WQ0023261_Monitoring - 04-2022_20220526

DWR - NonDischarge Monitoring Report Submittal •4 ..
NORTH CAROLINA
Enrlr...1M Qua(ily
Monitoring Report Submittal
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Permit Number#* WQ0023261
Name of Facility:* Onslow Water and Sewer Authority-Swansboro WWTF
Month:* April Year:* 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR Swansboro NDMR&NDAR 2.41MB
April 2022.pdf
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2,NDMLR,GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* Sherry A Jones
Signature:
Date of submittal: 5/26/2022
This will be filled in automatically
Initial Review
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Reviewer: Gerald,Wanda

Is the project number correct?* WQ0023261
Is the monitoring report accepted?* Yes No
Regional Office* Wilmington
Accepted Date: 6/18/2022

FORM:NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page / of3
Permit No.: WQ0023261 Facility Name: Swansboro WWTF County: Onslow Month: April i Year: 2022
PPI: 001 Flow Measuring Point: 0 Influent ID Effluent El No flow generated I Parameter Monitoring Point: CI Influent 0 Effluent 0 Groundwater Lowering El Surface Water
Parameter Code --> 840 5005.0.'",'.':- 00076 <,;T00::-:-., 50060 --<.::0410-: 31616 i<*99019.-: 00625 .::,00-00.2_.; 00600 ;::00885-„:"- 00530 '..,--:701j1 00940 f'
..... ....., „ ..._. . ..
.,,, .,,.„ „.„:..„ .
Tri ,:. „:-;::.'s ', . ,,-'-'" '--,----:-."-;, .- - ,'
.> g 2,..-...-:,.,.,-....,. z. , .'.,:.-,- ,- 71 -'<sl:'<'. .<-•-:;,:--<, 2 -:',',<",4'--',:-',' .B' g :':::-,:í.-.:'':.- g ,-,z--,::--;',ef:- _ .60 0 ''.._,'K,I-0,: 1:34)
1 < ..1 o c ',5 s':-9.',r,-,i,,,:,-- .42 --:,,:':::,,-,o,:.,--,,-,. o •,-,5 P. ---;-,t-o.--':1- 6 It-- ..,,7::1;-,-,-,,, o -6 E.., -,'.--.-F-4.,:":.--:- o e. .„,,-,0,,,,o;,-.:'- o a-, -,,,0,-.0.,1, 0 --...-:,,,f..'•-,-,...,..
,.., (..) , r, o ,-..... :,..1....:1:,-,--,:. - .:,..,-,,,,,,:::-.*:.,... ,-- 0 0 ,... ›_.:511.2 55''f:-::- Li- o 5.' -:E,„--..;- 1" «-tt :-:::,:***-i--:',.:,', I- :=1 ',,,V-7.7.4-',., 1"" 0,(0 ''1-7'.:11':(0'', •C ;:'.'''','-: .,,,'-'''.'.
CI
0 „ „
24-hr hrs ':',.'..:::„GFC(.--,-, NTU „l'...1:----$0,---;..',.:- n10/1- -''""'I'il.giL'<::: #/100 mL i"-'::---IIIWL;-::, mg/L ),---T-:.0)41:L--- mg/L :"-"-;r0-giU,--,: mg/L -.--:,-intgiL,','-l-. mg/L
1 13:45 0.75 --'3,60,¡803.s.- 4.22 -7-.f 7...'n'-';'--!' 0.05
2 0 -.':34.2:',401,,'"---- 4.22 ;',;'- 7.3$:;:::',: 0 :::,'-'12:",l--':'-"j"--<- :::--„1-1--':'-'..:".-::_:- -1,..:<':-.-::3.-1----.'-;:':-.
