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Home My WebLink AboutWQ0001664_Monitoring - 10-2022_20221114Monitoring Report Submittal Permit Number #* Name of Facility:* Month: * October Report Information WQ0001664 Belvedere Plantations WWTF Type * NDMR, NDAR-1, NDAR-2, NDMLR Confirmation Email Address:* Name of Submitter: * Signature: Date of submittal: Initial Review Year:* 2022 Upload Document* Belvedere Plantations 7.9MB October 2022 WWTP DMR.pdf PDF Only Please upload one PDF containing all applicable monitoring reports (i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59). greg.spillman@carolinawaterservicenc.com Greg Spillman u V, 11 /14/2022 This will be filled in automatically Reviewer: Gerald, Wanda Is the project number correct?* WQ0001664 Is the monitoring report accepted?* Yes NO Regional Office* Wilmington Reviewer: _anonymous Review Date: 11/15/2022 NON-DISCHARGEMONITORING Permit No.: WQ0001664 Facility Name: Belvedere Plantation WWTF County: Pender Month: October Year: 2022 PPI: 001 Flow Measuring Point: influent \ �ffiuent \ No flow generated Parameter Monitoring Point: Influent FA, Effluent Groundeater L-Vering Surface Water Parameter Code 00310 \\ \\ 60060 00610 00620 \ 00400 \ ` `\ \\\ \\ \\\ \ 70300 00076 \\\ iss C \\\\\ \\ - \\ \\ \\\ \\\ \ \\ \•\ \ \ 100 24-hr hrs m 1L 9 \ \ ` \`, `\,. \ \ \ , \,\ g g \ g su`\ \ \ mg1L \: NTU ` <10 2<103 10:20 1 \\ \\\ A<2 0.12 \ \ <0.2 \ \\\ <0.02 a\\ ` \ \\ 4 11:15 1 \\ \s \\&08\\\ .\0.2\\ \ \\\\\ \\ -- \\ \ \\ \\\2-02 \\-\ \\ \ \ \\\ \\\ \ \ \\\ \\ \ \\\ .\ \\\\ 7.03 \\\\\\ \\ \\\\ \ \ 1.98 \\ 7 .1:10 1 \ \\ \\\ \ \ \\\ 0.2 l 13 \\ \ \ \\\\\\ \ 2 < \\ \ \\\ \ <10 101 10:15 1 \\\\\\ . \, \�\ <2 \ 0.06 �`\\\_`\\\ <0.2 �\\ .,�� 197 \�\\i�\� t.ir'\\ \\\ \\\\ \ 2.02 11 10:40 1 _ <2 \ 0.07 \ \ \\\ \a\ <0,2 \ \ \ 4 06 \\' \\ \\ t.27 \` \\ � \\\ \\ \\ \\ 2.01 \\ \\\ \ \ \ 12 03:45 1 \\ \,. \ \\ \.\ \\ ,:. \ \\ \ \ \ \ \ > 2 20 \\ \\\\ \ \\\\ \\ \\\\\`\ \ \\\ \ \\ \ \\\\\ \ \\\\\\ \ 7.5 \o� \\\\\\\\ \\\\\\\\\ 1.04 \ \\\ \\ \ \\ \\ \\ \\ \\\\ \\\\\\ \\\\\ \ \\ 8-39 \ \ \\ \a\ pg- \ \\�\ 7.53 \ \\\\\\. \\\\\\ \ 2 \ \ \ \\\ 15161 \. 17 10:55 1 v>v v ° <2 O 2 tv\ <0.2 v v 5.41 \ \ 7.38 \v v ` v �� y\ 1.74 18 09:40 1 \ \\\ \ <2 0 1 \ \ \\ <0.2 v,: \ 4.69 - 1 9 1 0:00 1 \' \\ \\\ \ \ \\ \ \ \ 0.52 \ \ \ \ \ \ \`\\ 7.24 \ \ \ \ \\ \ \\\\ \ \\ \\ \ 2 \ \ \ \ \ 20 02:45 1 \ \ \ \ \ \\ \: \ \ \\ \` \ ` 0.89 \\ \ \ \ \ \\\ \ 8.34 \ vA 21 10:10 1yvvv� vv\, 1.51 AV \ \\ y A vv Z08 \v vyv, �vv y. v v v y`� � A\\vv 4,53 v V �\ \ v .Ayy vAv yvy y yyy v vA\ <10 vy v 23 vV yvv y�v <10 2.62 yvyv y 24 03:55 1 y ��A ` `\ < yv vy . v vyyy 2 v v v\ 0.27 vyv \ < \\V A 0.2 v yv\yam \vyvyy 4.56 \ �� \\vv yyA 7,09 vV 25 09:50 1 \vAv\ yAv <2 t21 vyy-<0.2 1 yy v�AV vAyvcyyy VvyAvv yv� 6vAv yyy\yv 26 11:55 1yyy vvyav �yvvA.vy`Vy�v03 Avve v.2A