WQ0005790_Monitoring - 12-2023_20240205

Monitoring Report Submittal
Permit Number#* WQ0005790
Name of Facility:* Fish Factory Road Treatment Plant
Month: * December Year: * 2023
Report Information
Type* Upload Document*
Revised - NDMR, NDAR-1, NDAR-2, NDMLR December 2023 DMRS Revised.pdf 6.38MB
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: * Kenny Von Voigt
Signature:
Date of submittal: 2/5/2024
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* W00005790
Is the monitoring report accepted?* Yes NO
Regional Office* Wilmington
Reviewer: _anonymous
Review Date: 3/13/2024

r
FORM NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Pageof
Permit No.: W00005790
Facility Name: Fish Factory Road Water Reclamation and Treatment Facility
County: Brunswick
Month: December
Year: 2023
Did irrigation
Field Name:
1
Field Name:
2
Field Name:
3
Field Name:
4 & 4A
occur
Area (acres):
2.2
Area (acres):
21
Area (acres):
2
Area (acres):
22
at this facility?
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
r,
Hourly Rate (in):
04
Hourly Rate (in):
0.4
Hourly Rate (in):
0A
Hourly Rate (in):
0.4
Annual Rate (in):
156
Annual Rate (in):
156
Annual Rate (in):
156
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
Yes - NO
Field Irrigated?
❑ YES E]NO
Field Irrigated?
YES EINo
Field Irrigated?
Ij YES NO
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1
PC
71
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69
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66
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66
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10
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0
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0.00
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0.00
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11
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0-00
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12
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54
0
36
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0.00
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0.00
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0.00
0.00
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13
PC
61
0
36
4
0
0
0.00
0.00
0
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14
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15
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17
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60
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59
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19
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48
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0
360
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21
22
23
24
25
26
27
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C
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C
CL
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58
57
53
61
78
69
72
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0.00 0
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229 0
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0
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000 000
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0 00 000
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0.00 000
000 0.00
000 000
000 000
000 000
000 000
000
0 00
1
57
0
3 6
4
E165
52
57
0
0
3 6
36
4
4
Monthly Loading:
12 Month Floating Total (in):
0
0 00
000
0
0.00
0.00
0 00
0 00
0

FORM NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ of
Permit 1. • nnc>
r
�m
136
23
33
436
53
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
oU
Did irrigation occur
at this facility?
Weather Freeboard
c _
O 2 y
o m m rn v6 a
a a p 2
t E a
a° F a N M a
Q O A
°F iM ft ft
4
6 4
6 4
4
6 4
C 53 0 3 6 4
C 53 0 36 4
C 60 0 3-6 4
C 72 0 3 6 4
R 65 01 36 4
C 52 2.6 3 6 4
C 54 0 3 6 4
PC 61 0 3.6 4
C 52 0 3 6 4
C 56 0 3 6 4
C 65 0 3 6 4
R 60 3 1 3 6 4
PC 59 0 6 36 4
C 48 1 0 3.6 4
C 48 0 3.6 4
C 58 0 36 4
C 57 0 36 4
C 53 0 3.6 4
t-acnity Name:
Field Name:
Area (acres):
Cover Crop:
Hourly Rate (in):
Fish Factory Road
5 & 5A
2 5
04
Water Reclamation and
Treatment Facility
County: Brunswick
Month:
2023
Field Name:
Area acres )
Cover Crop:
Hourly Rate (in):
6
: 1 25(
0 2
Field Name:
Area (acres):
Cover Cro- P
Hourly Rate (in):
7
Wberopear:
8
1 7
1 55
0.2
Hourly Rate (in):
02
Annual
Field
0) a
E °'
2 a
o a
>¢
gal
0
0
0
0
48,000
48,000
48,000
0
0
0
0
0
0
0
0
0
0
48,000
48.000
0
0
0
0
Rate in
Irrigated?
a
u
E
i=
_
min
0
0
0
0
240
240
240
0
0
0
0
0
0
0
0
0
0
240
240
0
0
0
0
YES
a
c
a
m
in
0.00
000
0,00
0 00
0 71
0.71
0.71
000
000
0.00
0.00
0 00
0.00
0 00
0 00
0.00
0.00
0.71
071
0.00
000
0.00
000
156
❑
E
E»
x o m
_
r2
in
000
000
0.00
0 00
0.18
0.18
0 18
0.00
0.00
0.00
0.00
0.00
0 00
0.00
0.00
0.00
0.00
0 18
0.18
0 00
0.00
000
0,00
Annual Rate (in):
127
Annual Rate (in):
127
Annual Rate (in):
127
Field
° v
a
> a
gal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Irrigated?
❑ rE5 ❑ No
Field Irri aced?
9
YES ��j NO
Field Irrigated?
_ .YES
m
E m
_ m
~_
min
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
°
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I
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in
0 00
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. 5 a
= o
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in
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a
a Q
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~_
min
_c
A a
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in
a c
E a
= J
in
0 00
0
0
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0.00
0
0
0.00
0 00
000
0 00
0 00
0,00
000
000
0 00
0.00
0 00
000
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0 00
0 00
0 00
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0,00
000
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0
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0 00
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0,00
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0
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0
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0
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0
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0
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0
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0
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0
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0
0
000
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0
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0.00
000
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0.00
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000
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0.00
0.00
000
0.00
0
0
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0 00
000
0
0
000
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0.00
0.00
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0.00
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0 00
0 00
0 00
0 00
0 00
0.00
0.00
0 00
0.00
0 00
0 00
24
25
C
C
61
78
0
0
3.6
36
4
4
0
0
0
0
000
000
000
000
0
0
0
0
0,00
000
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0.00
0
0
0
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0.00
000
0
0
0
0
0 00
000
0.00
0 00
26
CL
69
0
3.6
4
0
0
0 00
0.00
0
0
000
000
0
0
0.00
000
0
0
000
000
27
R
72
1
36
4
0
0
000
000
0
0
000
000
0
0
000
0.00
0
0
000
000
28
PC
57
0
3.6
4
0
0
0,00
000
0
0
000
0.00
0
0
000
0,00
0
0
000
000
29
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65
0
36
4
0
0
0.00
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0
0
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0.00
0
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30
C
52
0
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0
0
000
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0
0
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0
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0.00
0.00
0
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000
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31
C
57
0
36
4
0
0
000
000
0
0
000
000
0
0
0.00
0.00
0
0
000
000
Monthly Loading:
240,000
3 54
0
0 00
0
000
0
000
12 Month Floating Total (in):
46 19
517
31.09
25 75

