HomeMy WebLinkAboutWQ0028666_Monitoring - 03-2023_20230428 (3)Monitoring Report Submittal
...................................................
Permit Number#* WQ0028666
Name of Facility:* Cannonsgate at Bogue Sound
Month: * March Year: * 2023
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR 2023 03 Cannonsgate DMR.pdf 2.78MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * ermartin@aquaamerica.com
Name of Submitter: * Erikah Martin
Signature:
cgimz# r�<Lt&*
Date of submittal: 4/28/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald
Is the project number correct?* WQ0028666
Is the monitoring report accepted?* Yes No
Regional Office* Wilmington
Reviewer: _anonymous
Review Date: 6/1/2023
FORM NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) ( l0
a.
Permit No. WQ0028665
Facility Name Cannonsgate at Bogue Souna
County; Carteret
l�la'C
Month
Year ^?
V
PPI: /�
�JQ1
l't ': � t PrN y �fNk •t'r4'
Flow Measuring Flint:
Parameter-
o rmgtP
pu,l'e
JtM Lawffng _-s�rtMp
w,,t
00600
GOMaO
00665
70300 00530
00078
Parameter Code -+
goo
00310
00940
31616
00610 00625
00620
-
c
E
v E
c
zs
0
u
~
o~in
U
a m Z
Z
0
rn
a
O {
�-
24-hr
hrs
GPD
mgtL
MOIL#/100
mL
mglL
mg/L
m
mg1L
su
mg/L
m
mg/L
NTtJ
1 07 oo
2
40.000
7.32
2 0T00
3
34-000
O.157
3 07 00
2
42.000
7.35
---
4
42.000
726
0.176
—
5
42 000
<10
-
6 07 DO
2
34,0
-
<1000
—
7
C700
3
29,000
-
7.19
0144
8
0700
3
37 C00
82
1
<0.2
_
-� 5
426
7.19
725
i
618
0139
0.174
9
0700
5
33 000
-
722
_ _
01
10
0700
2
4 t O00
11
41.00C
-
—
7 31
-
0 18
<10
12
41,000
13
07 CO
3
37,000
<10
14
0700
3
43,000
<0.2
C 5
39
a
7,2
7.38
5 6S
<<, -,
1
0 15
p,115
15
12.00
1
30 000
7 31
-
16
07 oa
2
ao 000
_ _
_ _
7.28
0 154
17
0700
2
41, 000
— -
7.15
0.101
18
41.000
0.14
19
41 000
<10
20
07 00
40000
719
-
21
0700
4
41,000
_
0.125
725
0.118
22
0700
2
38.000
7.33
23
07 00
2
36.000
LO 144
735
0 133
24
0700
2
37.667
7.29
0 178
25
37 667
- - -
__ _�
-
26
37, 667
--�--10
CIO
27 0700 3
52,000
' 2a
p
176
28 0700 2
40,000
7,22
-
29 0700 2
38,000
0 146
7.26
0.141
30 0700 1
52 000
719
_
31 17 00 1
33.687
C 156
725
0 125
Average:
39,441
000
8200
1 00
000
;,
40.80
41 00
662
616-00
000
Oil
Daily Maximum:
52 000 1
200
8200
1.00
0.20
050
4260
42,6C
7,38
7-60
616.00
2 50
1000
Daily Minimum:
30 000
2 CO
8200
1 00
0.20
050
3900
3940
7 t5
563
61800
2 5C
C 10
Sampling Type.
Recorder :;ompoa:e
Campma*
Grab
Composite
Composite
Compoefte
Composde
Grab
omposte
Composit0 Composite
Recorder
Monthly Avg. Limit,
200.000
10
14
4
15
Daily Limit
15
25
8
1
6 to 9
10
1C
Sample Frequency: Contirxwue
2 x Month
3 x Year
7x Monti
2 xMorAh
1 klin!h 1
2 x Morkh
2x Month
5 x Wei
2 x M-th,
3 x Year 2
x Vorm
Cormmlous
FORM NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR);i: _ 2 ct _ 10
Sampling Person(s) Certified Laboratories
Name: Raymond Lacy Braxton Name: Environmental Chemists, INC
I
Name:
�I Name:
UUtrs do rnortt[ormg aaca ana sampling frequencies meet the requirements in Attachment A of your permit?
