WQ0003299_NOV-2022-PC-0666_20221123

CS
P. O. BOX 327 • SEABOARD, NC 27876
September 13, 2022
Ms. Vanessa Manuel
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NC DEQ
3800 Barrett Drive
Raleigh, NC 27609
Dear Ms. Manuel,
Ph: [phone] • Fax: [phone]
lJc�o o 3291
Below are the written responses to the Notices of Violation and Intent to Access Civil Penalty
that were sent via Certified Mail with letter dated October 27, 2022.
NC Dept of Environmental Quality
NOV 2 3 2022
Raleigh Regional Office
Notice of Violation and Intent to Access Civil Penalty tracking number: NOV-2022-MV-0149.
During the month of January 2021, prior 2 ORC's have since left, and next ORC not contracted
until November 22, 2021. The Town of Seaboard would like to ask for an amendment to this
matter.
Yours Truly,
Christine Bass, Clerk
Geraldine Langford, Mayor
Notice of Violation and Intent to Access Civil Penalty tracking number: NOV-2022-MV-0148.
During the month of February 2021, prior ORC has since left, and next ORC not contracted until
November 22, 2021. The Town of Seaboard would like to ask for an amendment to this matter.
Yours Truly,
Christine Bass, Clerk
Geraldine Langford, Mayor

Notice of Violation and Intent to Access Civil Penalty tracking number: NOV-2022-LV-0793.
During the month of March 2021, prior ORC has since left, and next ORC not contracted until
November 22, 2021. The Town of Seaboard would like to ask for an amendment to this matter.
Yours Truly,
Christine Bass, Clerk
Geraldine Langford, Mayor
Notice of Violation and Intent to Access Civil Penalty tracking number: NOV-2022-LV-0792.
During the month of April 2021, prior ORC has since left, and next ORC not contracted until
November 22, 2021. The Town of Seaboard would like to ask for an amendment to this matter.
Yours Truly,
Christine Bass, Clerk
Geraldine Langford, Mayor
Notice of Violation and Intent to Access Civil Penalty tracking number: NOV-2022-PC-0665.
During the month of May 2021, prior ORC has since left, and next ORC not contracted until
November 22, 2021. The Town of Seaboard would like to ask for an amendment to this matter.
Yours Truly,
Christine Bass, Clerk
Geraldine Langford, Mayor
Notice of Violation and Intent to Access Civil Penalty tracking number: NOV-2022-PC-0666.
During the month of June 2021, prior ORC has since left, and next ORC not contracted until
November 22, 2021. The Town of Seaboard would like to ask for an amendment to this matter.
Yours Truly,
Christine Bass, Clerk
Geraldine Langford, Mayor
Notice of Violation and Intent to Access Civil Penalty tracking number: NOV-2022-PC-0664.
During the month of December 2021, parameters missing Chlorine and pH weren't recorded on
the bench sheet with the changing of ORC's there was some confusion. We have since corrected
the recording of information and the sheets that paperwork is to be sent in on. The Town of
Seaboard would like to ask for an amendment to this matter.
Yours Truly,
Jeffrey Long, ORC
Geraldine Langford, Mayor

Notice of Violation and Intent to Access Civil Penalty tracking number: NOV-2022-PC-0663.
During the month of June 2022, the Chloride was missing due to an overlook error, but we've
since started using a new form and hopefully this will change the mistake. The Town of
Seaboard would like to ask for an amendment to this matter.
Yours Truly,
Jeffrey Long, ORC
Geraldine Langford, Mayor
Notice of Violation and Intent to Access Civil Penalty tracking number: NOV-2022-PC-0471.
During the month of July 2022, there was a late/missing NDAR-1. This was mailed out early due
to the ORC being on vacation. Not sure what happened once placed in the care of the United
Postal Service. The Town of Seaboard would like to ask for an amendment to this matter.
Yours Truly,
Jeffrey Long, ORC
Geraldine Langford, Mayor
Notice of Violation and Intent to Access Civil Penalty tracking number: NOV-2022-MV-0147.
During the month of August 2022, the weekly pH was missing due to an overlook error, but
we've since started using a new form and hopefully this will change the mistake. The Town of
Seaboard would like to ask for an amendment to this matter.
Yours Truly,
Jeffrey Long, ORC
Geraldine Langford, Mayor

