WQ0000731_Monitoring - 05-2021_20210621

DMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page_ / of_Z
pp, ni No.. WQ0000731
Facility Name: Lake Toxaway Company
county: Transylvania
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sampling Person(s)
Certified Laboratories
Gary Norton
Name: Richard McCrary
Name: Enviromental Testing Solutions, Inc
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? L1QCompMnt ❑Non{omptiarM
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
Pennittee Certification
ORC: Gary Norton
Permittee: Lake Toxaway Company
certification No.: 21853
Signing Official: Scott McCall, by signatory authority
Grade: It Phone Number. 828-553-2990
Signing Official's Title: Broker, Lake ToxaWay Company
Has the ORC changed since the previous NDMR? ❑ Yes (] No
Phone Number. 828-966-4260 Permit Expiration: 10/31/2021
. A9
Signature Date
Signature Date
BY this signature. I certify that this report is accurale and complete to the best of my knowledge.
I cerilfy, under penally 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 evaluated the information
submflted. Based on my Inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submkted is, to the best of my knowledge and bellei, true, accurate, and complete. i am
aware that there are significant penalties for submitting false information, fmlrding the possibiify 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

1 07-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I of 4P
WQ0000731
Facility Name: Lake Toxaway Company
County: Transylvania
Month: May
Year: 2021
Fidirrigation
Field Name:
FW-1&9
Field Name:
W
F-2
Field Name:
T-3&8
Field Name:
W
F-3
occur
Area (acres):
2.3
Area (acres):
0.68
Area (acres):
0.97
Area (acres):
3.07
at this facility?
Cover Crop:Turf
9 rass
Cover Crop:
P�
Turf rass
9
Cover Crop:
P�
Turfgrass
9
Cover Crop:
P:
Turfgrass
9
21 YES ❑ N0
Hourly Rate (in):
0.22
Hourly Rate (in):
0.15
Hourly Rate (in):
0.21
Hourly Rate (in):
0.23
Annual Rate (in):
13.93
Annual Rate (in):
32
Annual Rate (in):
31.26
Annual Rate (in):
10.97
Weather
Freeboard
Field Irrigated?
YES ❑ No
Field Irrigated?
2 YES ❑ No
Field Irrigated?
(] YES ❑ No
Field Irrigated?
❑ YES ENO
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1
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2.5
5.5
2
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3
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4
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5.5
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6
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57
930
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460
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0.02
930
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0.04
8
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9
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101
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11
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13
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65
930
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0.01
460
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0.02
0.02
930
10
0.04
0.04
161
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2
17
CL
18
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5.5
19
C
68
930
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0.01
460
10
0.02
0.02
930
10
0.04
0.04
20
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21
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2.5
22
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52
930
10
0.01
0.01
460
10
0.02
0.02
930
10
0.04
0.04
23
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24
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5.5
26
C
3
27
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281
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2.5
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LP6
930
10
0.01
0.01
460
10
0.02
0.02
930
10
0.04
0.04
Monthly Loading:
4,650
0.07
2,300
0.12
4,650
0.18
0
0.00
12 Month Floating Total (in):
1.17
4.09
VY,1.61
1.75

� v
'cation rates exceed the limits in Attachment B of your permit? 0Compliant El Non -Compliant
adequate measures taken to prevent effluent ponding in or runoff from the sites? p Compliant ❑ Non -Compliant
PWapsa suitable vegetative cover maintained on all sites as specified in your permit? pcompliant [I Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? Elcompliant ❑Non-compriant
Were all freeboards maintained in accordance with the specified freeboard. heights in your permit? 21Compliant [I 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
ORC: Gary Norton
Certification No.: 29126
Grade: SI Phone Number: 828-553-2990
f Has the ORC changed since the previous NDAR-1? ElYes El No
' Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:
Lake Toxaway Company
Signing Official: Scott McCall, by signatory authority
Signing Official's Title: Broker, Lake Toxaway Company
Phone Number: 828-966-4260 Permit Exp.: Oct. 31, 2021
Signature Date
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
vith 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

