WQ0035049_Monitoring - 06-2020_20200729

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0035049
Name of Facility:* Maple Hill WWTF
Month:* June
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Year:* 2020
Upload Document*
June2020_NDMR_NDAR1.pdf 606.44KB
FDF Only
Please upload only one combined pdf document. Upload GW-59 individually.
Confirmation Email Address:* [e-mail]
Name of Submitter:* Kenny Keel
Signature:*
K" W
Date of submittal: 7/29/2020
This will be filled in &Aorratically
Initial Review
Reviewer: Williams, Kendall
Is the project number correct?* WQ0035049

Is the monitoring report r Yes r No
accepted?*
Regional Office* Wilmington
Accepted Date: 7/29/2020

FORM: NDMR 10-13
NON -DISCHARGE MONITORING REPORT NDMR )
Page ,1i of
Permit No.: WQ0035049
Facility Name:
Maple Hill WWTF
PPI: 001
Flow Measuring
Point:
0
Influent El
Effluent ❑
No flow
County:
Pender
Month: June year 2020
Parameter
Code
50060 00400 06310
generated
parameter MonitoringPoint:
❑Influent ❑ Eff art ❑ Groundwater U;wering ❑Surface Water
00530
0061Q
00620
00626
3161B
g08pQ
QO$65
G0940
70300
a,
a
• F
aE rn
3
5
x
�p
o
p!
CO
-a
O
°
m
If
p
C
_ C
0
$
m
o� CoIL
am
a
z
LL o
�
3
�� o
1-1
�
1
24-hr hrs
10:00
GPD
sIL
u
m
mg1L
m
ma/L
m
#l100 mL m
MOIL
m L
Q
5
3,750
8.3
mgJL
2
09:45 5
7,526
9
3
10:00 5
5,781
7.7
09:45 5
6,004
7.5
5
t4
09:30 5
9,873
7.6
6
07:30
13,715
T
08:00
19,703
8
09,30 4
14,570
7.6
9
09:00 5
13,524
7.6
f0
11
10:30 5
10:00
11,467
7.6
5
4.9
6.3
15.4
5.4
19.B
7.39
5
12,491
7.7
12
09:15 4
13,404
7.5
13
13,874
14
! b,937
15
02:00 4
25,098
7.6
16
D9:30 4
22,667
7.6
17
01:30 4
16,003
7.5
18
09:45 4
5,846
7.6
19
01:45 4
7,654
7.3
20
9,873
21
12,420
22
02:00 3
7,597
7.3
23
08:30 5
7.725
7.6
24
01:30 4
8,681
7.4
25
10:DD 5
9.165
7.3
26
12:40 4
8,294
7.6
27
9,482
28
10,263
29
09:00 7
11,446
7A
30
09:30 4
28,884
7.3
31
Average;
Daily Maximum:
12,057.
28,884
9.00
5.00
4.90
6.30
15.40
5.40
1.00
19.60
*7.39
Daily Minimum:
3,750
7.30
5.00
5.00
4,90
4.90
6,30
6.30
15.40
5.40
1.00
19.60
Monthly
Sampling Type:
Recorder
Grab
Composite
Composite
Composite
15.40
Composite
5.40
Composite
1.D0
Grab
19.60
Ca
Avg. Limit:
42,000
n/a
30
30
15
a
Grab
Composite
Composite
Daily Limit:
n/a
6 to 9
Na
n/a
Na
n/a
Na
200
Na
n/a
Na
n/a
Sample Frequency:
Ccant1nous
5XWK
Weekly
Weekly
Weekly
n/a
Weekly
Na
Weakly
n/a
Weekly
Na
Monody
n/a
Mandy
Na
Na
3XYR
3XYR