DocuSign Envelope ID: 88FA9288-4FDA-4D9B-9B65-15056EBA259B
ROY COOPER
Governor
ELIZABETH S. BISER
Sec rctcr
RICHARD E. ROGERS, JR.
1 fir'-"x:.FJS
Geraldine Langford, Mayor
Town of Seaboard
PO Box 327
Seaboard, NC 27876
NORTH CAROL!NA
Environmental Quality
October 27, 2022
SUBJECT: NOTICE OF VIOLATION
Tracking Number: NOV-2022-MV-0149
Permit No. WQ0003299
Town of Seaboard WWTF
Northampton County
Dear Permittee:
A review of the January 2021 Non -Discharge Monitoring Report (NDMR) for the subject facility revealed the
violation(s) indicated below:
Monitoring Violation(s):
Sample Monitoring
Location Parameter Date Frequency Type of Violation
001 Flow, in conduit or thru treatment 1/25/2021 Continuous Frequency Violation
plant (50050)
001 Flow, in conduit or thru treatment 1/27/2021 Continuous Frequency Violation
plant (50050)
001 Flow, in conduit or thru treatment 1/28/2021 Continuous Frequency Violation
plant (50050)
001 Flow, in conduit or thru treatment 1/29/2021 Continuous Frequency Violation
plant (50050)
001 Flow, in conduit or thru treatment 1/30/2021 Continuous Frequency Violation
plant (50050)
D„-A forth Cai.ogr . Prpertinem of Er rnnnottnk Qu day Q; un o! WatWatt,Reca,rxs E Q ILArajh itegiee.10ince 31*00 &omit Drive 1*o*k 1. ^xthCaro3na MOO
919.7M.4400

DocuSign Envelope ID: 88FA9288-4FDA-4D9B-9865-15056EBA2598
ROY COOPER
ELIZABETH S. BISER
iC, refer
RICHARD E. ROGERS, JR.
(iy7Y tern
Geraldine Langford, Mayor
Town of Seaboard
PO Box 327
Seaboard, NC 27876
k,
NORTH CAROL:NA
Environmental Quality
October 27, 2022
SUBJECT: NOTICE OF VIOLATION
Tracking Number: NOV-2022-MV-0148
Permit No. WQ0003299
Town of Seaboard WWTF
Northampton County
Dear Permittee:
A review of the February 2021 Non -Discharge Monitoring Report (NDMR) for the subject facility revealed the
violation(s) indicated below:
Monitoring Violation(s):
Sample Monitoring
Location Parameter Date Frequency Type of Violation
001 Flow, in conduit or thru treatment 2/27/2021 Continuous Frequency Violation
plant (50050)
001 Flow, in conduit or thru treatment 2/28/2021 Continuous Frequency Violation
plant (50050)
Reporting Violation(s):
Sample
Location Parameter Date Type of Violation
001 Chloride (as CI) (00940)
2/28/2021 Parameter Missing
001 Chlorine, Total Residual (50060) 2/28/2021 Parameter Missing
E
419.7?I.4200
Huth Carolina De r.0 toont N' Environmental Qt aN v : Urowicxn of Watt, fecrwr..es
Rate h Regional O(1ke : 3i7OQ 'Wren Drive ! Raleigh Norris Caro*w 27M04

