WQ0013398_Monitoring - 10-2020_20201208

FORM: NDAR-1 4-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No WQ00'13398
Facility Narr1e; Sandpiper Bay WVVTF
County: Brunswick
Month: Octobef
Year: 2020
Did irrigation occur
at this facility?
[] YEP
Field Name:
Area (acres):
0-FW
Field Name:
g-GR
Field Name:
O-PER
5.5
1
51
Field game:
1 -RGH
21
1
51
❑ YES ❑ NO
of E C
T� 3 c
�� E �v
p M K p
m =
J J
in in
23
Area (acres):
2.5
Area (a�;res):
Area (acres):
Cover C,
'rop:
(in):
'dY.t1.4USlGGSRYYLWNA'SITYFkLtI.
Annual Date (in);
Cover C-rop:
Hourly Ratd (01),,
:,.
Annual Ra% (In):
1
51
❑ YES ❑ NO
rn > >,°�
a,c �5
�� E �'v
m x O to
J Tt J
Cover prop:
Cover Crop:
:riu^•u........ ...0 y..,
51
�� J. ( (in):
..., ..
Annual katO (in):
Field Irrigated?
m� o
E2
a rn
0 CLo
Q F• =
Hourly Rat# ( njC
Annual Rate (in):
Field Irrigated?
Weather
Freeboard
Field Irrigated?
0 YES ❑ NO
Field Irrigated?
❑ YES
rn
>c
m
O
J
in
0 NO
>
p
v
o
m
-
v
a
E
2
a
d
d
o,
o
m °'
wa
am
`-'
> 0
4�
my
Ew
n
o a
� Q
o
m�
E _�
1=
Min
rn
a�
m
p
J
E m
>
�`E
o'v
is O A
= J
m M
Em
a
o C.
> Q
'a
a;
F 1 rn
E
shin
> >.°1
t�
K'o m
o
--�
my
E°'
a
0 0
Q
a
�
m
iti rn
=
°F
in
ft
ft
gal
in
in
9a1
in
in
gal
rnin
in
gal
min
1
65
65
0.10
0.10
0.10
0.10
10,000
10
0.15
0.15
0.15
0.15
0.15
2
3
10,000
10
0.15
4
5
PC
72
3.4
2.3
10,000
10
0.15
6
65,000
0.10
7
C
83
3.6
2.3
10,000
10
0.15
8
10
9
10,000
0.15
0.15
10
0.15
11
CL
94
3.9
2.6
2.1
10,000
10
10
0.15
12
CL
82
3.1
2.1
13
10,000
0.15
0.15
14
65,000
0.10
0.15
0.15
15
CL
86
3.4
2.1
10,000
10
0.15
16
17
10,000
10
0.15
18
C
79
3.6
2.1
10
19
10,000
0.15
0.15
0.15
20
21
C
80
3.7
2.2
10,000
10
0.15
22
10
23
65
10,000
0.15
0.15
24
C
94
3.8
2.2
65,000
0.10
0.15
25
CL
74
3.7
2.2
10,000
10
0.15
26
C
84
3.8
2.2
55
0.15
0.15
27
10,000
10
0.15
28
C
87
3.8
2.2
0.00
50
29
10,000
10
0.15
30
C
68
3.8
2.2
65,000
0.10
31
0
Monthly
FloatingTotal
Loading:
(in):
260,000
0.42
6.04
150,000
2_21
23.66
0
0.00
0.14
12
Month