,
3 0 :,-3,44,379'...-: 7.41 1.----.7.11---- :„ 0.01
4 06:30 5.25 ,-'320,2133:", 7.41 '.?',11:,7;37,,,, .. 0.04 7::„..',,6:1--.,.,-.-.1.-, <1.00 ,-,''50.500,-- <3.00 '';',-2..6:,5.:'s-r," 26.8 ---:',-',''3,6.21'.--,. 7.4
5 07:00 3.5 35848."4,:; 6.42 ,'1'-,--:'',1»-''-,..: 0.01 ..z,- -:'119,'„l-<--J. 4.1 ' - 0;100<:: <3.00 ,'".''',".1'7.8,-.;,,,,-' 27.9 ‹,,,- ,3..,52, ,--,' 8.1
6 07:00 3 -",'1.51.,559,."'' 6.39 ,,k--7.87"..:-..';" 0.02 -,,.,,,,,,-',--::-.:::'..,,-, - ,',,..-,--1,..---,,"..,:,,',,,
7 07:00 9.5 ","'355,,774:: 6.39 :5'-'::1'.34-51.'::::: 0.06
8 07:00 3.5 -,:‹329;572,>":2. 4.32 ,. 1:,-:7,,412,,,,:, 0.06
, .
9 0 -,,-.350,,655; 5.5 -:',".''Yi7,32--"-.;,.", 0.06 '-',',-.1:',::::--,,:,;'... ,, , -
10 0 '["1-20.;254..[--, 3.72 -",-,;.;,--,7::44,-.,:-'.: 0.05
.
11 07:00 2 ':<3.50.,511,::::- 2.86 :1"-:---It'.41.',-; 0.05 40::::::-.: <1.00 ,-,".,--1000:»i <3.00 , 26.8 26.8 26.8 -'-',-,'3...e2-,'-,-' 2.7
. ,
12 07:00 4 ,..",34.1,;M,, 2.18 ," ...7.36,"- -.1 0.03 '..:.,-,,,2.4-',".., <1.00 ,,,--',}0.,..5.0,0- <3.00 -.,,,1J.--28",,..,---,,- 28.1 ;'--,:-Z.3.55..„ , <2.50
, , .- .
13 06:45 0.5 ;"›,,"004,564-,:,,,- 2.19 *,,-,,7,16:,,„',"--... 0.02
14 06:45 1.75 328¡351,.: 2.94 7.32',:,-,; 0.04 15 0 :'140;16.6,:s 2.49 7,28::::::-.. 0.05
16 0 -;:050;030:,: 3.59 -7,2',.---„-Y--.., 0.05
17 0 :::3,02,135l--. 2.43 ;'-'-'-'-'-T37.,:',:;',-,' 0.06 18 06:30 2.75 ..382;110;-. 2.24 V--,7.3.3-:::::-.' 0.03 ' -6--::::-,,,. 2 -'-',;.<0,500'.,: <3.00 '.-'---3 l':,7----- 31.8 -'.;-,:',-4:62:1-'::;':. <2.50
19 07:00 9 -'--,<, :40;413,3':, 1.41 :',',-1-,,729::--,,,', 0.02
20 07:00 1.25 '-'-',3,55,-;256„- 2.73 7.34,"'-,---,› 0.04 ,›',-.<2.0,,,',', <1.00 ,"'<0,500""" <3.00 -.:1-,..2941--,'.,,,, 29.2 '-,';"..3.0,'.--, <2.50
21 07:00 5.5 '-'-',"1516,52:'-; 3.7 :,:.--r-',7,32:7,,-, 0.06 22 07:15 4.75 ''.,329,1427- 3.48 -:,-;f-:-7.-,2:::::-:: 0.02 ,,,";;':','',':',•::','5',''„ ';',1':1',.'„''.''-:: .„,, ,.„,,r,„,
23 21:30 2 ",---323,560',', 8.04 -':',.-„7.37,; ',, 0.03 l."''':,:',.:-,".,>., .,"?..,'".'„,;,,,,,,:-
. , .