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page_2 of_2—
Sampling Person(s) Certified Laboratories
Name: Samples were collected by the Certified Laboratory Name; Environmental Chemists, Inc.
Name:
Name: Jay Baker
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? o Compilant ❑ Non-c mpllant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the dale(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary,
Operator In Responsible Charge (ORC) Certification Permittee Certification
ORC: Christopher K. Pickett Pertrtittee: Pander County Utilities
Certification No.: 995432 Signing Official; Kenneth Keel
Grade: WW2 Phone Number: 910-259-1570 Signing Official's Title: Director
Feb ❑ Yes p No Phone Number: 910-259-1570 Permit Expiration: 3/31 /2021
1 1 _�9
7 l Z!i
Signature Date Signature Date
By this signature, I certify titer this report is accurrate and complete to the best of my knowledge. I codi
fy 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 all qualified personnel property gathered and evakasted pre 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 false information, including the possibility of fines and Imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

Lenviro r,�
ANALYTICAL & CONSULnNG CHEMISTS
Pender County Utility Operations
Post Office Box 995
Burgaw NC 28425
Attention: Kurt Lonander
-Arla-vitronmentai Chemists, Inc.
6602 Windmill Way, Wilmngton, NC 28405 - 910.392.0223 Lab - 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 - 252-473.5702 Lab/Fax
255-A Wilmington Highway, Jacksonville, NC 28540 - 910.347.5843 Lab/Fax
info@environmentalchemists. coin
Date of Report: Jun 23, 2020
Customer PO #:
Customer ID: 08100095
Report #: 2020-09606
Project ID: Maple Hill WWTP
Lab ID Sample ID:
Collect
Collect Date/Time
Matrix Sampled by
20-23957 Site: Effluent
10:00 AM
Water Mike Miracle
Test
Method
Result Date Analyzed
Ammonia Nitrogen
EPA 350.1
Total Kjeldahl Nitrogen (TKN)
EPA361.2
6.3 mg/L
06/17/2020
Residue Suspended (TSS)
SM 2540 n
5.4 mg/L
06/18/2020
SOD
4.9 mgfL
06/1112020
Nitrate Nitrogen (Calc)
SM 5210 8
5 mgfL
06/10/2020
Nitrite Nitrogen
EPA363.2
Nitra#e+Nitrite-Nitrogen
EPA 353.2
1.20mg/L
06/11/2020
Nitrate Nitrogen
subtraction Method16.6
mg/L
06/21 /2020
Lab ID Sample !D:
15.4 mg/L
06/22/2020
Collect Date/Time
Matrix Sampled by
20-23958 Site: Effluent - Grab
6/10/2020 10:02 AM
Water Mike Miracle
Test
Method
Results Date Analyzed
Fecal Coliform
idexx co lag-1s
Temperature
<1 MPN/100mi
06/10/2020
SM 2550 B
22.8 C
06/10/2020
pH
say asoa H a
Tots] Phosphorus SM 4500 P F 7.6 units 06/10/2020
Comment: 7.39 mg/L 06/19/2020
Reviewed by:
Report #:: .2020-M05