FORM: NDAR-1 q8-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) page of
Did the application rates egceed the limits in Attachment B of your permit'#
❑ Compliant ❑ Non-Corrrpliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sits? ❑ Compliant ❑ Non -Compliant
Was a sA41419 vegetative cover maintained or► all SILOS as specified In your permit? 21 Compliant q NW%ripliant
Were all setbacks listed in your permit maintained for every application to each perrnitted site? El Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance With the specified freeboard heights In your permit? Q Compliant ❑ Non -Compliant
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 describe the corrective
action(s) taken. Attach additional sheets if necessarv.
IOperator in Responsible Charge (ORC) Certification II Permittee Certification I
ORC: Wilbur Allen Williams
Certification No.: 15664
Grade: 81.1 Phone Number: [phone]
Has the OFtC changed since the previous NDAR-1 i ❑ yes ❑ No
Signature Date
By this signature. I certify that this Wort is accurrate and complete to the best of my knowedge.
Permi$ee: _
timothy P. — ilma
Signing Official:
Signing Official's Title: General Manager
Phone Number: [phone]
Permit Exp.:
113I/Z,
5/:31y1'4
Signature Date
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 §ssure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or Persons who manage the system, or those persons directly responsible fbr 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 subrnitting false information, including the possibility of fines and imprisonmeht for knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Dail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 f18-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of __
Permit NO.:
Facility Nan1e; Sandpiper Bay WVVTF
County: Brunswickt7.82
Octobef
Year; 2020
Did irrigation occur
at this facility
Field Name:
E1-TEE
28
51
[I YES N0
Field Name:
P-1
Field Name:
Field Name:
P-3
Area (acres);
coverCrop:
j-JQt,j jy (in):
Annual Rate (in):
Area (acres):
4.59
Area (acres);
Cover prop;Cover
Annual Rath (in):
Area (aFreS):
Crop:
1.16
Cover (%rop:
51
❑ YES ❑ NO
Hourly Ratd 01*
Annual Rate (in):
1
51
❑ YES 0 N0
rn E �, °'
�, c E E
a E= 'v
p ra x 0 0
J _j
in in
Hourly Rat
Annual Rate ("in );:
1YES
�!
51
❑ YE° No
of
c ` c
x
Q J = J
in in
Weather
Freeboard
Field Irrigated?
Field Irrigated?
Field lrri dted?
g
Field Irrigated?
E m
O Q
Q
gal
-o
y
H= Qf
Fein
co
p
0
0
U
r
N
.'�
L°
Q
G
d
o
:°
a
a
°'
m
�0
°' m
�' m
.g
> O
M
M
m
E d
n
o a
Q
W
m ::
E�
i= •i:
=
c
G
m
a 0
J
E rn
L c
E `o
x 0 p
= J
m z7
E m
o
0 0.
Q
v
;;
H, .T
:
v a
E ,m
z
o a
� Q
01
co
Is •�
=
rn
-' c
m `°
0 p
J
c
E v
K O R
= J
°F
in
ft
ft
gal
nim
in
in
gal
ruin
gal
rein
in
in
1
0.06
0.06
0.06
0.06
0.06
0.06
0.06
2
45,000
A5
A5
0.06
3
4
5
PC
72
3.4
2.3
45,000
0.06
6
7
C
83
3.6
2.3
8
45
A5
9
10
45,000
0.06
11
CL
94
3.9
2.6
2.1
12
CL
82
3.1
2.1
13
14
15
CL
86
3.4
2.1
45,000
0.06
16
17
18
C
79
3.6
2.1
45,000
A5
0.06
19
20
21
C
80
3.7
2.2
45,000
A5
0,06
22
23
24
C
95
3.8
2.2
25
CL
74
3.7
2.2
26
C
84
3.8
2.2
45,000
A5
A5
0.06
27
28
C
67
3.8
2.2
0.06
29
30
C
68
3.8
2.2
45,000
0.06
31
Month
Monthly
Floatin
Loading:
Total
(in):
360,000
f2.95
0
0.06
0
MMMM_
0.00
j
0
0.00
12