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 dates) of the non-compliance and describe the corrective actions)
taken Attach addihnnal ahruatc ;f nwrocan.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC. Raymond Lacy Braxton '" Permlttee: Aqua NC lNC
Certification No. 999$95 Signing Official: ClAtt�- �
Grade: IV Phone Number: 910-431-9248 Signing Official's Title: rCro-ra'-stal Regional Supervisor
2%1�ITL,
Has the ORC changed since the previous NDMR? Phone Number: 910 7W4-a;L rt Permit Expiration: 8/31/2024
Signature Date
By this 107nature ! certify that th,s report ;s accurrate and complete to the best of my knowledge
r I
_
Signature Date
I oenity, under penalty of law that this dOCUnleht and as attachments were prepared wider my direction or supervmw jr,
accordance with a system designed to assure that ad quald;ed personnel property gathered and evaluated the utformaws
submitted Based on my ;ngwry of the person of persons wtio manage the system, or those persons diree-tty responsible for
gathenng the Information, the information submitted is, to the best of my kncnMedge and belief, hue. accurate_ and complete ! am
aware that there are sipndlcant penalties fur submitting false «dormabon. Inctuci ng the possibility of fines and urprisonmeni for
knrwnng vtolatron5
Mail Original and Two Copies to.
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM Nt7hIR 10 ' NON -DISCHARGE MONITORING REPORT (NOMR) Page � �G
Permit No.: VV00028666
Facility Name: Cannonsgate at Bogue Sound County Carteret
Month: March
Year: �U
PF1' 002
L. _rent snl :n >:v i�rr rated
Flow Measuring f-oln
n n'
Parameter I�lon `nt1�j
I r rrxtwate I owerr. +
Poti x1 M • 14a.rr
Parameter Code - i
50050
_
I
-
I
--
p
c-
a,
U 1 ~ N
Ix
O
24-hr I hrs
U.
GPD
--
�------
-- -
1
07-00 2
29,000
2
07-00
3
20,000 -
—
3
0700
2
27.333
-
-
4
27.333-
5
27333
_
----
6
07.00
2
23,000----
7
07.00
3
30,000
_
8
0700
3
30,000
9
0700
5
14.000
-- —
10
07.00
2
3C.000
_
-
11-
12
30,000_
---�
13
07:00
3
23,000
14
0700
3
-
36.000
-
i
-
15
1200
1
14 000
--
16
0700
2
27 000
-
17
07-00
2
27,333
-_
-
18
27,333
-
19
27,333
20
07 00
1
32.000
21
07:00
4
26,000
-
-
----
22
07.00
3
23.000
-
---
23
07 00
2
26.000
-
24
07:00 i
2
25.333
25
25.333
—
26
25 333
27
07:00
3
2T000
28
07,00
2
26,000
— -
-
29
0700 2
26,000
30
07:00 I 1
39.000
--
31
17-00 1
23,000
-
Average:
26,581
Daily Maximum:
39,000
_ -
---
Daily Minimum:
14,000-
_ Sampling Type
Recorder
Monthly Avg. Limit:
80.000
---
-
_ _
---
Daily Limit:
-
-
Sample Frequency: Cmtmuovs
—
FORM NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) page _L__ c' Io
Sampling Person(s) 1I Certified Laboratories
Name. Raymond Lacy Braxton 11 Name: Environmental Chemists INC
Name 11 Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
If the facility is non -compliant, please explain in the space below the reason(sl the facility was not in compliance Provide in your explanation the date(s) of the non-compliance and describe the corrective action(sl
taken Attach additional sheets if necessary
Operator in Responsible Charge (ORC) Certification
ORC Raymond Lacy Braxton
Certification No.: 999895
Grade- IV Phone Number: 910-431-9248
Has the ORC changed since the previous NDMR?