FORM. NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0005790
Facility Name: Fish Factory Road Water Reclamation and Treatment Facility
County: Brunswick
Month: December
Year: 2023
Field Name:
9
Field Name:
10
Field Name:
11
Field Name:
12
Did irrigation occur
Area (acres):
1 99
Area (acres):
1 75
Area (acres):
2.47
Area (acres):
1 62
at this facility?
Cover Crop:
Cover Crop:
p:
Cover Crop:
-
Hourly Rate (in):
02
Hourly Rate (in):
0.2
Hourly Rate (in):
02
Hourly Rate (in):
0.2
Annual Rate (in):
127
Annual Rate (in):
127
Annual Rate (in):
127
Annual Rate (in):
127
Weather
Freeboard
Field Irrigated?
vEs ❑ No
Field Irrigated?
E YES ❑ NO
Field Irrigated?
__ vEs No
Field Irrigated?
0 YES ❑ NO
a
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3
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
PC
71
02
3.6
4
2,062
12
004
004
7 857
46
0 17
0 17
6.257
46
0.09
0.09
2.865
16
007
007
2
R
75
01
36
4
2,110
12
004
0.04
7,948
47
017
0 17
6,361
46
0,09
009
2,878
16
0 07
0 07
3
CL
69
0
36
4
2.036
12
004
004
7 900
46
0 17
0 17
6.435
45
0 10
0 10
2.821
16
0 06
0,06
4
C
66
0
36
4
2.040
12
004
0,04
8 110
46
0 17
0 17
6,618
46
0.10
0 10
2.995
16
0 07
0 07
5
C
66
0
36
4
2,298
13
0.04
0.04
8 035
46
0 17
0 17
6,571
45
0 10
010
2,886
16
0 07
0 07
6
C
53
0
36
4
2,263
12
0.04
004
8,131
46
0 17
0.17
6,723
45
0.10
010
2,786
16
0 06
0 06
7
C
53
0
36
4
2,241
12
004
0 04
8 040
46
0 17
0 17
6,640
45
0.10
0.10
2.838
16
0 06
0 06
8
C
60
0
36
4
2,267
12
004
0.04
7 988
46
0 17
0 17
6,618
46
0 10
0 10
2 834
16
0 06
0 06
9
C
72
0
36
4
2.115
12
004
0.04
7,887
46
0 17
0 17
6,632
45
0.10
0 10
2,882
16
0 07
0 07
10
R
65
0 1
36
4
2,141
12
004
0.04
8.097
46
0 17
0 17
6,850
45
0.10
0.10
2,965
16
0 07
0.07
11
C
52
26
36
4
2.324
12
004
0.04
8,162
46
0.17
0.17
6,898
45
0.10
0 10
2.956
16
007
007
12
C
54r
3 6
4
2,328
12
0 04
0.04
8,110
46
0 17
0 17
6,867
46
0.10
0.10
2.825
16
0 06
0 O6
13
PC
5136
4
2,350
12
0.04
004
8.062
46
0 17
0 17
6%7
46
0,10
0 10
2,873
16
0.07
007
14
C
523
6
4
2,346
12
0 04
0.04
7.983
46
0.17
0.17
6,950
45
0.10
0.10
2.843
16
006
006
15
C
563
6
4
2,211
12
0 04
0 04
7 905
46
0 17
0 17
6,806
45
0.10
0.10
2,899
16
007
007
16
C
6536
4
2,193
12
004
004
8,127
46
0 17
0 17
6,959
45
010
0 10
3.02616
007
0.07
17
R
60
3.6
4
2,394
12
004
004
8,110
46
0 17
0 17
6,945
45
0,10
0.10
2.965
16
007
007
18
PC
59
06
36
4
2,420
12
004
0.04
8,219
46
0 17
0 17
6,924
45
0.10
0.10
2 891
16
007
007
19
C
48
0
36
4
2,424
12
004
0.04
8,075
46
0 17
0 17
6,985
45
010
0.10
2.817
16
006
006
20
C
48
0
36
4
2,389
12
0.04
004
7,979
46
0.17
0.17
6,919
45
0.10
0.10
2.838
16
006
006
21
C
58
0
36
4
2,241
12
004
0.04
7,988
46
0 17
0 17
6,945
45
0 10
0 10
2.851
16
006
006
57
0
36
4
2,245
12
004
004
8 158
46
0 17
0.17
7,085
45
0 11
0.11
3,039
16
0 07
0 07
22
C
C
53
0
36
4
2,241
12
004
004
8,136
46
0 17
0.17
7,159
45
0.11
0.11
2.974
16
0 07
0 07
23
C
61
0
3.6
4
2,429
12
0.04
0,04
8,144
46
0 17
0 17
7.054
45
0 11
0 11
2,899
16
0 07
0 07
24
25
C
78
0
3.6
4
2,459
12
005
005
8 044
46
0 17
0 17
7,168
45
0 11
0 11
2,856
16
0 06
0 06
69
0
36
4
2,450
12
0,05
0,05
8,053
46
0 17
0 17
7,146
45
0 11
0 11
2.882
16
0 07
0 07
26
CL
72
1
3 6
4
2,276
12
0.04
0.04
8 066
46
0 17
0.17
7,124
45
0 11
0.11
2,856
16
0 O6
0 06
27
R
57
0
3.6
4
2,272
12
0 04
0,04
8.127
46
0 17
0 17
7,181
46
0.11
0.11
2.982
16
0 07
007
28 PC
C
65
0
3,6
4
2,468
12
0.05
0 05
8.110
46
0 17
0 17
7,238
45
0 11
0 11
2,921
16
007
007
29
30 C
52
0
3.6
4
2,503
12
0 05
0.05
8,001
46
0 17
0.17
7,312
45
0 11
0 11
2,930
16
007
0.07
0
3 6
4
2.524
12
0 O5
0.05
8.035
46
0 17
0,17
7,211
45
0 11
0.11
2.882
16
0.07
007
31 C
57
Monthly
Loading:
71,059
1 32
249,584
5 25
213,518
3.18
89,755
"s
2.04
21.15
s :i<,fi
`P"
58 20
;..0
37,46
1
26 47
12
Month
Floating Total
(in):