yyy,Z23 698 v - y -A_ 2 27 05:10 1 vyv-V y �`yyy, . `\y\Av yyvvv vyy y y.,\ y Av �yy 0.22 Vvyy \� \vAvvvy yy. �A`yyy�A.. �yyA, yy�vy�y y�yvy y yy �yy. A\\v.v ma T57\yVAyyyAy 28 03:05 1 \ \\ \, \\\ \\ 2.20 \ \\ \ \\\ \ \\\\ \\\\ 6.92 \ \ \ \ \201\ \ \; \ \\\\j \ \\\\\\\ \\\\\\\\\ \\ \\\\ \ \ \\\ \ \ \\\ \\ \<10 \\ o Average: g \\\ \ \ \ \ \ \\ \EON \\ \ 0.00 \\\ \ \\\ \\\\ \\\ 0.29 \\ \ \\\ \ 0.03 \\ . - \\ \\ \ 3 60 \ - \\\ \ \\ \ \ \\`\ \\\ _ \2.22 \\ \\\ \ \ \\ Dail Maximum Y \\\\ \ \\ \\\\ \\\ \ 2.00 \\ \\\\\\ \\\\\, 1.51 \\ \ \ �\\ - \ 0.20 \\ \ \\ \`. 5 41 �\ \ 7.53 \ \ \ \ \\ s \ �\ \\ \ \\\ \\ \\ \ Daily Minimum \ \. 2.00 \\\\ \ \ \_\\ 0 {l2 \; ? \\\\ 0.20 \\\ \\ \-\\ \ \ 0.02 " \\ \\ \ \ \ 6.90 v 1.04 \\\\\\\\\ vv vy yv� Sampling P T g Type: �A v\ vvv . Composite ,- Grab v\V yy� vvv Composite vyy v Composite \ , Grab y.,_ Composite y y Recorder vv y\v MonthlyLimit �,y yy y \\�\ ,.�� 10 y v y\ , yV\V�y�� \y syy �A� y y y 4 yv \ �y\y yV\yvA �A 1O ywv yyyV y yyy. vv v vv v y y Dail Limit..A`>y�yyVA�yy\yvy y \\\ \ \ \� y�yAyA.vv \ \\\\ yvvyyv�yy�y \ \\ ywA,A� \\\\:\\\\ A\y\.yyy�y \\\ \\ 6 9 A\yyv\y \a\\ \\\ vy.y\vvv \\ \ \0 10 yy,v,y�, \\ \ Sample Frequency vvvv yv yvvvyy- VVA �v 2 X Week 5 X Week �. 2 X Week vv ` y � X Week y y \� 5 X Week 3 X Year \yV v \ \ . \.. \ \ ,. �\ \ \:, .\ �.. , FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of Certified Laboratories Name: Enviromental Chemists, Inc. IOW # 94 j Name: 1 Name: Carolina Water Services Inc. - Eastern Region Certificate # 5162 Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? C compliant C 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: Greg Spillman Permittee: CWSNC Certification No.: 1004824 Signing Official: Tony Konsul Grade: 4 Phone Number: 252-241-0661 Signing Official's Title: Director of Operations Has the ORC changed since the previous Nf?MR? fes NoPhone Number: 704-576-1685 Permit Expiration: 3/31/2026 Digitally signed by Tony Konsul DN: C=US, OU="Director, State Operations", O=Carolina Water Service of NC, CN=Tony Konsul, Tony Ko n s u l ReTony Kons appra ing this document com Reason: approving this document inot,- 82 Location: 5821 Fairview Rd, suite 401 Charlotte NC 28209 Date: 2022.11.14 10:47:30-05'00' 11/14/2022 Foxit PDF Editor Version: 11.2.2 Signature mate 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 tau=, that this document and all attach rents were prepared under my direction or supervision: in accor dance w 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 far gathering the information. the information submitted !'a 10 the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalt€es for submitting false Information, including the possibility of fines and impnsonment for knowing wolations. Mail Original and Two Copies to: [Division of Water