D4rr �r
tttalyst:
Calibratmn Time Cal But%r4.0 s.u. Cal
}L� [ )
FadBty Ntmt•. ( tl N 94
f'rtnsft #- _ VI0- 0 +DL4 c,
H
Ref Method: SM45f70 H+B -2011 fnstrearlau JD
s.0 Check Buffa 7.0 s. u. Cammenss
f//
'PH check buff must tad within t 0.1 pH units of the buffer's true value
a su butler Louth._ RiM�90! 79! Em 1 iJltf 7 su 6uiYCr EoaMl: qq
10 su buffer Lath: gjcg 2905A14 Exn t4P10
Sample location Sattlpk Callw1m Sample Analysis pH Result I Wft�-;Bufrer
Time♦ I Time* I s_u Check value s.tt. CammenlsemQuslifiers
I. All pH values in pH units (i.e. sE�fRecoM all daft to dw nearest o,01 S.SO at L BM repplt abons Ow must be wtlhut # 0 1 units of the butler's trtse value
report slt tfre nearest 0.1 s.u.
Refertstoe Method: SM 4500 CI-G20i I: Hach 8167 TI)tAl Rssldllal Chlorine (TRC)
Pleae circle ipble Mcleod ltratnmtem ID;
Standard Result Check Time clrcck S S
,R (wbm _wymng Sreredsld Loc Colkttttat ,g r TRC Result
fV or nl E, _ ie t�aafSrZetf Time TI1na �W' or m VL Co7QrrSAData QaaltiQs
at m sines
TIiC Daily Check Standard 6w valeta l+WL or mg/L wmpw= rare
Check standards must recover within f10'%of the check standard's trite value or mg/L
'%nnttai Calibration Curve Verification Date:
Reagetu 131m* Value: lWhen applicable. Analyse and document a reagent blank when standards, sample dilutions or PT Sssnples one prepata#}
Dbwlved Ottygm (pO)
Refetance Medtod:SM 45000 -20E 1 Instrument 113-
Cabbratiow Calibration variable Meter reading ; F89-andlYsig calibration
Verification or % elTteiency venftcanott (when necessary)
Time g c Tempermune after cafilinwon Comments
_ - Tlteotr:tical Calculated
Sample Location
Analysis
Use this crow "--ii perfannitat a
Comments/Deta Qualifeers
• When Performing analyses at multiple locatwns, the meter m
1" samust be recaiibrated at each site before analysis nr a post -analysis calibratrote vcrtficatign must 6e pertbperformed.1ple t8 nt�asu"Jtrttity In rtty Arealal anLVtir onstte. mlv ume areal% -zed tenuous he rccOf" w,dl a time that dfeti are nwasured ill 5ttu or tnitnedfately
Tnaperatrre
sample Sample Temper
Sample Location Collection Analysis Oc
TI 'rime ri~
l
I t''antnle is me-lsurtaf dirIMIN ri the c€ream inky-jr (.ts 'Ile. vnh t:tnc. stl;d+rLJ cc.tid�i Ile
lnnual Verification Dare
Field NrgOrinll Note.
Comments/Dau Quslif-ters
tr,th 21 nu14: thaE thCr .1fC fT1LMSUieXI Iri Slllt %1l 3Fnlncdlirtjv
r
Rev 0712019 1)(W.QA.401

Environmental Chemist, Inc-, Wilmington, NC Lab #94
6602 Windmill way
Wilmington, NC 2$405
Sample Receipt Checklist 910.392.0223
Pblg
Client:
W
. OateyIt b 0
Report Number: — ( 0
Receipt of sample:
© YES ❑ NO
Delivered UPS ❑ FedEx ❑
C YES ❑
NO
N/A I. were custodyOther
seals present on the copier?
N/A
©ri final temperature
upon
2. If custody -seals were resent, were t
eceipt •C hey intact/unbroken?
How temperature taken: ❑ T m Corre temperature upon receipt 'C
e perature Blank
ainst Bottles
IR Gun ID: Thomas Traceable S/N 192511657
D YES Ci
NO
Co
IR Gun rrectiongFactor &c. 0
3. If temoerature of cooler exceeded FC,
YES ❑
YES C)
NO
was Project M r.
4. Were properl /QA notified?
custody procedures {relin uishedJretervedj followed?
NO
S. Were sample 1D's listed on the COC?
YES ❑
YES
NO
6. Were samples Ia's listed on sample containers?
YES ❑
NO
7. Were cplliti n date and time listed on the COC?
YES ❑
NO
S. Were tests to be performed fisted on the COC?
YES ©
NO
NO
9. Did samples arrive in proper containers for each test?
❑
Ia. Did samples arrive in good condition for each test?
FYEYSES
NO
11. Was adequate sample volume available?`
i7
YES ❑
NO
N©
12. Were samples received within Pro r holdin time for requested tests?
YE5 0
NO
13. Were acid preserved samples rocehred at a pH of <2? •
YE5 ©
NO
1d. Were snide samples received at a a127
15. Wert sulfide
YES ![03
NO
sam les received at a H >9?
16. Were NH3MN/phenol received at a chlorine residual
YES
7
NO
of cp.5 m/L? �•
17. Were Sulfide/Cyanide received at a chlorine residual
YES ❑
NO
In of <a.g m/L?
' TOC/Volatiles are pH checked at time of analysis and recorded on the benchsheet.
"• Bacteria samples are checked for Chlorine at time of analysis and recorded on the benchsheet.
Sample Presemilition: (Must be completed for any sample(s) Sample(s) incorrectly preserved or with headspace)
were received incorrect#
by adding (circle one): H2SO, HNO3 HCl y preserved and were adjusted accordingly
Time of preservation: Time
If more than one preservative is needed, notate in comments below
Note: Notify customer service immediately for incorrectly Preserved samples. Obtain a new sample or
natrfy the state lab if directed to analyzed by the customer. Who was notified, date and time;
Volatiles Sarnple{s)
were received with headspace
COMMENTS:
DOC. QA.002