FORM NDAR-1 05-16 NON -DISCHARGE
Permit No.: W00005790
Facility Name: Fish Factory Road Water Reclamation and Treatment Facility
County: Brunswick
Month: December
Year: 2023
Field Name:
13
Field Name:
14
Field Name:
Field Name:
Did irrigation occur
Area (acres):
1.19
Area (acres):
098
Area (acres):
Area (acres):
at this facility?
Cover Crop:
Cover Crop:
Cover Crop:
covercro p:
Hourly Rate (in):
0 2
Hourly Rate (in):
02
Hourly Rate (in):
Hourly Rate (in):
Annual Rate (in):
127
Annual Rate (in):
127
Annual Rate (in):
Annual Rate (in):
Weather
Freeboard
Field Irrigated?
YES NO
Field Irrigated?
Yes C: NO
Field Irrigated?
YES NO
Field Irrigated?
YEs ❑ NO
p
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°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
PC
71
02
36
4
5.825
46
018
018
0
0
000
000
2
R
75
0 1
36
4
6,047
46
0.19
0.19
0
0
000
000
3
CL
69
0
36
4
6,091
46
019
019
0
0
000
000
4
C
66
0
36
4
6,291
45
0.19
019
0
0
0 00
0 00
5
C
66
0
36
4
6,187
46
0.19
0.19
0
0
000
000
6
C
53
0
36
4
6,248
46
0.19
019
0
0
000
000
7
C
53
0
3-6
4
6.191
46
0.19
0.19
0
0
000
000
8
C
60
0
36
4
6,784
50
021
0 21
0
0
000
000
9
C
72
0
36
4
6,331
46
020
0.20
0
0
0.00
0.00
10
R
65
01
3.6
4
6,623
45
0,20
0.20
0
0
000
000
11
C
52
26
3.6
4
6,579
45
0.20
0.20
0
0
0.00
000
12
C
54
0
36
4
6,418
45
0.20
0,20
0
0
000
0.00
13
PC
61
0
3.6
4
6,462
45
020
0.20
0
0
000
000
14
C
52
0
36
4
6,466
45
0.20
020
0
0
000
000
15
C
56
0
36
4
6,353
45
0.20
020
0
1 0
0.00
000
16
C
65
0
36
4
6,618
45
020
020
0
0
0.00
000
17
R
60
31
36
4
6,666
45
021
021
0
0
000
000
18
PC
59
06
36
4
6,466
45
020
020
0
0
000
000
19
C
48
0
36
4
6.518
46
0.20
020
0
0
000
000
20
C
48
0
3 6
4
6,632
46
0.21
0,21
0
0
000
0.00
21
C
58
0
36
4
6,662
45
0.21
0.21
0
0
000
000
22
C
57
0
36
4
6,915
45
021
0 21
0
0
000
000
23
C
53
0
36
4
6,871
45
021
0,21
0
0
0,00
000
24
C
61
0
36
4
6,623
45
0.20
020
0
0
0.00
000
25
C
78
0
3.6
4
6,697
45
0.21
021
0
0
000
000
26
CL
69
0
3 6
4
6,714
45
0.21
021
0
0
0.00
0.00
27
R
72
1
3 6
4
6.714
45
021
021
0
0
000
0.00
28
PC
57
0
3 6
4
6,980
45
0,22
0.22
0
0
0.00
0.00
29
C
65
0
3 6
4
6,876
45
021
021
0
0
000
0,00
30
C
52
0
3 6
4
6.697
45
21
021
0
0
000
0.00
31
C
57
0
3 6
4
6.754
45
21
021
0
0
0.00
0.00
Monthly Loading:
202,300
2
j89 31
00
`%,>a/'
000
r. 81.83
0
0.00
C
0 00
12 Month Floating Total (in):,
61