Signature Date
'3y this signaluie i t.'6ltlty that ties report is &(xunate and complete to the best or my kt/amedge
Permittee Certification
Permittee• Aqua NC. INC
f
Signing Official:
Signing Official's Title: %�COOoastal Reginal Supervisor
Phone Number: 910 / , 14 Z Permit Expiration: 8/31/2024
Signature Date
certify, u penalry of law, that this abrxlment and at attaCYlments were "paced under my, direction or aipennsnon in
:wcordance with a system designed to assure that aft qualified personnel property gathered and evatuated the information
submitted Based on my inquiry of the pennon or, persons who manage the system, or tnose persons direetry resprxfsibie fa
gathering the uNnrmabon the information submtted is to the best of my kna**Oge and belief in,e.. aowrate. and complete I am
aware that there are s3nlfncant Watches ffx submitting false information Miuding the possibility of (rles and wwrisonment far
Knowing violations
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
r=JRM NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) �aqe SS cf /0
Permit No.: W00028666
Facility Name: CannOnsgate at Bogue Sound
County: Carteret
Month March
Year: 2023
PPI' 003 Flow Measuring hdin `Ii x' f " y"' No FloN qr
nr t ou�dvrai r Lower r; ` rt ►,. i'Jater
Parametel�lorfitonrig 1'br �.
Parameter Code
+ 50050
31616
D0600
-
00400
o
E v
ix
O
c
O
F
F- N
V
Q
LL I LL o
U
I
►�- .�
2
c
-su
-
1--
24-hr
hrs
GPD #1100 mL
m L
j
-
1
07-00
2
.50,000
--
-
—
— --
2
07'00
3
96,000
-
3
07-00
2
b4 666
4
44.666
-
5
2
44.666
-
6
07.00
48,000
-
—
- - -
7
07.00
3
50,000
-
8
0700
3
308,000
='
2.2
6.89
v
9
0700
5
0
-
--
_-
10
07:00
2
2.000
11
0
---
12
0
-
13
07 00
3
0
14
0700
3
59.000
- - "-
15
12,00
1
0
16
07.00
2
181,000
_
17
97:00
2
96,667
-
- - -
18
% 667-
19
96,667
20
0700
1-
-
21
0700
4
107,000
- -
22
07.00
3
65,000
-
—
- -
23
0700
2
34.000
24
07.00
2
133,000
25
133,000
-
--
26
133.000
27
0700
3
62,000
-
28
07:00
2
38,000
--
—
07 00
2
88,000
v
- -
J29
30
07:00 '
96.000
—
31
17:00
66,667
_
-'—
Average:
74 924.71
1 00
2.20
Daily Maximum:
308,000.00
1,00
2.20 1
689-
Daily Minimum:
0.00
1 00
2 20
6-89
�-
Sampling Type:
Ra,;o dw
G,ab
Grab
Grab
-
Monthly Avg. Limit:
-
Daily Limit:
Sample Frequency:
Gontcnuoue
Monthly
Monthty
Monthly
_--
FORM NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Pag> k of Ia
Sampling Person(s) I! Certified Laboratories
Name: Raymond Lacy Braxton 11 Name: Environmental Chemists. INC
Name: 11 Name:
r Non c
Uoes all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
If the facility is non -compliant please explain in the space below the reason(s) the facility was not in compliance Provide to your explanation the date(s) of the non-compliance and describe the co•rective actions
taken Attach additional sheets if ner. p_%%ary
Operator in Responsible Charge (ORC) Certification
ORC: Raymond Lacy Braxton
Certification No.. 999895
Grade: Iv Phone Number:
Has the ORC changed since the previous NDMR?
N., 11 Permittee:
Signing Official
910-431-9248 II Signing Official's Title
Signature Date
By this s.gnitlure, I :.ensy that this retiort ds accum
rre and complete to the best of my knowledge.