Analytical & Consulting Chemists
Sample Identification
WWTP PPI OOcom
to ula�.n_.__
■ 14L►['i°m
1/month
BOD 30 m9k TSS 30 MOIL, NH315 mg/L, igcal 200
12.
Temperature when Received:
Delivered By:
Comments: ��
ENVIRONMENTAL CHEMISTS, INC OFFICE.- 91�0-392-02233FAX[phone]
424
NCDENR: DWp CERTIFICATION # 94 NCDHHS: OLS CERTIFICATION # 37720 inf FAX ts.co 2-4424
o�environmenialchemists.00m
COLLECTION AND CHAIN OF CUSTODY
PROJECT NAME: Ma le Hill WWTP fPPI 001
REPORT
CONTACT NAME: PO NO:
REPORT TO: ORC PHONE/FAX:
COPY TO:
emai#:
SAMPLE TYPE. I =Influent, E = Ef�uent, W = Well, ST = Streams SO =
on SoII, Sl_ =Sludge, Other:
`16
PRESERVATION
e$� s ��
Teals) ai ANALYSIS REQUESTED
3 x BOD. TSS_ Nr)9
�iiuiUjUf
V,r" L-c I G
mm�=
no
By:
x
TDS
x Fecal Caliform, Total P
Cv j0' �a
lle Requesated:
TURNAROUND:

FORM: NDAR-1 10-13 NOWDISCHARGE APPLICATION REPORT NDAR-11
{ ) Page ,1_ of ^4_
Permit No.: WQ0036049 Facility Name: Maple Hill WWTF County: Pender Month: June Year: 2020
Did irrigation occur Field Name: 1 Field Name: 2 field Mane: 3
Field Name: 4
at this facility? Area (]� 1.72 Area (acrses]: 1.72 Area (acres]: 1 72 Area (acres): 1.72
Cover Crop: Bermuda Cover Crap: Bermuda Cover Crop: Bermuda
Cover Crop: Bermuda
❑ YES ❑ NO Hour�r Rate rop: 0.41 Hourly Rate (in]: 0.41 Hourly Rate (ire): 0.41 Hourly Rate (in): 0.41
Annual Rate (in): 29.71 Annual Rate (in): 29.71 Annual Rats (in]: 29 71 Annual Rate (in): 29.71 Weather Freeboard Field lydgstadT MYES p No Field irrigated? p YES
❑ No Field irrigaied7 0 Yes ❑ HO Field Irrigated? EI Yes p NO
m m
ao � m �+,� �+ OE ti w E w e w co.
IL �" �.
OF in ft ft min In 111 al min In in min in In al min In in
1 C 72 0.3 4.7 398 30 001 0.01 399 30 0.01 0.01 400 30 0.01 0.01 397 30 0.01 0.01
Z G 73 0 4.7
3 C 76 0 4.7 360 30 0,01 0.01 362 30 0.01 0.01 363 30 0.01 0.01 357 30 O.Oi 0.01
4 PC 74 0 4.7
5 CL 76 0 4.7 405 30 0A1 0.01 406 30 0.01 0.01 405 30 0A1 0.01 403 30 0.01 0.01
6 PG 73 0 4.7
7 CL 75 0.2 4.7 372 30 0.01 QA1 363 30 0.01 0.01 365 30 0.01 0 01 363 30 0.01 0.01
a CL 73 1.1 4.7
9 CL 80 0 4.7
10 PC 81 0 4.7 395 30 0.01 0.01 395 30 0.01 0.01 395 30 0.01 0..01 394 30 0,01 0.01
11 CL 78 0 4.7
12 R 73 0.4 4.7
13
14
15 R 63 1.4 4.7
16 CL 64 0.3 4.7
17 CL 71 0.2 4.7
18 C 69 0 4.7
19 C 79 0 4.7
20
21
22 C 91 0.5 4.8
23 PC 77 0 4.8 368 30 0.01 O.D9 364 30 0.01 0.01 363 30 0.01 0.01 361 30 0.01 0.01
24 PC 87 0 4.8
25 R 76 0 4.8
26 C 87 0,2 4.$
27
28
29 CLr76 0.3 48 399 30 0.01 OA1 399.01 D.01 400 30 0.01 0.01 398 30 OA10.01
30 C 0 4.7
31
Monthly Loading: 2,697 0.06 2,688 0.06 2,694
12 Month Floating Total (in]: 9.24 0•� 2,673 0.06
9.02 6 89
9.15