24 0 .2357-869-.1 8.64 ':-::7,47:-,-; 0.01
25 07:00 3.75 '331,856-,s. 8.53 ?7.54:-,.:. 0.03 -,',,,,-.-2,'-'.-.,, 1 ' <0.5,00.. <3.00 ',,',,:,263,-,"‹, 27.5 ".,.."",3.91::::,; <2.50
26 06:30 2.5 -,i,323,51.1.-,- 2.32 ":',':734,--":".. 0 -.,•,-:<2.00-',, <1.00 '','<0,500--, <3.00 ,'303'>:';' 31 -'",4.84-¿;,:. <2.50 '-',c-",'
27 07:15 2.75 ",-.32,1,--;151:. 2.28 ,1-'7,35.--,,,l' 0 . .
28 07:15 4.75 '-389,370: 1.32 ."-,-"''7.23:-..--'s 0.09 29 07:00 0.5 -,-340,503''. 1.75 7.23:--: 0.02
30 0 ',-i,321 107' 1.82 ' 7.26:'_.,-, 0.04
. . . .
31
,
Average: .„--340,976-- 4.10 -"---', '':----,---,-'-' 0.04 ..3.40,.,--- 1.30 "..;' 0,00.--',- 0.00 .,:28:31',- 28.64 "'-'-'3:90'.. , 2.28
Daily Maximum: '-382,71.1 8.64 :'->,7-.54',- 0.09 ,8.0.0" , 4.10 .0.50-,' 3.00 - 31--,70„ 31.80 ,",4.62,.,- 8.10
Daily Minimum: --302,135 " 1.32 '1",'7:20:-' 0.00 :.'.2:00:-:- 1.00 ','-,:0,:.50.' ... 3.00 --21;30.-: 26.80 l':-'3.52-T.;' 2.50 "-
Sampling Type: Recorder Recorder ,.,.Grab:: : Grab :COniposite Grab Composite Composite Composite Composite Composite Composite Composite Composite
Monthly Avg.Limit: - 600;000 - _ , , 10 . ,
14 4
Daily Limit: " :.- ' 10 '. 6-9. : ', '15- ' 25 '--6 ,'
Sample Frequency: Continuous Continuous -5 x week 5 x week ' 2 x week' 2 x week 2 x week 2 x week 2 xiiveek 2 x week -2 x week. 2 x week ,3i<year 3 x year

FORM:NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page of 3
Permit No.: WQ0023261 Facility Name: Swansboro WWTF County: Onslow Month: April Year: 2022
PPI: 002 Flow Measuring Point: ❑Influent ❑Effluent 0 No flow generated Parameter Monitoring Point: O Influent ❑Effluent ❑Groundwater Lowering p Surface Water
Parameter Code --► ,50080''' 31616 70300 00400 =_0p680. 00940 " 0061,0: 00620 0066�
` w Ém E a, . ,.
ó —'"": o S,
Ó U 1 Ó tf u. o F-, " }.", !m; . �, .E.: . Z "" ._:�
oo O _ V Gi V *>� G ,
24-hr hrs `;CPD #1100 mL 'mglL °i. su ,mgjL.-� mg1L mg1L'�, mg1L m g " :'
1 13:45 0.75
2 0 .,
3 0
4 06:30 5.25 -, _ - r
5 07:00 3.5 ,
6 07:00 3 ..>.
7 07:00 6.75
8 07:00 3.5 ,_
9 0 "
10 0
11 07:00 2
12 07:00 4 z.
13 06:45 0.5 k- ,':;` .
14 06:45 1.75
15 0 � .:,_
16 0 ,
17 0 ,
18 06:30 2.75 '"" , .
19 07:00 9 -�
20 07:00 1.25
21 07:00 5.5 t„
22 07:15 4.75 .., ,
23 21:30 2
24 0 25 07:00 4.25
26 06:30 3.5 -, '.
27 07:15 2.75
28 07:15
29
30
31
Average: #DIY101: - . " _
Daily Maximum: 0"�- _.,
Daily Minimum: _ 0- . . . ,
Sampling Type: - Grab "Grab_ > Grab -":-Grab"; Grab ' Grab " Grab Grab �-.