FORM NDAR-1 05-16
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page of
Did the application rates exceed the limits in Attachment B of your permit?
E] Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
0 Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
QCompliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
❑compliant ❑Noncompliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
El compliant ❑Non -compliant
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 dates) of
the non-compliance and describe the corrective
action(s) taken Attarh arirfdinnal chootc if norac—
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Kenneth Von Voigt
Certification No.: 1006360
Grade: 2 Phone Number: 9103521435
Has the ORC changed since the previous NDAR-1? ❑ Yes 0 No
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge
Permittee:
Town of Oak Island
Signing Official: Lisa Stites
Signing Official's Title: Town Clerk
Phone Number: [phone] Permit Exp.: 7/31/27
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 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM. NDAR-2 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page of
Permit No.: W00005790
Facility Name: Fish Factory Road Water Reclamation and Treatment Facility
County: Brunswick
Month: December
Year: 2023
Did infiltration occur at
this facility?
❑ YES NO
Site Name:
HR-1
Site Name:
Site Name:
Site Name:
Area (acres):
161
Area (acres):
Area (acres):
Area (acres):
Rate (GPDlft2):
2.57
Rate (GPD/ft'):
Rate (GPD/ft'):
Rate (GPD/ft'):
Weather
Freeboard
Site Infiltrated?
YES - NO
Site Infiltrated?
❑ YES ❑ NO
Site Infiltrated?
Yt ; NO
Site Infiltrated?
❑ YES ❑ NO
y
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It
gal I
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GPD/ft' I
ft
gal
min
GPD/ft'
ft
1
PC
71
02
36
4
0
0
000
2
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75
0 1
36
4
0
0
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3
CL
69
0
36
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0
0
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4
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66
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36
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6
C
53
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36
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7
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53
0
36
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0
0
000
8
C
60
0
36
4
0
0
0.00
9
C
72
0
36
4
0
0
0.00
10
R
65
0 1
36
4
0
0
0.00
11
C
52
26
36
4
0
0
000
12
C
54
0
36
4
0
0
000
13
PC
61
0
36
4
0
0
000
14
C
52
0
3 6
4
0
0
000
15
C
56
0
3 6
4
0
0
0.00
16
C
65
0
3 6
4
0
0
0.00
17
R
60
3 1
3 6
4
0
0
0.00
18
PC
59
06
36
4
0
0
000
19
C
48
0
3 6
4
0
0
0.00
20
C
48
0
36
4
0
0
000
a
21
C
58
0
36
4
0
0
000
22
C
57
0
36
4
0
0
0.00
23
C
53
0
36
4
0
0
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24
C
61
0
36
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0
0
000
25
C
78
0
36
4
0
0
000
26
CL
69
0
36
4
0
0
000
27
R
72
1
36
4
0
0
0.00
28
PC
57
0
36
4
0
0
000
29
C
65
0
4
0
0
000
30
C
52
0
�44
0
0
0.00
31 C 57 0 4 0 0 000
Monthly Loading (GPD/ft'): 0 00 #DIV/0' #DIV10I #DIV/01
Year to Date Loading GPD/ft' :