Resources Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 7699-1617 FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NOMR) Page Permit No.. VV 00{ 1664 Facility Name; Belvedere PlantationVUVl1TF County: Fender Month: October Year. 2022 PPI: 002 Flow Measuring Point. ? influent \ E cent � tic flow generatted Parameter Monitoring Point: \ influent\ Effluent\ Groundwater Loverin t \ surage water Parameter CO{8 ==1 Kill' �\:\�\ 1 \\ \ \ \\ \\ \ \\\\\\\\ \ ; :\\\�� \\wsa�\off 3009: 1\\\ \\\ \\ a\ \ IM \\ \ \ \ \SIZE \ \\ \ \ o\\\\\ \\\\\ \\ \ \ \ \ \\\ 6 0937 7 09:01 1 \\ o\ \ \ \ \\ 111 09:30 1 affi 12 0901 1 \\ ��.:: \ \\\\ `\ \\\;. \;\\ �\ \\ 13 02: 38 1 \\\\\ \\\\\ \\ \\\ \ \\ \ \ NMI' \ \ \ \ \ \ \\ \ \\\\ 14 15Av 16 17 09:34 9 18`{} 1 �� A Avvv '. v vV` Vv� 0��vyV� yy V � yV�v. A 19 08-51 1 VA 20 10:35 1 y y�v y vy 21 02:21 1 22 10 $ 08:57 1 25 08:58 1 \ \ \\ \ \ ... \ ISBN 26 10:10 1 27 05:30 1 30 Average: Daily Maximum: ` Daily Sampling Type: Month) Limit Daily Limit. Sample Frequency:\\ \ \ \\ \\ \ \ \ \ \\ FORM_ NDMR 05-16 NON -DISCHARGE MONITORING REPORT (ND11 R) Page of gampling Person(s) Certified Laboratories Name: Greg Spillman Name: Enuiromental Chemists, Inc. DW # 94 Name: game: Carolina Dater Services Inc. - Eastern Region Certificate # 5162 Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? -j CcmOlia t c npiiant 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 Grade: 4 Phone Number: 252-241-0661 Has the ORC changed since the previous NDMR? Yes No 13WM Signature Date By this signature certifv that this reports accurrate and curnp;ete to °he best of my knowledge Per ittee Certification Permittee: CWSNC Signing Official: Tony Konsul Signing Officials Title: Director of Operations Phone Number: 764-576-1685 Permit Expiration: 3/31/2026 Digitally signed by Tony Konsul DN: C-US, OU-'Director, State Operations", O-Carolina Tony Ko n s u I later Tony. rice of No, lin CN-Tony eo ice E-Tony.Konsul @carotin awaterservicen c.com Reason: 1 am approving this document Location: 5821 Fairview Rd, suite401 Charlotte NC 28209 Date: 2022.11.14 10 5012-05'00' 11/ 14/2022 Foxit PDF Editor Version: 11.2.2 Signature Date codify, under penalty ty of law, that this document and all attachments were prepared under my direction or sunervision in accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted Based onn y i9quiry of the person or persons who manage ?he syste;n , or those persons directly responsible fair gathering the info, matter,,, the information submitted is, to the best of rtle knowledge and belief, true, accurate. and Complete. 