Monthly Avg.Limit: . "
Daily Limit: "
Sample Frequency: 3 x Year '3 xYear 3 x Year '3.x Year. 3 x Year Ix Year 3 x Year . 3)(Year '

FORM: NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page 3 of 3
Sampling Person(s) Certified Laboratories
Name: Mark Young, Zachary Dail Name: Onwasa Laboratory Cert#539
Name: Tina Norman Name: Envirochem Cert#94
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 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 necessary.
Operator in Responsible Charge(ORC)Certification Permittee Certification
ORC: Mark Young Permittee: Onslow Water and Sewer Authority
Certification No.: WW4: 1001105 Signing Official: Dave Mohr
Grade: 4 Phone Number: 910-545-6877 Signing Official's Title: Chief Operations Officer
Has the ORC changed since the previous NDMR? ❑Yes E No Phone Number: 910-937-7521 Permit Expiration: 10/31/2026
k —14/Z - €9.-9-A3)0.13
Yl'
gnature Date Signature Date
By this signature,I certify that this report is accurrate and complete to the best of my knowledge. 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 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 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

FORM:NDAR-2 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-2) Page / of Z
Permit No.: WQ0023261 I Facility Name: Swansboro WWTF I County: Onslow Month: April Year: 2022
Did infiltration occur at �� Site.Nam�; 1. Site Name: 2A ,,S1te�larrte:�� , �-Z,B„ ', Site Name: 3
.. -
this facility? � �� '- �
y �: Ara�(acre�)z �;�5 �_�, � Area(acres): 2.88 �lrea(a�réS� � 3�8�;= Area(acres): 3.48
❑YES ❑NO -,;: Ralik(OPo�2�� 044 -; Rate(GPDfft2): 0.9044 e(�
��Rate �i J04�4 .. r Rate(GPD/ft2): 0.9044
_. ,. .f};9
Weather Freeboard r^�� 9it�,lrifiltra�ed? Y
� �S��- 1W-'ONO�� YES ❑NO Site Infiltrated? O tif.�IofiMtrated7 .,0 YES � t� (]Q �. Site Infiltrated? YEs ❑No
d � 53 . ' .c, �,
° � � d � S a � .� � íi �.M'�: ® a m rn º ° ty ty t t'c : a v
� Ú L° � � � � v �� ar . 4+ a,�� �Q,,; E m m .... -+, e ó O E áx, ed.� ,�.� O É y m r �, c c pO
p .. á L° � º�: - m � � Q � � � � w :� � c:�° _ '
a+ cs o ñ >, a ;�p�� c � ta a+ e ia c . « m �a e
I cPa i=+� , º �. óº i= w oo m tilt': �.� , Gto óc i= E ao �i .-
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R m ` N � N r- :.,`!.Q . �- ` J' 4.,m.� � Q C J LL m ..,�`, �"y RI.. ' � C J tL m
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� � Q. :. ... .. �': ..-.. " � *`� .;
°F in ft ft gal I': ..min=_� .�rRt?lftz #'_ ;„ gal min GPD/ft2 ft ,gal l rr"i�ln ><GPDIft2 ::.fk -; gal min GPD/ft2 ft
1 C 62 0 1.3 �>118,353;��� 1449_�°'-',`0 54,; „ 68,203 1440 0.54 ,' 92,020'; ,'"1440 ��;',0,54 � 82,277 1440 0.54