FORM: NDAR-1 Q8_11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of__
Did the opplication rates eXceed the limits in Attachmerit B of your permit?
❑ Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponaing in or runoff frgm the sits?
❑ Compliant
❑ Non -Compliant
Was a spitable vegetative cover maintained on all sites as specified in Your permit?
0 Compliant
Q Non -Compliant
Were all astbacks listed in y6Ur pripit maintalmad f6r every appileatj6p td each permi'tt@d sito?
D Compliant
U Non -Compliant
Were all freeboar(is maintained in accordance With the (specified freeboard heights in your permit?
Q Compliant
❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) tpe facility was not in compliance. Provide in your explanPtion the date(s) of
the non-compliance and
describe the corrective
actiop(s) taken. Attsch additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
ORC: Wilbur Allen Williams
Certification No.: 15664
Grade: Y1 Phone Number: [phone]
Has the OFtC changed since the previous NDAR-1 a ❑ Yes F No
Signature Date
By this signature, I certify that this heport is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:
Timothy P. 1 ilma
Signing Official:
signing Official's Title: General Manager
Phone Number: [phone]
Permit Exp.
f/'311L,i
5/V4
V)l� 0 / LJ r l' 2-12, 6
Signature Date
I certify, under penalty of Iqw, that this document and all attachments were prepared under my dire"ion or supervislolr in accordance
with a system designed to fissure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible fbr gathering the Information, the
information submitted Is, to the best of my knowledge and belief, true, accurate, and complete. I wn aware that there are significant
penalties for subrnitting false information, Including the possibility of fines and Imprisonmeht for knowing violations.
Mail Origihal and Two Copies to:
Divisibn of Water Quality
Information Proces0ing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 (18.11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit NO.: W000'13398
Facility Narr1Q: Sandpiper Bay WVVTF
County: Brunswick
Month: Octobef
Year, 2020
Did irrigation
at
❑ vE�
this
occur
facility?
( O
Freeboard
Field
Name:
P-4
7.23
51
Field
Name:
(acres):
(irop;
Rate (in):
Rate (in):
P-5
1
❑ N0
c
x°
°
in
Field
Name:
(acres):
P-6
Field
Name:
(acres):
Crop:
Ratd (�Y)�i
Rata (in):
P_7
6.21
51
o
❑ YE_
m 'm
O J
in
Area
(acres):
Area
5.39
Area
2.6
61
Area
Cover(;
rop:
(in):
Rate (in):
yin
Cover
Hourly
Annual
Cover
h
prop:
(in):
RW (in):
Cover
Hourly
Annual
1
Annual
)
❑ NO
E
X° MO
J
in
[k.10fiV
Annual
�..
❑ No
>°
x° N
a:JE
51
T
Weather
Field Irrigjted?
❑ YES
Field Irrigated?
❑ YES
Field Irrigt�
ted?
❑ YES
Field Irrigated?
gated?
❑ NO
r
CL
0)
°
CL
gg
,
°
°
d
aE
CL
wj
d
E
c
A
0
in
°>
E ai
°
o °.
> Q
y, y
vcc
Eo
x O
Z J
OF
in
ft
ft
gal
in
gal
rein
in
gal
ruin
in
gal
Wn
in
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
0
0.00
0
0.00
Monthly Loading:
Floating Total
0
0.00
0
0.00
12
Month
(in):

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the Application rates exceed the limits in A tachmerit B of your permiYt Q Compliant ❑ Non -Compliant
Were adequate measures taken to PPevent effluent ponging in or runoff from the sits? ❑� Compliant ❑ Non -Compliant
Was a slli,110010 Vegetative corer M,AItitained orl %lii $015 as specified in your permit? El Compliant Cq P'IFIl"Fgfftpriant
Were all setbacks listed in your permit maintained for every application to each perrriitted site? 0 Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance With the specified freeboarO heights in your permit? ❑� Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) tpe facility was not in compliance. Provide in your explanation the date(s) of the non-compliance antl describe the corrective
actions) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
ORC: Wilbur Allen Williams
Certification No.: 15664
Grade: $1 Phone Number: [phone]
Has the ORC changed since the previous NDAR-1 T ❑ Yes ❑ No
Signature Date
By this signature. I certify that this teporl is accurrate and complete to the best of my knowledge.
Permittee Certification
Permihee: _
timothy P. — ilma
Signing Official:
Signing official's Title: General Manager
Phone Number: [phone]
Permit Exp.
o%4i?
5 /14
_—1 �` , 12 k
Signature Date
I certify, under penalty of I§w that this document and all attachments were prepared under my direttlon or supervisiop In accordance
with a system designed to §ssure that all qualified personnel property gathered and evaluated the information submitted. Based on my
inquiry of the person or Persons who manage the system, or those persons directly responsible fyr 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 subrnitting false information, Including the possibility of fines and impdsonmeht for knowing violations.
Mail OrigiPal and Two Copies to:
Division of Water Quality
Information Proces4ing Unit
1617 Dail Service Center
Raleigh, North Carolina 27699-1617

FORM: woAR-1W8_1I NON -DISCHARGE APPLICATION REPORT (NDAR4) Page —m—___
V
County: Brunswick
Month:
Year:
Did irrigation
El YE-6
occur
NO
Field
Name:
P-8
51
Field
Name:
('-rop:
P-9
Field
Name:
P-DR
445
51
Field
Name:
7
Crop:
Crop.
Rat? (in):
RatP (in):
S-1
NO
in
Cover
Annual
(,rop:
(in):
Rate (in):
NO
in
Cover
Cover
Annual
trop:
(in):
RaW (in):
Cover
Cover
Hourly
Annual
Hourly
Annual
Field lrrig4ted?
Rate
Ratfi (in):
I
51
El YES
in
- [21 NO
in
1
51
Waather
Freeboard
Field Irrig.1ted?
YES
NO
Field lrrig�ted?
YES
Field Irrigated?
E:1 YH,
to
rnin
in
ft
ft
gal
n1in
in
gal
rnin
in
gal
in
gal
Iiiin
in
r'F
10
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
0
0.00
0
0
L
0400
Monthly Loading:
12
Month
Floatin Total (in):