1 am aware that there are significant penalties for submitting false information, including the possibility of ones and impnsonment for knowing violations Mail Original and Two Copies to: Division of • Information # # Unit 1617 Mail Service Center zaleigh, NorthCarolina FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page Permit No.: WQ0O01664 Facility Name: Belvedere Plantation WWTF County: Pender Month: October Year: 2022 PPI: 003 Flow Measuring Point: \ Infuent \ Effluent No flan generated _ Parameter Monitoring Point: � Influent \ E;ftu-nt \ Ground,ater Loweri:r \ Surface Water Parameter Code b oti94{i \\ \ \\ yA f}U61Q �\ �� oo4tl0 ` � � \\v ,y 7030Ei � \ y VA 50ti60 y t[ - \vvAA \\,vv -rs VyAy vy,A\�� A� ��A v \ - A . � � Av \ a \\�yy y v, AV Ayv. vim- \VA \ esy,Av �\ -" A\ �'AAy yA A75 y � v yy vvA — _ y � a >. _ �A A _ y� :. A;A vA 4� A F- {}�.E {wy\�\\,A. O a,Avv AVvvyy�.ya, vA�A\y LAVA\V yVyvv�� \�A�y-�`� Avg vAVA: 24-hr hrs v-'\y\VAV \��\\\�\, \\\ mgfL •.yam V mgfL v�� AA \�� su ysVA� ��\ �\ mglL y.� v -.., �\ � g1L ��y � y v v .. - vv \ y�� A\VV\ yyv`\ y yAy\v` yv yyyyy�yyay A yyyA\may. oA A\V�V\ yn �y � � �Ay ��y yVAy. �:��y.v.., ��yvvA\VAyv •yam .;","y...�\ � ��AAV\y 2 3 09:41 1 \ \\\ \\ <0.2 \ ' \.699`\ \ \\ \ \\ \\\\\ \ \\\ \\ \\ \\ NE 10 08:51 1 ` ``` \\\ y ` \\. < ` ` - \ RE, \0 vyvvy y v v v \ A ` vv v. v 11 09-30 \\\�` iN \ \ \ ism \\ \\ \ a \ \\\ \ \\ \\\ 12 09:01 \\\\ \\`\ \\ \\\ \\ \\\\\\ \\\\ 15 \\\14 \ \\ \ s \ \ \ \ \\ \\ \ \\\ 16 \ \ \ \ 17 09:34 1 \ ` <0 9 7.0; \ � Q 18 09:02 1 \\` \:\ \ \ \ \ \ \ \ ;\ \ \ \ \ 19 0851 1 ` \` \ \ \ \\ \\ \ \ 2il 1035 1 "\\ \\ \ \\ \` ` `` \ \ \\\\ \ \ \ \ 21 02:21 1 ` \ NMI 22 23 25 08:58 1 \`\\ \\`\\\ \o\\�\\\\�`\�x \ \\ \ \ \\\ \ \ \\\ \. \ 26 10:10 1 27 05:30 1 29 30 Average: \\ \\ \\\ \ \\ \ \ ' ,: \ \ 0 \,T16 \ .\aom Daily Maximum wily A�inimu \\\\ �\\\�\� � ,\\� \\ „, \, 0-02 `\ ` \ \� �\\ 8 �� \\ �\ \� Sampling T \y _ A\A\ta5 y\, A Graf . , A �. Grab . V Grab Monthly Monthly Limlt: \a\ \\:\ oae \\\ 250 \\\, \ `\ .\ 1.5 \"" \\, \' \`\\\\` \\\\ \\\ a\ VON Daily Limit: \\\\\ \ \\ \ \ \\\\\\ \\\ \\ \ 6.5=8.5 ` Sample Frequency: ii Yeaf \ Weekly � ` ` �\ ...`,.3 .Nieekly NON -DISCHARGE MONITORINGREPORT E •. Sampling Person(s) II Certified Laboratories Name: Greg Spillman 11 Name: Enviromental Chemists, Inc. DW # 94 Name: 11 game: Carolina Water Services Inc. - Eastern Region Certificate # 5162 Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Compliant Non-Comol.ant 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(si taken. Attach additional sheets if necessary. Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: .Greg Spillman Permittee: CU1iSNC Certification No.: 1664824 Signing Official: Tony Konsul Grade: 4 Phone Number: 252-241-6661 Signing Official's Tale: Director of Operations Has the ORC changed since the previous NDMR? es No Phone Number: 104-576-1685 Permit Expiration: 3/3112026 Digitally signed by Tony Konsul DN: C=US, OU="Director, State Operations", O=Carolina Water Service or NC, CN=Tony Konsul, com this document Reason: 82 approving this document Tony Konsul ReTony. I am approving Location: 5821 Fairview Rd, 401 Charlotte NC 28209 ,$ 2 suite Date: 2022.11.1410:52:09-05'00' 11/14/2022 Foxit PDF Editor Version: 11.2.2 Signature Date Signature Date By this signature, 1 certify that this report :s accurrate and complete to the best of my know`cedge. 