07-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) PageOf G
W00000731
V
Facility Name: Lake Toxaway Company
County: Transylvania
Month: May
Year: 2021
Field Name:
FW-4
Field Name:
T-5
Field Name:
T-6
Field Name:
FW-6
gation occur
Area (acres):
1.06
Area (acres):
2.11
Area (acres):
0.68
Area (acres):
1.33
at this facility?
Cover Crop:
P�
Turfgrass
9
Cover P�
Turfgrass
9
Cover P�
Turfgrass
9
Cover P�
Turf rass
9
YES ❑ NO
Hourly Rate (in):
0.19
Hourly Rate (in):
0.24
Hourly Rate (in):
0.15
Hourly Rate (in):
0.23
Annual Rate (in):
26.25
Annual Rate (in):
16.55
Annual Rate (in):
32
Annual Rate (in):
24.99
Weather
Freeboard
Field Irrigated?
Q YES ❑ No
Field Irrigated?
❑� YES ❑ NO
Field Irrigated?
FZI YES ❑ NO
Field Irrigated?
0 YES ❑ NO
>.
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in
ft
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min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
C
2.5
5.5
2
C
3
R
1.6
4
R
1.25
5.5
5
C
6
C
3
7
PC
57
930
10
0.03
0.03
2,320
10
0.04
0.04
460
10
0.02
0.02
1,390
10
0.04
0.04
8
CL
9
CL
2
10
C
111
R
0.2
2.5
5.5
12
C
13
R
0.6
14
PC
15
PC
65
930
10
0.03
0.03
2,320
10
0.04
0.04
460
10
0.02
0.02
1,390
10
0.04
0.04
16
PC
2
171
CL
18
PC
5.5
19
C
68
1
930
10
0.03
0.03
2,320
10
0.04
0.04
460
10
0.02
0.02
1,390
10
0.04
0.04
20
PC
21
C
2.5
22
C
52
930
10
0.03
0.03
2,320
10
0.04
0.04
460
10
0.02
0.02
1,390
10
0.04
0.04
23
PC
24
R
0.1
25
PC
5.5
26
C
3
27
PC
281
R
0.2
5.5
29
CL
2.5
301
PC
64
930
10
0.03
0.03
2,320
10
0.04
0.04
460
10
0.02
0.02
1,390
10
0.04
0.04
311
C
Monthly Loading:
4,650
0.16
11,600
0.20
2,300
0.12
6,950
0.19
12 Month Floating Total (in):
1.51
1.88
1.14
1.78

'cation rates exceed the limits in Attachment B of your permit? p compliant ElNon-Compliant
adequate measures taken to prevent effluent ponding in or runoff from the sites? El Compliant ❑Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑p compliant [I Non -compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? pCompliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 21Compliant [I 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
[ORC: Gary Norton
Certification No.: 29126
Grade: SI Phone Number: 828-553-2990
I Has the ORC changed since the previous NDAR-1? Yes 0 No
J"ice
' Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:
Lake Toxaway Company
Signing Official: Scott McCall, by signatory authority
Signing Official's Title: Broker, Lake Toxaway Company
Phone Number: 828-966-4260 Permit Exp.: Oct. 31, 2021
``—�% (16 /Z i
Signature Date
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
vith a system designed to assure 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 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

,qi,,-
Q0110
- Toxaway Company.
.
—
.. irrigation occur
Field Name:
re 1 � Fri IT-M
Field Name:
this facility?
Area (acres):
Area (acres):
at
Cover Crop:
Cover Crop:
o ..
-.
-.
Hourly
-.
Annual Rate (in):
'w-.
W-MMMIMPTI Mill
Annual Rat, (in)-.
'..•. .Field
•. ••
Q •
Field Irrigated?
Fi- • Irrigated?.
•
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3 /4
ication rates exceed the limits in Attachment B of your permit? ❑✓ Compliant ❑Non -Compliant
pa'deqUate
measures taken to prevent effluent ponding in or runoff from the sites? - 0Compliant El Non -Compliant
suitable vegetative. cover maintained on all sites as specified in your permit? O compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 0Compliant El Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 21compliant El 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.
IOperator in Responsible Charge (ORC) Certification II Permittee Certification
ORC: Gary Norton Permittee: Lake Toxaway Company
Certification No.: 29126 Signing Official: Scott McCall, by signatory authority
Grade: SI Phone Number: 828-553-2990 Signing Official's Title: Broker, Lake Toxaway Company
Has the ORC changed since the previous NDAR-1? ❑ Yes M No Phone Number: 828-966-4260 Permit Exp.: Oct. 31, 2021
e`-�% �. , o Z / /Z/
' Signature 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
th 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 direly 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 Quality
.Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