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT NDAR-1
� ) Page _2 of 4�
Permit NO.: WQ003504$ Facility Name: Maple Hill WWTF
County: Pe der Month: June Year: 2020
Did irrigation occur Field Name` 5 Field Name: 6 Field flame: 7
Field Name: 8
at this facility? Area (act): 1.72 Area (acres): 1.72 Area (acres): 1.74 Area (acres): 1.71
Cover Crop: Bermuda Cover Crop: Bermuda Cover Crop: Bermuda Cover Crop: Bermuda
p YES ❑ NO Hourly Rate (in): 041 Hourly Rate (in): 0.47 Hourly Rate (in):, 0.41 Hourly Rate (in): 0.41
Annual Rate (in): 2971 Annual Rate (in): 1 29.71 Annual Rate (in): 29.71 Annual Rate (in): 29.71
Weather Freeboard Field Irrigated? p .Yes 1 N0 Field Irrigated? p YES ❑ No Field i
In c m �? ❑ Y� ❑ NO Field Irrigated? p YES ❑ NO
"a E E f "15 E c'
°F In ft ft F min In in al min in In al min in in
1 C 72 0.3 4,7 409 30 0.01 0.01 413 30 0.01 0.01 I min in in
2 C 73 0 4.7
3 C 76 0 4.7 373 30 0.01 0.01 376 30 0.01 0.01 410 30 0.01 0.01 395 30 0.01 OA7
4 PC 74 0 4.7
5 CL 76 0 4.7 416 30 Q01 0.01 418 30 0.01 OA1 373 30 0.01 0.01 374 30 0.01 0.01
B PC 73 0 4.7
7 CL 75 0.2 4.7 374 30 0.01 0.01 377 30 0.01 0.01 414 30 0.01 0.01 397 30 0.01 0.01
81 CL 73 1.1 4.7
9 CL 80 0 4.7
10 PC 81 0 4405 30 0
..01 0.01 7 378 30 0.01 0.01 376 30 0.01 0.01
71 CL 78 0 4,7 408 30 0.01 0.01 403 30 0.01 0.01 396 30 0.01 0.01
12 R 73 0.4 4.7
13
14
15 R 63 1.4 4.7
16 CL 64 0.3 4.7
17 CL 71 0.2 4.7
18 C 69 0 4.7
19 C 79 0 4.7
20
21
22 G 91 0.5 4.8
23 PC 77 0 4.8 377 30 D.01 0.01 379 30 0,01 0.01 378 30 0.01 0.01
24 PC 87 0 4.8
25 R 76 0 4.8
26 C 87 0.2 1 4.8 398 30 0.01 0.01
27
26
29 CL 81 0.3 4.8 411 30 b.01 0.01 412 30 0.01 OA1 409 30 OA1 OA1 397 30 0.01 0.01
30 C 81 0 4.7
31
Monthly Loading: 2,765 0.06 2,783 0.06
12 Month Floating Total (in): 878 2,783 0.06 2,732 0.06
8.85 8.77 8,69