1 certify, under penalty it law, that this document and all attachments were preaared under uny direction or s„ pervis=on m accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the nfor matt n submitted.. Based on my :nquity of the person o persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the hest 'If my knowledge and belief, true. accurate, and complete-. I am aware that there are signsfecant pe .a#fies for submitting false information, Mcluding the Possibility of tines and impos :nment for knowing violations MailOriginal and Two Copies to: Division of Water Resources Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 FORM: ivDAR-21.0-13 - - , _ , UON-DISCHARGE APPLICATIl REPORT ( A -2) Page of Permit No.: lNC 0001664 Facility Name: Belvedere Plantation WWTF County: Pender Month: October Year: 2022 Did infiltration occur at\ \. \ `\ \\\\ \ Site Name: B \\ \\\\ \ " \\\\ Site Name: 1 \ this facility? \\\\\\\\\ \ \\\\\\\YES,\\\`\, (acres}: 0.27 `\\\ \\ Area (acres): \\\ \\\\ \\ \\\\\ \\ \ \ \ \\ \\\\\ \\\\ \ \\ \ \ Rate GPi)1ft }` ? Infiltrated. 8.55 \ v _ av \\\ ` \�\\\�\ \\\ "\ \ ` \\\ \ \\INE `\ a \ \�\� \ Rate {GPD1ft }: \ \\\\\\\ ,. \ \ \\ \\ \ :, Site infiltrated? YES ' NO Weather Freeboard E 0 CL\ V# L3. L1 \ \ -\\ \ \ \ \ \\ \ \ ��\ \ \`\ O CLtat F - G3 p \ S\ \\ \ \ O fi F- - [ \\ .. °F in ft ft \w `v\ `V ` v� v y\ \ \ \. \.\.. \ \ `.\\\ 106,732 0 \\ \ \\\ 106,732 0 \O \\ \\\ \. gal min GPDlft s ft v vv, \\ \ y v \ vv v y v \\ \\\ gal m"tn GPt}1ft' ft 1 CL 1 0 0 00 , ` \..\ 37.142 0 \\ \ \ 2 PC 1 0 0,00 \\ \ 37,142 0 3 C 58 1 10, 14 106,732 0 v y, - v ' w Ay` 3Z 141 \\: 35,044 `y 36,009 35,850 1 0 0 00 000 0 00 0 Ou 0 4 PC 59 0 92.275 Q 0 0 5 CL 71 0 92.116 90,309 0 0 y\ y 9 0 Q 0 0 6 CL 76 0 \; 0 vy 7 CL 77 0 81,079 0 0 1 0 0 00 \\ 33,219 0,. C 84.576 0 0 v vv v TIF: 35.934 0 9 CL 843576 r i v `�: 0 0 00 35.934 0 v \ 10 C 688 0 10' 14 34,5i6 i 100,585 j 0 0 1 0 > \ 0 0 l 0.00 \ 35,934 0 vv v \ \ \ \\ \\.,.\, 11 CL 71 U I 0 0 0(} 42,759 0 12 CL o 0 84 62 1G6,0 3 0 0 f I �� 0 0 0 00 36,702 0 \ i ' 13 PC £ 8 j v.3 J O 46,6 11 i 0 i 14 PC ! 63 F 0,2 i 82,921 0 0 I 0 00 V i 8,548 v �� - i 1 15 C L _ i v fS 0 t, 4t /; f� U 43L: O cAp ... .� : . V,.,TT�f i} IS V PC I 82 92i L'- \� �_ r\ 0.J €,. 