Phone Number:
Permittee Certification
Aqua, NC. INC
moo.,
G�►se�i s
: Coastal Regional Supervisor
zr-*/M,
910 ?+39 0;'94 Permit Expiration: 8-81-24
�72oLs
re Date
I cenity under penny of law. that the document and all attachments were prepared under my dlre�..bon or supervision In
accordance with a system designed to assure that at: qualified personnel property gathered and evaluated the, mfrxmatron
submitted based on my inquiry of tie person or persons who manage the system or those persons directly responsible for
gathering the mtormation the information submitted is, to the best of my knowledge and ti chef. true accurate. and complete i am
aware that there are stgrrnhcant penalfies for submitting false information, including the possibility of fines and imprisonment for
tumwvtg v�olatrons
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM NOMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 7 cf1(_
Permit No.i W00028666 Facility Name: annonsgate at Bogue Sound County: Carteret Month: March
:Parameter Code 011MU-SE-M!
ED
Average:'
Daily Maximurn::��
Daily
FORM NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NOMR) Page _O of 10
Sampling Person(s)
Name, Raymond Lacy Braxton
Name
Certified Laboratories
Name: Environmental Chemists, INC
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? A0, conroaant
If the facility is non -compliant, please explain in the space below the reasons) the facility was not in compliance Provide n your explanation the date(s) of the non -comp lance and describe the corrective action(s)
taken Attach additional sheets if necessary
Operator in Responsible Charge (ORC) Certification
ORC Raymond Lacy Braxton
Certification No.: 999895
Grade: IV Phone Number: 910.431-9248
Has the ORC changed since the previous NDMR9
Signature Date
6y this signature i certify trial this report is accurrate and compiete to the bent of my knowiedge
Permittee Certification
Permittee. Aqua, NC. INC
Signing Official
Signing Official's Title: Coast/al Regina! Supervisor
Phone Number: 910 ?` / L Permit Expiration: 8/31/2024
- 27 704Y
ignature Date
i certify, under ?.ItvGfMai this document and all attachments were prepared under my direction or sigwv5ron n
accordance with a system designed M assure that all qualified personnel properly gathered and evaluated the mtormation
submitted Based on my inquiry of the person or persons who manage the system, or those persons directly responsible to'
gathering the information the information submitted is to the Crest of my knowledge and belief, bue. accurate. ad aomWete ! am
aware that there are signtf cani pena"i-9 fir submitting false information includ.ng the pbs&bddy or Pores and imprisonment fir
knowing va3"ns
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh. North Carolina 27699-1617
FORM NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) r __! of
Permit No. W00028666
ONE County: Carteret
- Month: March
I
... ..:
:: ,...,
�, .,
��
��■i
i
m
; ;:
0�
��i■�i�
FORM NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page la ct to
Sampling Person(s) 11
I Certified Laboratories
Name: Raymond Lacy Braxton Name: Environmental Chemists. INC
i
"lame Name: —
noes all monitoring aata and sampling frequencies meet the requirements in Attachment A of your permit?
If the facility is non -compliant. please explain in the space below the reasons? the facility was not In compliance. Provide in your explanation the date(s) of the non-comphance and describe the corrective act�on(st
taken Attach additional sheets if neressary
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC Raymond Lacy Braxton Permittee: Aqua NC. INC
T. d A.,_I,MW
t..
Certification No-- 999895 Signing Official: [ ..11 {1 uins
Grade: IV Phone Number: 910-431-9248 Signing Official's Title: Coastal Reginal Supervisor
Has the ORC changed since the previous NDMR? Phone Number 910 �l L Permit Expiration: 8/31/2024
Signature Date
BY Ih:s srgr:altire I ceNty that this report IS a:-currate end compiete to the hest of my knowledge
Sig re Date
0e140. under penalty of law that this document and all attachments were VOOWed under MY direction IN supervision n
accordance with a system designed to assure that all qualdled personnel property gathetea and evaluated I?w information
submitted Based on my inquiry of the person or persons who manage the system or those persons directly respnnsthte for
9athertrq the information ete nformatton submitted ,s. to the best of my knowledge and Niel true accurate
aware that there are 4tgnificant penalties for submitting false informationrncludelg the possa wlity of fins arvf
knowvtg wolatians
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 1c ' . NON -DISCHARGE APPLICATION REPORT (NDAR-2) 'D3; l
Permit No.:
VVQ0028666
Facility Name-
Cannons Gate at eogue Sound
County: Carteret
Month: March
Year.