WQ0000731
Facility Name: Lake Toxaway Company
County: Transylvania
Month: May
Year: 2021
ridirrigation
Field Name:
02-FW-15.
Field Name:
02-FW-16
Field Name:
02-T-10.
Field Name:
02-T-11
occur
Area (acres):
2.02
Area (acres):
1.34
Area (acres):
1.11
Area (acres):
1.62
facility?
Cover Crop:Turf
9 rass
Cover Crop:
P�
Turf rass
9
Cover Crop:
P�
Turfgrass
9
Cover Crop:
P:
Turfgrass
9
❑a YES ❑ NO
Hourly Rate (in):
0.3
Hourly Rate (in):
0.23
Hourly Rate (in):
0.28
Hourly Rate (in):
0.25
Annual Rate (in):
10.77
Annual Rate (in):
12.16
Annual Rate (in):
17.75
Annual Rate (in):
11.08
Weather
Freeboard
Field Irrigated?
YES ❑ NO'
Field Irrigated?
21 YES ❑ NO
Field Irrigated?
: ❑ YESNO
Field Irrigated?
FA YES ❑ NO
❑
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°F
in
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gal
min
in
in
gal
min
in
in
gal
min
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in
gal
min
in
in
1
C
2.5
5.5
2
C
3
R
1.6
4
R
1.25
5.5
5
C
6
C
3
7
PC
57
2,780
10
0.05
0.05
1,390
10
0.04
0.04
1,860
10
0.04
0.04
8
CL
9
CL
2
10
C
11
R
0.2
2.5
5.5
121
C
13
R
0.6
14
PC
15
PC
65
1,780
10
0.03
0.03
1,390
10
0.04
0.04
1,860
10
0.04
0.04
16
PC
2
17
CL
181
PC
5.5
19
C
68
2,780
10
0.05
0.05
1,390
10
0.04
0.04
1,860
10
0.04
0.04
20
PC
21
C
2.5
22
C
52
2,780
10
0.05
0.05
1,390
10
0.04
0.04
1,860
10
0.04
0.04
23
PC
24
R
0.1
251
PC
1
5.5
261
C
1
3
271
PC
28
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29
CL
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30
PC
64
2,780.
10 -
_ • 0.05
'0.05
1,390
10
0.04
0.04
1,860
10
0.04
0.04
31
C
Monthly Loading:
12,900
0.24
1 6,950
0.19
MOO
0
0:00
9,300
0.21
12 Month Floating Total (in):
2.35
1.78
2.1fi
1.98

N / (a
ication rates exceed the limits in Attachment B of your permit? ❑� Compliant ❑Non -Compliant
adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑r Compliant El Non -Compliant
Was a suitable vege
tative cover maintained on all sites as specified in your permit? ElCompliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted 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 necessary.
Operator in Responsible Charge (ORC) Certification II Permittee Certification
ORC: Gary Norton Permittee:
Lake Toxaway Company
Certification No.: 29126 Signing Official: Scott McCall, by signatory authority
Grade: SI Phone Number: 828-553-2990 Signing Official's Title: Broker, Lake Toxaway Company
Has the ORC changed since the previous NDAR-1? Elyes 'El No Phone Number. 828-966-4260 Permit Exp.: Oct. 31, 2021
Signature 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
th 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

s /A
W00000731
Facility Name: Lake Toxaway Company
County: Transylvania
Month: May
Year: 2021
ridirrigation
Field Name:
02-FW-17 ,
Field Name:
02-FW-18
Field Name:
02-T-17
Field Name:
02-T-18
occur,Area
(acres):
1.87
Area (acres):
2.64
Area (acres).
158"
Area (acres):
1.25
faCl Ilty?
Cover Crop:Turf
9 rass
Cover Crop:
P�
Turfgrass
9
Cover Crop:
P�
Turfgrass
9
Cover Crop:
P�
Turf rass
9
❑� YES ❑ No
Hourly Rate (in):
0.27
Hourly Rate (in):
0.35
Hourly Rate (in):
0.26
Hourly Rate (in):
0.25
Annual Rate (in):
10.42
Annual Rate (in):
9.41
Annual Rate (in):
' 11.67
Annual Rate (in):
14.04
Weather
Freeboard
Field Irrigated?
. Q YES ❑ No , `
Field Irrigated?
E YES ❑ NO
Field Irrigated?
❑ YES". E No
Field Irrigated?
❑� YES ❑ No
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min
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1
C
2.5
5.5
2
C
3
R
1.6
4
R
1.25
5.5
5
C
6
C
3
7
PC
57
2,320
10
0.05
0.05
4,180 _
10
0.06
0.06
1,390
10
0.04
0.04
8
CL
9
CL
2
101
C
Ill
R
1
0.2
2.5
5.5
12
C
13
R
0.6
14
PC
15
PC
65
-2,320
10
0.05
0'.05
4,180
10
0.06
0.06
1,390
10
0.04
0.04
16
PC
2
171
CL
18
PC
5.5
19
C
68
2,320.
10
0.05
0.05 ,
4,180
10
0.06
0.06
1,390
10
0.04
0.04
20
PC
21
C
2.5
22
C
52
2,320
10
0.05
0.05
4,180
10
0.06
0.06
1,390
10
0.04
0.04
231
PC
24
R
0.1
25
PC
5.5
•'
26
C
3
27
PC
28
R
0.2
5.5
291
CL
2.5
30
PC
64
2,320`
10
_`-0.05
0.05
4,180
10
0.06
0.06
1,390
10
0.04
0.04
31
C
Monthly Loading:
11,600
20,900
0.2911
0
0.00
6,950
0.20
12 Month Floating Total (in):
---------
00.23
2.15
2.66
2:05
1.89