DocuSign Envelope ID. 88FA9288-4FDA-4D9B-9B65-15056EBA259B
ROY COOPER
!,we!mor
ELIZABETH S. BISER
Sei whir
RICHARD E. ROGERS. JR.
Pit ec tm-
Geraldine Langford, Mayor
Town of Seaboard
PO Box 327
Seaboard, NC 27876
.. ;i:'I_
Environmental Quality
October 27, 2022
SUBJECT: NOTICE OF VIOLATION
Tracking Number: NOV-2022-LV-0793
Permit No. WQ0003299
Town of Seaboard WWTF
Northampton County
Dear Permittee:
A review of the March 2021 Non -Discharge Monitoring Report (NDMR) for the subject facility revealed the
violation(s) indicated below:
Limit Exceedance Violation(s):
Sample Limit Reported
Location Parameter Date Value Value Type of Violation
001 Flow, in conduit or thru 3/31/2021 134,000 174,774.19 Monthly Average Exceeded
treatment plant (50050)
Reporting Violation(s):
Sample
Location Parameter Date Type of Violation
001 Chlorine, Total Residual (50060) 3/31/2021 Parameter Missing
Remedial actions, if not already implemented, should be taken to correct any noted problems. The Division of
Water Resources may pursue enforcement actions for this and any additional violations. If the violations are of a
continuing nature, not related to operation and/or maintenance problems, and you anticipate remedial
construction activities, then you may wish to consider applying for a Special Order by Consent (SOC).
£DEQ \..::1,: .. y:.r+mntta Ernin>lvnt+tta?QeeaFt DN:sWn' Ware:Rnt''"
Radr.ylt R g a! (Nt�cr :fN4Ml Barrrtt E7tive RaWyh. Kurth Car ,fin UMw

DocuSign Envelope ID: 88FA9288-4FDA-4D9B-9B65-15056EBA259B
ROY COOPER
ELIZABETH S. BISER
Sc ri'iLFil
RICHARD E, ROGERS JR.
Dire(
Geraldine Langford, Mayor
Town of Seaboard
PO Box 327
Seaboard, NC 27876
Environmental Quality
October 27, 2022
SUBJECT: NOTICE OF VIOLATION
Tracking Number: NOV-2022-LV-0792
Permit No. WQ0003299
Town of Seaboard WWTF
Northampton County
Dear Permittee:
A review of the April 2021 Non -Discharge Monitoring Report (NDMR) for the subject facility revealed the
violation(s) indicated below:
Limit Exceedance Violation(s):
Sample Limit Reported
Location Parameter Date Value Value Type of Violation
001 Flow, in conduit or thru 4/30/2021 134,000 135,460 Monthly Average Exceeded
treatment plant (50050)
Remedial actions, if not already implemented, should be taken to correct any noted problems. The Division of
Water Resources may pursue enforcement actions for this and any additional violations. If the violations are of a
continuing nature, not related to operation and/or maintenance problems, and you anticipate remedial
construction activities, then you may wish to consider applying for a Special Order by Consent (SOC).
North C iroH a aepurin rnt ar E iuuranenttaP Quell s amykkn of Watt, Rcsoursrs
Radrgh Itcginnal (Mitt ; 3600 8arrt i t) , Itaiekth.
W127M.d?00

DocuSign Envelope ID 80DF6D0B-3D34-4738-B1DF-1BAE210AFB2A
ROY COOPER
c<lvt.,r?;r
ELIZABETH S. BISER
Sec r n
RICHARD E. ROGERS, JR_
Direr oor
Geraldine Langford, Mayor
Town of Seaboard
PO Box 327
Seaboard, NC 27876
NORTH CAROL. .
Environmental Quality
October 27, 2022
SUBJECT: NOTICE OF VIOLATION
Tracking Number: NOV-2022-PC-0665
Permit No. WQ0003299
Town of Seaboard WWTF
Northampton County
Dear Permittee:
A review of the May 2021 Non -Discharge Monitoring Report (NDMR) and Non -Discharge Analysis Report (NDAR1)
for the subject facility revealed the violation(s) indicated below:
Reporting Violation(s):
Sample
Location Parameter Date Type of Violation
7/31/2021 Late/Missing NDMR
7/31/2021 Late/Missing NDAR-1
Remedial actions, if not already implemented, should be taken to correct any noted problems. The Division of
Water Resources may pursue enforcement actions for this and any additional violations. If the violations are of a
continuing nature, not related to operation and/or maintenance problems, and you anticipate remedial
construction activities, then you may wish to consider applying for a Special Order by Consent (SOC).
a:fna Lfrp .r; mutt Of Env tooa cntai Quaid I t,vninn n! Watt, Rc,norcr
t kr,aim.A OfCce = MOO Barren Onve Rakeigh North C , oa
4N.701.4200