FORM: NDAR-1 C18-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) page of__
Did the application rates exceed the limits in Attachment B of your permit'?
Were adequate measures taken to prevent effluent pontling in or runoff from the SOS?
Was a siuitabie vegetative over M41Ihtained ort , III SR06 as specif id ICI yOUr permit?
Were all setbacks listed in ,your permit maintained for every application to each permitted sit#?
Were all freeboartis maintained in accordance with the specified freeboard heights In your permit?
0 Compliant ❑ Non -Compliant
Compliant ❑ Non -Compliant
2] Compliant Q I'M'(° Apipliant
Q Compliant [] Non -Compliant
❑� Compliant ❑ Non -Compliant
If the facility is non-corripliant, please explain in the space below the reason(s) tpe facility was not in compliance. Provide in your explanption the date(s) of the non-compliance and describe the corrective
­*;t n(s) taken_ Atte. k „4Aiti —i sheets if nece...r„
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Wilbur Allen VVilliams Permittee:
Timothy P. 1 ilma
Certification No.: 15664 Signin8 Official:
Grade: g1 Phone Number: [phone] Signing Officials Title: General Manager
Has the 09C changed since the previous NDAR-1i ❑ Yes M No Phone Number: [phone] Permit Exp.: 14
Signature Date Signature Date
By this signature, I certify that this teport is accurrate and complete to the best of my knowledge. I certify, under penalty of l§w, that this document and all attachments were prepared under my direction or supervisiop in accordance
with a s,Ptem designed to 9ssure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or F ersons who manage the system, or those persons directly responsible fbr 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 subrnitting false information, including the possibility of fines and imphsonmeht for knowing violations.
Mail Origihal and Two Copies to:
Divisibn of Water Quality
Information Procesoing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) page _ of _
PermitNO.: W000'13398
Facility Naryie: Sandpiper Bay WVVTF
County: Brunswick
Month: Octobef
Year: 2020
Did irrigation
at
El YE5
this
occur
facility?
NO
Field
Name:
S-2
1.82
51
E] YES
Field
Name:
Cadres):
Crop:
Pfl)�
(in):
S-3
Field
Name:
S-4
S-4
4,16
6:
-
51
Field
Name:
(arres):
Crop:
S-5
6,6
Area
(acres):
Area
4.1
Area
(acres);
r t"..
trop:
(in):
(in):
Area
Cover
Crop:
(in):
Rate (in):
Cover
Hourly Ratd
1
51
YESE
C
0
in
Cover
Covert
jj�j�#JV R.#lr'O
Annual RatO
Cover
Hourly Rate
Hourly Rato
Annual Ratb
Field Irrigated?
01-W
(in):
1
51
-
Annual
Annual Rat4
—
Weather
.2
.3
W
It
Freeboard
Field Irrigaited?
.9 m
tM
E
NO
E
3 r- S
E
P o 0
Field Irrigated?
NO
Field Irrigated?
]YES N 0
E
S
'a E
M
0 0 0
❑ YE6
M
0
0 NO
0
W
:E
M
4)
(U
I
CL
E
4)
1
0
(n
.0
CL M
.2
>, 'a
M
Ln
E RD
—
0 CL
> <
0
in
E .2
0 a
>
P.
E
X
M :r 0
0 10
E .0-
.2 "a
0 CL
>
Inin
E .2
0 CL
>
i7- Rm
Min
E
= >1
3
>( 0 M
M X 0
OF
in
ft
ft
gal
chin
in
gal
rnin
in
gal
in
in
gal
in
in
2
3
4
5
6
7
8
9
10
11
12
13
14
Is
0.0
0 0
16
17
18
19
20
21
22
23
24
0.00
E
E4i
25
26
27
28
0.00
29
30
311
Monthly Loading:
Floating Total
(in):
7
I .
0
0
000
.6
12
Month