2023
Did infiltration
occur at
Site Name:
1
Site Name:
2
Site Name:
3
this
facility?
Site Name:
4
Area
(acres):
1 66
Area actei
(
7
Area (acres);
1.32
Area (acres):
036
Rate (GPD/ft�):
1 145
Rate (GPD45
Rate (GPD/ftZ):
1.145
Rate (GPD/ft'):
1 145
Weather Freeboard Sr net 1 filtrated?
_ roc
NO
Site Infiltraw
Site Infiltrated
--,YES
]►tt)
Site Infiltrated?
-'rFc
0_.mc0
i
c
�
rn A
�
amm
m
w
a
e
g7--
m mc
O
?, c
oO
a
a
o 0.
0
S
o a =
m
mei0
Q
E
is
m
°F
in
ft
ft
9a I
min
GPOMe
ft
gal
min
GPD/ft
ft
gal
min
GPD/fe
I ft
gal
min
GPD/ft= I
ft
1
CL
76
2 7
10,000
0.14
2 9O
10,000
0 34
3.10
10,000
0.1T
3.30
?0,000
0.64
2.00
2
R
74
0 03
28
8,500
0.12
290
8.500
i 0.29
310
8.500
0 15
330
8.5GO
0.54
300
3
C
75
2 8
10.500
0.15
290
10.500
0 36
3.10
10,500
0 18
3.30
10.500
0.67
3.0Q
4
CL
75
9R
1nrnn,
5
C
6?
a iv Iv.ouu
__
U 1S
330
10,500
067
3.00
2. 8
10, 500
0. t 5
2 90
10.500
0 3-6
3.10 10, 500
0.18
3 30
10. 500
0 67
3.00
6
C
la
2.9
8.500
012
2.90
8.500
0 29
3.10 8,500
015
3.30
8.500
054
300
7
C
77
2.9
9750
Q.13
3.00
9,750
0 33
3.10 9.750
0.17
340
9,750
062
300
8
C
55
2.9
9.250
0.13
3 DO
9,250
032
3 1C 9250
0.16
3.40
9 250
0.59
3.00
9
C
6t
2.9
8,250
0.11
300
8.250
0.28
3.2C 8,250
014
3 40
8,250
053
3.10
10
R
57
014
2.9
10.250
_
0.14
300
10,250
035
3.2C 10,250
0 18
3 40
10,250
065
310 1
11
CL
57
2 9
10,250
014_
3.00
10,250
0.35
3.20 10.250
0-18
3.40
10,250
0.65
310
12
R
39
0.37
2.9
10,250
014
3 00
10 250
1
035
3.20 10,250
0.18
3 40
0.65
3 10
13
R
54
043
3
9.250
013
F 3.00
9.250
0 32
3.20 9,250
0.16
3.50
�_'�0,250
I 9.250
0.59
-320
14
C
52
3
10,750
015
3 10
10,750
037
L3 20 1 C.750
0 19
3 50
' 0.750
069
320
15
C
54
31
7,500
0.10
3.10
7,500
0 26
3.2C 7,500
0.13
3.50
7,500
0,48
3.20
16
C
64
3 1
10,000
014
3 1Q
1 a,000
034
3 3C 10,000
017
3.50
ji
10.000
0 64
320
17
CL.