38,543 Q \ \ 17 CL ?r I 0 62,921 u \ ,: \ 0 0 0 OJ \ \ 38,548 00\ 18 C 58 0 83,790 r \ \ 0 000 I 38,523 k 0 \ a: 0 \ 19L 47 0 82,511 0 \\ \ \ 0 n2 ea 00 37.500 20 CL 64 G 94,896 0 0 0 000 41176 0 21 CL 62 , fl i 0 2" 14 � 98 39 0 `\ , `� G} 0 I J CO \ 46811 \ 0 \� 0 22 CL 57,733 0 0 0 00 \\ 39,406 23 CL 57,I 0 0 0 0{}0 w y 39,4(}6 v �� V v \ \O v 24 C! 0 10'3" 14 57,733 0 \\ � o� 0 0 0.00 \ 1 \ 39,406 0 \ \\ \\ \ \ \ \k 25 PC 63 ) 633548 0 0 \ \ \\ 0 \\ \\ \ \ \ \ 0 0 J 00 :\. . \< 43.617 0 26 PC 72 0 68,522 0 OG \\ \ \ 46,355 0 27 CL 62 0 52,880 0 \\\-. \ \ \ 0 J 0 00 35,450 (}\ 28 R 62 0 91,971 € 0 \\ \\ \ \ _ 0 v 00 \' \.\\ \ \ 60.354 0 0\ \ \\ 29 y. 64,748 0 y 0 ]. 0 0 00 42158 30 R 1 64,748 0 \ \\ \\\ \ \\ 0 0 000 \ 42,158 0 311 PC 64 1.3 10'3" 14 64748 0 \\ \` - \ 0 .� AA \\ .-�.�iA 0 \, 9 04 \\o \ 42158 (} \\ \ \ \ A Aa- onthly Leading {GPt? ft }: ` \ E. 0.00 . \\.,..:.: #DIV10'. Year to Date load#r1 FORM: NDAR-2 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-) Page of Did the application rates exceed the limits in Attachment B of your permit? If not a basin, were the sites kept free of vegetation and raked? If not a basin, were there any instances of effluent poding in or runoff from the sites? If a basin, were there any instances of breakout from the berms? Was the onsite automatically activated standby power source tested and operational? Compliant Non-COrnpiiant Compliant No -Compliant Compliant Non -Compliant Compliant Non-C.ompllant . Compliant - No 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 actionts) taken. Attach additional sheets if necessary. Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Greg Spillman Permittee: Carolina Water Service, Inc N.C. Certification No.: 1004824 Signing Official: Tony Konsul Grade: 4 Phone Number: 252-241-6661 Signing Official's Title: Director of Operations Has the ORC changed since the previous NDAR-2? Yes l No Phone Number: 704-576-1685 Permit Exp.: 3/31 /26 Digitally signed by Tony Konsul DN: C=US, OU-'Director, State Operations', O=Carolina E-Tory.Konsul@carolinawatemervicenc.com Tony Ko I Water Service of No, - Reason: g this unrent approving this document n s u 82 Location: 5821 Fairview Rd, suite 401 Charlotte NC 28209 11/14/2022 }_ Date: 2022.11.14 10:51:06-05'00' Signature mate Signature Date By this Sig, atuir . e, Eft hat this repo. a ULe _ a., : complete to the -nest ofmv k =G§4ic.do.., re,a:i €ck at ...__�tr.m�and �.a,...m ..2..�'ea(�. under „l v,_c,<,1 . F...v^ ��< acc3rdance,th a system des fined to assure that. ali irfied Personnel ape gatnerea and eva!ughed the suornined Based On r^v .+.u,. r of 'he person or 'manage who anage the System, c- those person_ drre 1lves_.;Un_:c.-:Or gathering _ :he = . ,O ahion. the info ... o _ubmated _ the es. 0,, my .ow"edge and belief 'i je accurate and cc. - r t . ,.. oupe -that .r E _ are sign. cant pe. ait-_s far _uC ,.tting including he possib..T} of f,nes _ v .,.r. ison n e _i _<,_ fncovong V viations Mail Original and Two Copies to: Division of water Resources Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617