S�6
rication rates exceed the limits in Attachment B of your permit? pCompllant ❑Non Compliant
Fa'dequate measures taken to prevent effluent ponding in or runoff from the sites? El Compliant ❑Non -Compliant
suitable vegetative cover maintained on all sites as specified in your permit? Ocompliant ❑Non -compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ElCompliant El Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ElCompliant [I 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.
IOperator in Responsible Charge (ORC) Certification II Permittee Certification
ORC: Gary Norton Permittee: I
Lake Toxaway Company
Certification No.: 29126 Signing Official: Scott McCall, by signatory authority
Grade: SI Phone Number: 828-553-2.990 Signing Official's Title: Broker, Lake Toxaway Company
Has the ORC changed since the previous NDAR-1? El Yes 0 No Phone Number: 828-966-4260 Permit Exp.: Oct. 31, 2021
-/8-a 1 e~`,% /v 1v /Z/
' Signature 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 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 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

WQ0000731
Facility Name: Lake Toxaway Company
County: Transylvania
Month: May
Year: 2021
Fidrigation
Field Name:
02-DR-01
Field Name:
02-FW-11
Field Name:
02-FW-.12
Field Name:
02-FW-14
occur rigation occur
Area (acres)-'
1.63
Area (acres):
1.79
Area (acres):
2.35 . -
Area (acres):
1.64
at this facility?
Cover Crop:Turf
grass
9
Cover Crop:
P�
Turfgrass
9
Cover Crop:
P�
Turf rass
9
Cover Crop:
P�
Turf rass
9
El YES ❑ NO
Hourly Rate (in):
• 0.31. -
Hourly Rate (in):
0.34
Hourly Rate (in):
0.31 ;.
Hourly Rate (in):
0.31
Annual Rate (in):
13.79
Annual Rate (in):
13.75
Annual Rate (in):
9.28 : -
Annual Rate (in):
13.6
Weather
Freeboard
Field Irrigated?
❑-y* ❑ No
Field Irrigated?
Q YES ❑ No
Field Irrigated?
❑YES ❑ No'
Field Irrigated?
❑ YES ❑ No
❑
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-
A= C
°F
in
ft
ft
gal
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
C
2.5
5.5
2
C
3
R
1.6
4
R
1.25
5.5
5
C
6
C
3
7
PC
57
930
10
0.02
0.02
460
10
0.01
0.01
930
10
0.01
0.01
8
CL
9
CL
2
101
C
11
R
0.2
2.5
5.5
12
C
13
R
0.6
14
PC
15
PC
65
930
10
0.02
0.02
460
10
0.01
0.01
930
10
0.01
0.01-
16
PC
2
17
CL
18
PC
5.5
191
C
68
93.0
10
0.02
0.02
460
10
0.01
0.01
930
10
0.01
0.01
20
PC
21
C
2.5
;
22
C
52
930:
10
0.02
0.02
460
10
0.01
0.01
930
10
0.01
0.01
23
PC
24
R
0.1
251
PC
1
1
5.5
26
C
3
27
PC
28
R
0.2
5.5
29
CL
2.5
30
PC
64
- 930
10-'
0.02 i
0:02.
460
10
0.01
0.01
;. 930
'10
0.01
0.01,.
311
C
Monthly Loading:
4,650
0.11
2,300
0.05
4,650
0.07
0
0.00
12 Month Floating Total (in):
2.45
2.69
2.29
2.46

Vadequate
on rates exceed the limits in Attachment B of your permit? 21Compliant ❑Non -Compliant
measures taken to prevent effluent ponding in or runoff from the sites? Compliant ❑Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? OCompliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ElCompliant ❑Non-Comprent
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ElCompliant ❑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 lr Permittee Certification
ORC: Gary Norton . Penmittee: Lake Toxaway Company
Certification No.: 29126 Signing Official: Scott McCall, by Signatory authority
Grade: SI Phone Number: 828-553-2990 Signing Official's Title: Broker, Lake Toxaway Company
Has the ORC changed since the previous NDAR-1? El Yes No Phone Number: 828-966-4260 Permit Exp.: Oct. 31, 2021
Signature Date Signature I 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
'th a system designed to assure 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 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617