77
31
10.250
0 a
3.10
10,250
0 35
3-3C i0.250
0.18
3,50
10.250
0.65
18
R
68
036
3.1
10,250
014
310
10,250
0.35
330 10 25Q
018
3 50
10250
065
3.2D
320
19
PC
55
3.1
10,250
Q 14
3.10
10.250
0 35
3.30 10.250
0.18
3,50
10,250
0-65
i
3.20
20
R
48
002
3.3
10.000
0.14
3 20
10.000
034
330 ' 0.000
0.17
3.50
10,000
064
3.20
21
C
61
3.3
10.25C
0.14
3.20
10,250
035
3 30 ? 0,250
0.18
3.50
? 0250
_
0 65
3 20 {
22
C
65
3 3
9.500
0.13
3 20
9.500
0 33
340 9.500
0 17
3.60
9 500
_
0 61
3 30
23
CL
82
3.3
8.000
0.11
3 20
8.000
027
3.40 8.000
0 14
3 60
8,000
0.51
3.30
24
C
87
3.3
9,416
013
3 30 `
9.416
0 32 i
3.40 9.416
0.16
3,60
9-416
0 60
3 30
25
R
84
0.02
33
9.416
0.13
3 30
9,416
032
3.40 r 9.416
016
360
9 416
060
3.30
26
R
76
0.2
3 3
9.416
0,13
3 30
9,416
0,32
3 40 9.416
016
360
9,416
060
3.30
27 R 77 0 79 3 4
13 000 0.18
3,3 113,000 0 45
3 40 13,000 0.23
3 60
0 83
3 30
28 C 68 3.4
10.000 0.14
3 30 10,000 0,34
3 40 10,000 0 17
a3,O
3 60
064
330
29 C 58 0.06 3 4
9,500 0.13
3 40 9 500 0 33
340 9,5000.17
360
0 61
3-40
30 C 65 3
13,000 0.18
340 13.0DO 045
3.50 13.00C 0.23
3 60 13.000
0 83
3.40
31 C 75 3 5
8,416 0-12
3.40 8,416 029
3.50 8 416 0,15
3 60 8.416
054
3.40
MonthlyLoading(GPD/ft`):
0 14
3a
017
0621
Year to Date Loadin GPDIft' :
1.fi1
a p4
203
749
wCiRAA 14DAR-2 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page 2, of 21
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 ponding in or runoff from the sites?
-,IornplwIt ftort:oinpliani
_umplra:r _;��n (;ynphant
r%iCnmpl•anf ' -win-t:onhptia.a
If a basin, were there any instances of breakout from the berms? ornpiiarii NorvComphwr
Was the onsite automatically activated standby power source tested and operational? Compliant _Jfjon c"wit
If the facitiry is non -compliant please explain in the space below the reason(s) the facility was not in comp lance Provide in your explanation the date(s) of the non-compliance and describe the corrective
actien(s) taken Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) CertificationIL Permittee Certification
ORC: Raymond Lacy Braxton Permittee:
Aqua North Ca ghna INC
Certification No.: 999895 ••% iir�-
Signing Official: r' �6
Grade: IV Phone Number: 910 431-9248 Signing Officials Title. Coastal Regional Supervisor
Has the ORC changed since the previous NDAR-2? —ye, ho
-- Phone Number: g10 ;-=-�?g4 Permit Exp.: 8/311;24
Signature
By Mrs signature- I Certify that this report is ac urrate and ahmplate to the bust nSignature Date
e my tn,:a:- ! ,_ 1 ; ertrfy. under penalty W iaw that Mrs document and ato attachments weir prepared wider my direcu( n, ur in acr ordance
wdn a system designed to assure that all qualified personnel properly gathered and evaluated the information submtted. Based our,
my "f llry of the person or persons who manage the system, of those persons directly responsible for gathering the information the
information submitted is to the beat of my knowledge and belief true, accurate, and complete t am aware that there " stgn4cant
penaRies fa submitting false tnfnrmation including the possroarty of fines and empnsnrhmi!nt for kricnwhg violations
Mail Original and Two Copies to:
Division of water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617