2 C 43 0 1.3 ;.`1123Q8�. 144U:�-'"=0:5�_'' . 64,714 1440 0.52 87,-312 .k.1440 �,_(1152 78,067 1440 0.51
3 C 49 0 1.3 .,I:12i956�' 1440;;' 1.0;52''';'i.::: ::!.:-':','-''''j:: 65,088 1440 0.52 '`37,917s :-1440 `9:52, . 78,518 , 1440 0.52
4 C 46 0 1.3 `107677:,,- 1a44{I>� fl.49é � 62,045 1440 0.49 �T.Sz-,312 ' �'.14#0 D,52 . :� 74,849 1440 0.49
5 R 58 0.73 1.3 <,117,583:°.,1A4.0:, '-: {i.54':::7,.,920 �; 67,753 1440 0.54 7.00 -..91;413'-: -,1440 0:54 �-7,43ü,"1 81,734 1440 0.54 11.00
'� � � � ,:_0,.�8 ,;�;'�, ..�-� 86,995 1440 0.57
6 R 63 0.22 1.3 ��125181. 1440 � Itfi7:.� 72,115 1440 0.57 g7�8 �_��1�0
7 CL 64 0 1.3 ;,��1931�,. 144�,'- 0.55�='»„ , � � ;- 68,753 1440 0.55 92;702. ‘'�Y�44ti: .;;0:55 '�, � 82,940 1440 0.55
8 C 52 0 1.3 ';,198,1á2f; 1;440::. ..-0.;50.' ": ';5 62,308 1440 0.50 �84,066 _.'1440:,, i...4:Ta0 "', .:"`�..'- 75,165 1440 0.50
9 CL 52 0 1.3 115,015.: 1440<�. , 0:03,.` 66,274 1440 0.53 $9,41� ,i-i4#tl: °;0.53`= �;; �:.."': 79,950 1440 0.53
10 C 41 0 1.4 ,,905;046:; '1440 ;-. ;0.4�6'- , � -60,528 1440 0.48 ��61;6� ;:�44p. �<�48 � 73,018 1440 0.48
11 C 48 0 1.4 �.114,991.=-� 1440�-` °��0.53 , , 66,260 1440 0.53 69498 � "..,<1440 r0;63 79,932 1440 0.53
12 CL 63 0 1.5 ;412,103, ,`..,,,,--";„1440 1- :'051:- � '8.80 ;, 64,596 1440 0.51 6.80 ,87,153 -",i446<, '',"0:52.""` : ?„80.,',. 77,925 1440 0.51 10.40
13 C 63 0 1.5 '._99.,.$97:.. `144(1;<- � 0.46`, ,' 57,563 1440 0.46 �'i�7,664.� �';,1440,' ,,.0,46 '" ,��.,'-:.,-„3,„ --.',; 69,441 1440 0.46
.
14 CL 66 0 1,5 =;,1i17,7411; 1440:sr.' '-0.49"- : ,: -<-`"; 62,060 1440 0.49 H86,731;� : -14�30.:--� 4.6i}_:'; , _ , : 74,866 1440 0.49
15 PC 60 0 1.5 :'.101,741-' . 1440°� �, ...0.47- � � , 58,625 1440 0.47 � 7:9,097 ��,1440��' ';0�}7.�`�..-:;. `.',.:��:. 70,722 1440 0.47
18 R 57 0.04 1.5 ,;414,81.1.`-: ,144f3'-%:.`�U:�53� 66,157 1440 0.53 89,259:, "�1!I� . 4;. 53 :. ",::-. -:�. 79,808 1440 0.53
17 R 64 0.08 1.5 �':99300-> `1:44.6��'. 0.46;:. . Q44'. 57,104 1440 0.46 ' 77, , �,�1440 ' r�:46�,. :.. ,".::' 68,887 1440 0.45
18 R 60 1.29 1.5 ,�126,629.:�,.�144{i> '.;:0:5$ �� , �, :�-'�; 72,332 1440 0.58 97,091:". '"-1440-.' 'í0581,z:, ' 87,258 1440 0.58
19 PC 45 0 1.5 "i13;846 ',1440 ' . 0.52`= '1 ';:'.>1,, 65,485 1440 - 0.52 88,353','�1440< '.�0;52'�.,'�, �����- 78,998 1440 0.52
20 C 44 0 1.5 ,116;524`-'.,1440.,�. � ,0>54, � .:,.�::�,`_ 67,143 1440 0.54 90,59Ó'.�;�1440�:�0�54 ' .'., . �� 80,998 1440 0.53
21 C 49 0 1.6 �•,117;638:� --1440'`�::0.54��" �9.00.: 67,785 1440 0.54 6.60 �:91,456: '��,1440� :��0.54�:� ;'8.00.;� 81,773 1440 � 0.54 11.00
22 C 53 0 1.7 ���107,972' �1.440'�` 0;5t?= ," : . 62,215 , 1440 0.50 ''83;941. a440�� :�..0.50'.� �. _� 75,053 1440 0.50