FORM: NDAR-1 Ci8_11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of__
Did the Application rates exceed the limits in Attachment B of your permit? ❑ Compliant ❑ Non -Compliant
Were adequate measures tsken to prevent effluent ponging in or runoff from the sitips? Ej Compliant ❑ Non -Compliant
Was a sgitabis Vegetative cover MAilitained orl 411006 as specified in your permit? O Compliant q 4PP't59atpllant
Were all setbacks listed in your permit maintained for every application to each perrnitted site-? El Compliant ❑ NomCor)pliant
Were all freeboar(is maintained in accordance With the specified freeboard heights In your permit? ❑� Compliant ❑ Non -Compliant
If the facility is non-corripliant, please explain in the space below the reason(s) tpe facility was not in compliance. Provide in your explanation the date(s) of the non-compliance anti describe the corrective
artinn(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: VVilbur Allen Williams Permittee:
Timothy P. l ilma
Certification No.: 15664 Signing Official:
Grade: y1 Phone Number: [phone] Signing Official's Title; General Manager
Has the ORC changed since the previous NDAR-11 ❑ Yes 0 No Phone Number: [phone] Permit Exp.: 31/14
, A;7,
Signature J---Date Signature Date
By this signature, I certify that this teport is accurrate and complete to the best of my knowledge. I certify, under penalty of 19w, that this document and all attachments were prepared under my direbtion or supervisiolt in accordance
with a system designed to 9ssure that all qualified personnel property gathered and evaluated the information submitted. Based on my
inquiry of the person or Persons who manage the system, or those persons directly responsible fbr gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I ain aware that there are significant
penalties for subrnitling false informiation. including the possibility of fines and imprisonmeht for knowing violations.
Mail Origihal and Two Copies to:
Divisibn of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolinas 27699-1617

NON -DISCHARGE APPLICATION REPORT (NDAR-1)
�a�-
---
G:ORM: NDAR-1 08-11
County: Brunswick
Month:
Octobef
Year;
2020
Permit No•: WQ0013398
Facility Narrie:
Sandpiper Bay WWTF
Field Name: S-8
Field Name:
S-9
Field Neme:
S-6
Field Name:
S-7
1.71
Area (ar res):
4.83
Did irrigation occur
Area ac
( res):
2.23
Area (ad res):
4.34
Area (a(;reS);
at this facility's
Cover C,ro
Cover Crop:
ove hroP:
Cover Crop'.
1
��(Y (�� Ida (in):
)� �1r
Hourly Rata (in):
1
ff.,•11()i
Hourly Rate (in):..
_ Y
:. Hourly RatdT,�))��
- 5 ..
_
Annual Rath (in):
51
YE
❑ � f1
Annual Rate (in):
51
Annual Rat4 (m);
51(in):1
Annual i�atF
Field Irrigated?
❑ YE`,
0 NO
Freeboard
Field Irrigated?
YES ✓ No
❑
Field Irrigated?
✓ NO
❑ YES ❑
Field Irrig� ted? ❑ YES
NO
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at0i ►°i a
in
gal rhin
in in
gal inin
in
in
gal
r nin in in
°F in ft ft
gal chin in
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Monthly Loading:
0
0.00
0
0.00
0
0.00
0
12 Month Floatina Total (in):

FORM: NDAR-1 ()8-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the Ppplication rates eXceed the limits in A tachmerlt B of your permit?
Were adequate measures tpken to prevent effluent ponging in or runoff from the sites?
Was a suitablQ vegetative c9yor MAllitained orl 011 Sit0g. as specified in your permit?
Were all setbacks listed in .your permit maintained for every application to each permitted sitrx?
Were all freeboar(is maintained in accordance with the (specified freeboard heights in your POrmit?
❑� Compliant ❑ Non -Compliant
[] Compliant ❑ Non -Compliant
Compliant �i91i'gfnpliant
El Compliant ❑ Non -Compliant
0 Compliant ❑ Nan -Compliant
If the facility is non-corr+Pliant, please explain in the space below the reason(s) tpe facility was not in compliance. Provide in your explangtion the date(s) of the non-compliance anti describe the corrective
actioP(s) taken. Attach additional sheets if necessary.
operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: VVilbur Allen Williams
Permittee:
Timothy P. 1'ilma
Certification No.: 15664
Signing Official:
Grade: y1 Phone Number: [phone]
Signing Officials Title: General Manager
Has the ORC changed since the previous NDAR-17' El Yes 0 No
I
Phone Number: [phone] Permit Exp.: �31�
Signature
Date Signature Date
By this signature, I certify that this Feporl is accurate and complete to the best of my knoAledge
I certify, under penally of law that this document and all attachments were prepared under my dire .ion or supervisiop in accordance
with a system designed to assure that all qualified personnel property gathered and evaluated the information submitted. Based on my
inquiry of the person or frersons who manage the system, or those persons directly responsible fyr gathering the Information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I atn aware that there are significant
penalties for subrnitting false Information, including the possibility of fines and Imprisonmeht for knowing violations.
Mail Origihal and TWO Copies to:
Divisibn of Water Quality
Information Procest;ing Unit
1617 Mail Service Center
Raleigh, North Carolinas 27699-1617