DocuSign Envelope ID. 80DF6D0B-3D34-4738-B1DF-1BAE210AFB2A
ROY COOPER
ELIZABETH S. BISER
Sb`t rC fat
RICHARD E. ROGERS. JR.
Direr tor
Geraldine Langford, Mayor
Town of Seaboard
PO Box 327
Seaboard, NC 27876
NORTH r1'.;I.
Environmental Quality
October 27, 2022
SUBJECT: NOTICE OF VIOLATION
Tracking Number: NOV-2022-PC-0666
Permit No. WQ0003299
Town of Seaboard WWTF
Northampton County
Dear Permittee:
A review of the June 2021 Non -Discharge Monitoring Report (NDMR) and Non -Discharge Analysis Report (NDAR1)
for the subject facility revealed the violation(s) indicated below:
Reporting Violation(s):
Sample
Location Parameter Date Type of Violation
8/30/2021 Late/Missing NDAR-1
8/30/2021 Late/Missing NDMR
Remedial actions, if not already implemented, should be taken to correct any noted problems. The Division of
Water Resources may pursue enforcement actions for this and any additional violations. If the violations are of a
continuing nature, not related to operation and/or maintenance problems, and you anticipate remedial
construction activities, then you may wish to consider applying for a Special Order by Consent (SOC).
DE
North Carotin _kpnrmcM er ErnWmn.innat Qt.alU -. !t wm Water Rnarrre ;
R,de:yh Reliant<Ma, 1800 tlarre!t tarm Raieigh,N th Cu-iva 2760a

DocuSign Envelope ID: 88FA9288-4FDA-4D9B-9B65-15056EBA259B
ROY COOPER
G<iserrrrr
ELIZABETH S. BISER
St, re
RICHARD E. ROGERS, JR.
Direr 'or
Geraldine Langford, Mayor
Town of Seaboard
PO Box 327
Seaboard, NC 27876
•
NORTH CAROLINA
Environmental Quality
October 27, 2022
SUBJECT: NOTICE OF VIOLATION
Tracking Number: NOV-2022-PC-0664
Permit No. WQ0003299
Town of Seaboard WWTF
Northampton County
Dear Permittee:
A review of the December 2021 Non -Discharge Monitoring Report (NDMR) for the subject facility revealed the
violation(s) indicated below:
Reporting Violation(s):
Sample
Location Parameter Date Type of Violation
001 Chlorine, Total Residual (50060) 12/31/2021 Parameter Missing
001 pH (00400) 12/31/2021 Parameter Missing
Remedial actions, if not already implemented, should be taken to correct any noted problems. The Division of
Water Resources may pursue enforcement actions for this and any additional violations. If the violations are of a
continuing nature, not related to operation and/or maintenance problems, and you anticipate remedial
construction activities, then you may wish to consider applying for a Special Order by Consent (SOC).
L E�
North Carort,nn Department of Envittrmeetntat Que, t Atutsian.al Water Resources
Raletytt kevimsal Office ;MOO Barrett drive Ratekih. North Caro*. 2t,O7

DocuSign Envelope ID: 6277E4BF-E06F-4BAE-87E6-96D47A5A246C
ROY COOPER
ELIZABETH S. BISER
5+><retcrr}.
RICHARD E. ROGERS, JR.
Certified Mail # 7020 3160 0000 4115 4880
Return Receipt Requested
Geraldine Langford, Mayor
Town of Seaboard
PO Box 327
Seaboard, NC 27876
NORTH CAROLINA
Environmental Quality
October 27, 2022
SUBJECT: NOTICE OF VIOLATION & INTENT TO ASSESS CIVIL PENALTY
Tracking Number: NOV-2022-PC-0663
Permit No. WQ0003299
Town of Seaboard WWTF
Northampton County
Dear Permittee:
A review of the June 2022 Non -Discharge Monitoring Report (NDMR) for the subject facility revealed the
violation(s) indicated below:
Reporting Violation(s):
Sample
Location Parameter Date Type of Violation
001 Chloride (as CI) (00940)
6/30/2022 Parameter Missing
A Notice of Violation/Intent to Issue Civil Penalty is being issued for the noted violation of North Carolina General
Statute (G.S.) 143-215.1 and the facility's Non -discharge Permit. Pursuant to G.S. 143-215.6A, a civil penalty of
not more than twenty-five thousand dollars ($25,000.00) may be assessed against any person who violates or
fails to act in accordance with the terms, conditions, or requirements of any permit issued pursuant to G.S.
143-215.1.
If you wish to provide additional information regarding the noted violation, request technical assistance, or
discuss overall compliance please respond in writing within ten (10) business days after receipt of this Notice. A
review of your response will be considered along with any information provided on the submitted Monitoring
Report(s). You will then be notified of any civil penalties that may be assessed regarding the violations. If no
response is received in this Office within the 10-day period, a civil penalty assessment may be
prepared.
North Carolina Otp:a+meot of [.nvmmmenrxl (oa ity Ekvis om ,l. Watt 6tesmn
?alcis}lt kc3+o+wl OPcc i f80O Bartel Ot7YP kak4411 Nitx tit Carokws 110+04
+19741.4ItX1