23 CL 58 0 2.2 �106,12$ :1440":'' 0.49� „-, , 61,153 1440 0.49 :,82,5f18 :7<1440�� ; ;43-49. �' „ _ 73,772 1440 0.49
24' C 63 0 2.3 �117,381�> 1440"' , 0.54� � ' ' �I 67,637 1440 0.54 � 91,2571..��1440', " `?�.54'= ' � � 81,594 1440 0.54
25 C 61 0 1.7 108;849. 1440'7 0:50,, ' '' < 62,721 1440 0.50 ,.84,623 '7...1440, ;:�0.50° 75,663 1440 0.50
26 R 62 0.8 1.8 .,106,131 , .;1440 ` 0:49 , :8a60 '- 61,155 1440 0.49 6.60 , _82,511: _1440:" ' 0.49 ' `>7,60_�� 73,774 1440 0.49 10.60
27 C 57 0 1.9 -105;350.' ':1440.=' `-0,48 '. , ''�l . 60,705 1440 0.48 81,903 " '..;1440° °:0.48 "' -.. ' 73,231 1440 0.48
28 C 50 0 2 121,1 v3� '1440�:..,,..0.56 69,811 1440 0.56 94,189 . 1440 0:56 -' „ 84,216 1440 0.56
29 C 56 0 2 111,685' 1440 6.51 _ : 64,355 1440 0.51 86,828 1440: 0.51 . . ' 77,635 1440 0.51
30 R 59 0.04 2 105,3E3 1440 , 0.48' . ' �." 60,689 1440 0.48 81,882 � ""1440--> 0:48' ' '. s 73,212 1440 0.48
31 . . . " �
Monthlv Loadin� (GPD/ft ��.��1 ���, �z���,� � �;,������;f��,,��- �` "�� 0.51 J ' ��,� �,� ,�` 0.51 �� ��fi� .E 0.52 a:�� �,�. :h���,..��i 0.51 r
� 2 .: . _� � : ���t' a,� � S-. G� Y �Y�..�. �� � : ;:� .- ✓',�r .�,�r°�+ 3a'r !"r �
Year to Date Loadin� GPD/ft . _.. „ . z,.,. 1.96 „ . ... .sk���.�Ñ��9��,r.`.w,,..., 1.96 �������,� fi ,s,. .,,.,, 1.97 � wyu �r � S,nx,,:� T,fs� , 1.96101,1141311
... ,. , , , . . , . . _ _ ._ . ... ...:`'.� J ���4��:J��dr'

FORM:NDAR-2 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-2) Page of
Did the application rates exceed the limits in Attachment B of your permit? O Compliant El Non-Compliant
If not a basin, were the sites kept free of vegetation and raked? O Compliant ❑Non-Compliant
If not a basin, were there any instances of effluent ponding in or runoff from the sites? I]Compliant ❑Non-Compliant
If a basin, were there any instances of breakout from the berms? p Compliant ❑Non-Compliant
Was the onsite automatically activated standby power source tested and operational? 2 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 necessary.
Operator in Responsible Charge(ORC)Certification Permittee Certification
ORC: Mark Young Permitter: Onslow Water and Sewer Authority
Certification No.: WW4:1001105 Signing Official: Dave Mohr
Grade: 4 Phone Number: 910-545-6877 Signing Official's Title: Chief Operations Officer
Has the ORC changed since the previous NDAR-2? ❑Yes p No Phone Number: 910-937-7521 Permit Exp.: 10/31/26
gA ht:1-
Z.3/00Z¿
t
i natur ate Signature Date
By this signature,I certify that t report is accurrate and complete to the best of my knowledge. 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 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 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