 Fax: (919) 733-3558 Web: htto://www.ncwater.org 1-A. Facilitv Name: 1 For Office Use Only 1-B. Owner Name: Reaistration #: 1-C. Address: Citv: State: Zio Code: 1-D. Countv: 1-E. River Sub -Basin: 1-F. Contact Person: 1-G. Title: 1-H. Telephone: ( ) 1-I. Fax: 1-J. Email: 1-K. Water Use Type (select one): ❑ Agriculture-aquaculture ❑ Industrial-metal/plastic/fiberglass manufacturing ❑ Agriculture -row -crop farming and research ❑ Industrial -animal processing ❑ Agriculture -land drainage/waterfowl impoundments ❑ Industrial -textile manufacturing ❑ Agriculture -plant nursery ❑ Industrial-wood/paper products ❑ Agriculture -sod and turf production ❑ Industrial -environmental remediation ❑ Agriculture -Christmas tree production ❑ Mining -mineral extraction ❑ Agriculture -animal production ❑ PWS-drinking water (ID# ) ❑ Energy -hydropower ❑ Recreation -temporary filling of ponds ❑ Energy -pipeline testing (temporary) ❑ Recreation -golf course ❑ Energy -thermal -electric (steam -electric power, nuclear, El Recreation-snowmaking turbine generator) ❑ Industrial -chemical and pharmaceutical El sports manufacturing/processing SECTION 2: WITHDRAWAL INFORMATION 9-A Avarnna daily withdrawal and maximi im day withdrawal by mnnth in millinn nallnns nar rlav Wnm Month # of Days Used Average Daily Withdrawal MGD Maximum Day Withdrawal MGD Month # of Days Used Average Daily Withdrawal MGD Maximum Day Withdrawal MGD Jan July Feb Aug Mar Sep Apr Oct May Nov Jun Dec 9-R Grniind Water Infnrmatinn — Plaasa rmmnlata a rnw fnr aarh nrnund water withdrawal sniirca iisad in gnnq Well or Sump Identifier Latitude (35.123456) Longitude (-77.123456) Well Depth (Feet) Pump ake pth [�Feet) Screen Depth Well Diameter (Inches) Average Daily Withdrawalused MGD # of days Pumping Capacity (MGD) FeetTop I ) (Feet) Bet 941 Simfara Water Infnrmatinn — Plaasa rmmnlata a rnw fnr aarh siirfara water withdrawal sniirra usad in gnnq Source Identifier Source Type Latitude (35.123456) Longitude (-77.123456) Average Daily Withdrawal MGD # of days used Sub -Basin Pumping Capacity MGD Source Type — Choose one of the following: Lake, Pond, Quarry, Reservoir, River, or Stream. Rev. 05/08/2017 SECTION 3: DISCHARGE INFORMATION 3-A. Enter the averaqe daily amount of water discharqed each month in million qallons per day (MGD) Month # of Days Discharged Average Daily Discharge MGD Maximum Day Discharge MGD Month # of Days Dischared g Average Daily Discharge MGD Maximum Day Discharge MGD Jan July Feb Aug Mar Sep Apr Oct May Nov Jun Dec 3-B. Please complete a row for each discharqe method Identifier or Permit Number ' Discharge Type Latitude (35.123456) Longitude (-77.123456) Average Daily Discharge (MGD) # of Days Used Sub -Basin Permitted Capacity (MGD) " Discharge Type - Choose one of the following: Discharge, Hydropower, Land Application, Subsurface, or To Another System. SECTION 4: SURFACE WATER BASIN TRANSFER Complete this section if you withdraw or purchase water that is not returned to the river sub -basin from which it was withdrawn. 4-A. Please complete a row for each transfer of surface water from one sub -basin to another. Description of Transfer Source Sub -Basin Receiving Sub -Basin Daily Transfer Capacity MGD 4-B. Enter the average daily and maximum day surface water transfer amounts by month in million gallons per day (MGD): Month # of Days Transferred Average Daily Transfer MGD Maximum Day Transfer MGD Month # of Days Transferred Average Daily Transfer MGD Maximum Day Transfer (MGD) Jan July Feb Aug Mar Sep Apr Oct May Nov Jun Dec If latitude and longitude are unknown for any water withdrawal or discharge location listed above please submit a map clearly marking and labeling all water withdrawal and discharge locations on an appropriate US Geological Survey topographic map or a comparable map. Do you have any comments? PRINT/TYPE Name of Person Registering Rev. 05/08/2017 Digitally sianed by Ken Elliott DN: CN=Ken Elliott, O=Elliott P n E �tt Consulting, to ken the accuracy Reason: I attest to the accuracy and integrity Sigl Location: Elliott Consulting Date Date: 2021-10-22 16:16:06