DocuSign Envelope ID: 6277E4BF-E06F-4BAE-B7E6-96D47A5A246C
ROY COOPER
ELIZABETH S. RISER
RICHARD E. ROGERS, JR.
Certified Mail # 7020 3160 0000 4115 4880
Return Receipt Requested
Geraldine Langford, Mayor
Town of Seaboard
PO Box 327
Seaboard, NC 27876
NORTH .ARC.)LJNA
Environmental Quality
October 27, 2022
SUBJECT: NOTICE OF VIOLATION & INTENT TO ASSESS CIVIL PENALTY
Tracking Number: NOV-2022-PC-0471
Permit No. WQ0003299
Town of Seaboard WWTF
Northampton County
Dear Permittee:
A review of the July 2022 Non -Discharge Application Report (NDAR1) for the subject facility revealed the
violation(s) indicated below:
Reporting Violation(s):
Sample
Location Parameter Date Type of Violation
9/30/2022 Late/Missing NDAR-1
This Notice of Violation/Intent to Issue Civil Penalty is being issued as an addendum to the previous
NOV/NOI issued August 31, 2022.
A Notice of Violation/Intent to Issue Civil Penalty is being issued for the noted violation of North Carolina General
Statute (G.S.) 143-215.1 and the facility's Non -discharge Permit. Pursuant to G.S. 143-215.6A, a civil penalty of
not more than twenty-five thousand dollars ($25,000.00) may be assessed against any person who violates or
fails to act in accordance with the terms, conditions, or requirements of any permit issued pursuant to G.S.
143-215.1.
a ti;.i,iCerv.!nalkp�arru..n
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.Z4,TG3. J 2rX)
muma[%p��atny Itwasinn..` Water
;t
a <an w rth CaroG'm zmu i

DocuSign Envelope ID: 6277E4BF-E06F-4BAE-B7E6-96D47A5A246C
ROY COOPER
co.erne
ELIZABETH S. BISER
:Secreeurt
RICHARD E. ROGERS, JR.
DirecT,
Certified Mail # 7020 3160 0000 4115 4880
Return Receipt Requested
Geraldine Langford, Mayor
Town of Seaboard
PO Box 327
Seaboard, NC 27876
NORTH CAROL.; NA
Environmental Quality
October 27, 2022
SUBJECT: NOTICE OF VIOLATION & INTENT TO ASSESS CIVIL PENALTY
Tracking Number: NOV-2022-MV-0147
Permit No. WQ0003299
Town of Seaboard WWTF
Northampton County
Dear Permittee:
A review of the August 2022 Non -Discharge Monitoring Report (NDMR) for the subject facility revealed the
violation(s) indicated below:
Monitoring Violation(s):
Sample Monitoring
Location Parameter Date Frequency Type of Violation
001 pH (00400) 8/13/2022 Weekly Frequency Violation
001 pH (00400) 8/20/2022 Weekly Frequency Violation
001 pH (00400) 8/27/2022 Weekly Frequency Violation
A Notice of Violation/Intent to Issue Civil Penalty is being issued for the noted violation of North Carolina General
Statute (G.S.) 143-215.1 and the facility's Non -discharge Permit. Pursuant to G.S. 143-215.6A, a civil penalty of
not more than twenty-five thousand dollars ($25,000.00) may be assessed against any person who violates or
fails to act in accordance with the terms, conditions, or requirements of any permit issued pursuant to G.S.
143-215.1.
LD_Q
1w>t r I C...IA, a Ile l anr. of Ernuwmrrmal florEb l tt +x ,n of Water item,* TA,
Raleigh Rrgntwl Otiwr i 3100h::rr<tt Utter 8381Q1 Norio Carolina fbe3
,09191.410O

FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page _ / of _L
Permit No.: WQ0003299
Facility Name: Town of Seaboard l
County: Northampton
[ Month: July
I Year: 2022
PPI: 001
Flow Measuring Point: lA Influent MI Effluent [] No flow generated Parameter Monitoring Point: !,, ,nt r ] Effluent [] Groundwater Lowering L] Surface Water
Parameter Code 4.
50050 ` 00400
50060 '
00310
31616
00610
0062 00620 r 00600
3 Total0)
Phosphorus
00536-1 00940
70300 `'Y
00615
50050
O
O F
to
ce
O
t%
0 7 Total
Residual
r` Chlorine
m
4-
V .';
Q
e
" k
1-
Z
c
F- '�.
}`
U
® :.
Z
Z n
it
24-hr
hrs
;' GPD
su
mg/L
#1100 mL-.
mg/L
mg/L
mg/L
mg/L
mglL
mg/L
mg/L
mg/L
mglL *
GPD
1
09:49
0.5
6.4
0.34
0.022
2
04:00
0.5
-
0.028
3
12:00
0.5
0.015
4
10:21
0.5
0.33
.
0.021
5
10:20
0.5
0.024
6
10:51
0.5
k°'
<10 :.
20.5
18.91
18.97
3.28
46
0.06
0.02
7
12:00
0.5
0.027
8
08:54
0.5
0.35
_
0.065
9
09:52
0.5
0.04
10
08:30
0.5
0.066
11
10:16
0.5
0.33
0.066
12
09:20
0.5rt
0.069
13
10:53
0.5
0.043
14
08:30
0.5
0.038
15
08:00
0.5
0.31
0.041
16
11:30
0.5
0.046
17
09:10
0.5
0
18
12:03
0.5
0.3
0.09
19
11:00
0.5
0.037
20
08:30
0.5
0.025
21
08:00
0.5
0
22
08:00
0.5
0.3
0.074
23
09:10
0.5
0.06
24
09:00
0.5
0
25
09:20
0.5
0.29
0
26
01:00
0.5
0.087
27
10:00
0.5
0.054
28
09:26
0.5
_
0.05
29
09:40
0.5
6.4
0.28
0.041
Y
30
08:20
0.5
0.035
31
03:40
0.5
0.047
Average:
#DIV/0!
0.31
15.00
1.00 »:'
20.50
18.91
0.06
1897 x 3.28
11
0.06
0.04
Daily Maximum:
0
6.60
0.35
15.00
10.00 y; 20.50
18.91-
0.06
18.97 3.28
. • +
0.06
0.09
Daily Minimum:
0
6.40
0.28
15.00
10.OD a#. 20.50
G18.91 ?'`
0.06
18 97 ( 3.28
0.06
0.00
Sampling Type:
Recorder
Grab
Grab
t> Grab
Grab,°. ;' Grab
Grab
' Grab
Grab aq Grab
- •
Grab
Grab
Monthly Avg. Limit:
134,000
1'
Daily Limit:
� ,,r
..:.ur
Sample Frequency:
Continuous
Weekly
Weekly
Monthly
Monthly Monthly
Monthly
Monthly
Monthly Monthly
Monthly
3X Year
`' 3X Year
[

FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page / of i
Sampling Person(s)
Name:
Name:
Name:
Name:
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
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: Jeffrey Long
Certification No.: 992044
Grade: 1 Phone Number: 252-308-2984
Has the ORC changed since the previous NDMR?
HI Yes 2 No
8/10/2022
Signature \ Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee: Town of Seaboard
Signing Official: Christine Bass
Signing Officials Title: Office Manager
Phone Number: 252-589-5061 Permit Expiration: March 31 2022
8/10/2022
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 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