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT {NDAR-'I) Page ,_3 of
Permit No.: W00035049 Facility Name: MAPLE HILLWWTF
County: Pender Month: June Year: 2020
Did irrigation occur field Name: 9 Field Name: 10 Field Name: 11 Field Name:
at this faciiit Area (acnw): 1.75 Area (acres): 1.77 Area (acres): 1.72 Area (acres):
Carer Crop: Bemvuda Corer Crop: Bermuda Cover Crop: Bermuda Cover Crop:
p YES ❑ NO Hourly Rate (in): 0.41 Hourly Rate (in): 0.41 Hourly Rate (in); 041 Hourly Rate (in):
Annual Rate (In): 2971 Annual Rate (in): 29.71 Annual Rate (in): 29-71 Annual Rate (in):
Weather Freeboard Field Irrigated? Cam] YEs ❑ No Field Irrigated? p YES ❑ No Field Irrigated? 0 YES ❑ NO Field Irrigated? ❑ YES ❑ No
a c m hnga[L
IE
a� E 9 E_ °r in It ft at min In In al min in In I min In imin in in
C 72 0.3 4.72 C 73 0 4.7 401 300.01 001 396 30 0.01 0.01 373 30 0.01 0.3 C 76 0 4.74 PC 74 0 4.7 383 30 0,01 0.01 379 30 0.01 0.01 355 30 0.01 0,
5 CL 76 0 4.7
6 PC 73 0 4.7 E3717
30 0.01 0.01 398 30 0.01 0.01 378 30 0,01 0.01
7 CL 75 0.2 4,7
8 CL 73 1.1 4.7
9 CL 80 0 4.7 30 0.01 1 0.01 375 30 0.01 0.01 349 30 0.01 qAi
10 PC 81 0 4.7
11 CL 78 0 4.7 404 30 0.01 0.01 396 30 0.01 0.01 375 30 0.01 0.01
12 R 73 0.4 4.7
13
14
15 R 63 1.4 4.7
16 CL 64 0.3 4.7
17 CL 71 0.2 4.7
18 C 69 0 4.7
19 C 79 0 4.7
20
21
22 C 91 0.5 4,8
23 PC 77 0 4.8
24 PC 87 0 4.8
25 R 76 0 4.8 378 30 0.01 0.01 376 30 0.01 0.01 354 30 0 04 0.01
26 C 87 0.2 4.8
27
28
29 CL 76 0.3 4.8 406 30 0.01 0.01 401 30 0.01 OA1 377 30 0.01 0.01
30 C 81 0 4.7
31
Monthly Loading: 2,753 0.08 2,720 Diji.O6 2,561 0.05
12 Month Floatli total (in): 8 g1 0 0.00iw
8.88 8 71

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT NDAR-1
Page __4 of _4_
Did the application rates exceed the limits in Attachment B of your permit?
❑ Compliant ❑Non-Comptiarrt
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
R1 Compliant ❑tion-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
R) Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
121 Compliant ❑tion-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
El Compliant D onpilent
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and des Nbe th corrective
action(s) taken. Attach additional sheets if necessary
Operator In Responsible Charge (ORC) Certification
ORC: JAMES PROCTOR
Certification No.: 29132
Grade: WW_SI Phone Number: 910-259-1570
Has the ORC changed since the previous NDAR-17
❑ Yes p No
Permittes Certification
Permlttee:
Pender County Utilities
signing Official: Kenneth Keel
Signing official's Title: Director
Phone Number: 910-259-1570 Permit Exp.:
3/31/21
Signature / ( rr ( /
Date Signature
BY this signature, I certify that this report is awurrale and complete to the hest of my knowledge. i Date
certify, under penalty or law, that this document and ati attachments were prepared under my direction or supervialon In accordance
with a system designed to assure that all qualified pemmel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or Persons who manage the system, or those persona directty responsible for gathering the information, the
ard
information submitted is, to the best of my knowledge and befief, tore, accurate, and complete. I am aware that there are sign, he
Penalties for submitting false information, including the possibility of fines and imprisonment for icna that
violations,
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617