FORM NDAR-2 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page _ of
Did the application rates exceed the limits in Attachment B of your permit? ❑Compliant El Non -Compliant
If not a basin, were the sites kept free of vegetation and raked? ❑� Compliant ❑ Non -Compliant
If not a basin, were there any instances of effluent ponding in or runoff from the sites? (]Compliant ❑Non -Compliant
If a basin, were there any instances of breakout from the berms? E]Compliant ❑ Non-Comphant
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
..i k * e ..
acrrun(n) LaRe11 itac a morta s cc
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Kenneth Von Voigt
Permittee: Town of Oak Island
Certification No.: 1006360
Signing Official: Lisa Stites
Grade: 2 Phone Number: 9103521435
Signing Official's Title: Town Clerk
Has the ORC changed since the previous NDAR-2? ❑ Yes 21 No
Phone Number: [phone] Permit Exp.: 7/31/27
/ • ! 7 •ova
,� ��1,2_,& 6�t ) p 71a'l
Signature Date
Signature Date
By this signature. I certify that this report is accurrale and complete to the best of my knowedge
certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
wth a system designed to assure that all qualified personnel property gathered and evaluated the information submitted Based on niy
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 impnsonment for knowing violations
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mall Service Center
Raleigh, North Carolina 27699-1617

FORM NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page
i
Sampling Person(s) Certified Laboratories
Name: Kenny Von Voigt Name: Environmental Chemists
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ]compliant G Non{omplk—t
If the faahty 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.
On the 13th we witnessed an overage in our daily and monthly BOD limit
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Kenneth Von Voigt
Permittee: Town of Oak Island
Certification No.: 1006360
Signing Official: Lisa Stites
Grade: 2 Phone Number: 9103521435
Signing Official's Title: Town Clerk
Has the ORC changed since the previous NDMR? .J yes h No
Phone Number: [phone] Permit Expiration: 7/31/2027
0 y
Signature Date
Signature Date
By this signature. I candy that this raped is accunate and complete to the best of my knowledge
1 teddy, under penalty of lax. that this document and all attachments were prepared under my direction or supervision in
—ordance wpm a system designed to assure that all qualdied personnel property gathered and evaluated no information
submitted Based on my inquiry of the person or persons who manage the system, or those persons directly responsibie for
galhan ig me information, the mformahon submitted ls, le fire best of my knowledge and babel, true, accurate, and complete I am
aware that there are significant penalties for submitting false information, including the possibility of fines and impnsonment for
knowng violations
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

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