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Home My WebLink AboutWQ0002005_Monitoring - 04-2024_20240521Monitoring Report Submittal Permit Number#* Name of Facility:* Month: * April WQ0002005 House of Raeford Rosehill Report Information Type * NDMR, NDAR-1, NDAR-2, NDMLR Confirmation Email Address: Name of Submitter: * Signature: Date of submittal: Initial Review Reviewer: Year:* 2024 Upload Document* NDMR, NDAR-1, NDMLR April2024.pdf 1.23MB PDF Only Please upload one PDF containing all applicable monitoring reports (i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59). mason.drew@houseofraeford.com Mason Drew 44,460AI D)Lsw Wanda.Gerald 5/21 /2024 This will be filled in automatically Is the project number correct?* W00002005 Is the monitoring report accepted?* Yes NO Regional Office* Wilmington Reviewer: _anonymous Review Date: 7/31/2024 FORM: NOMLR 10-13 NON -DISCHARGE MASS LOADING REPORT ENOMLR) Page -I- of -5 Penmlt No.: WQ0002005 Facility Name: House of Raeford Farms, Inc. County: Duplin Month: April Year: 20224 Fhfld Name: L1 Flw Naats L2 Field Name: L3 FWd 16w L4 Field Name: L5 Area lacres): 12.04 Ams ): 12.04 Area (acres). 12.04 Arve (acrea): 12.04 Area (acres): 10.52 Cover Crop: Cover Crop; Gown Crop: cover Crop: Cover Crap: Load Type: PAN toad Typor PAN Load Type: PAN Load T W. PAN Load Type: PAN Field Loaded? (] YES ❑ No Fkdd Loaded? Q >M ❑ No Field Loaded? i] YES ❑ NO Field l osdsd? ❑ YES i] No Field Loaded? � YES ❑ No Z ' 4 E v r o Z 4 v 4 � � � � a, ! 1 0 > 4` 4 U z Month 1 m tEs/ac tbslsc Wslac lbala l m lbslac lbslac Ibalac lbalrtc i M ibe/ac ft/ac January468,000 36.3 11.8 11.8 W7,000 36.3 14.3 14.3 229,500 36.3 5.8 5.8 535,600 38.3 13.5 13.5 279,000 36.3 8.0 8.0 February468,000 37.4 12.1 23.9 408,5W 37.4 10.6 24.9 882,000 37.4 22.8 28.6 477,000 37.4 124 26A 418,500 37.4 12.4 20.4 March 675,00D 44.2 20.7 44.6 481,500 44.2 14.7 30.6 702.000 44.2 21.5 50.1 307,000 44.2 11.8 37.7 256,500 44.2 9.0 29.4 April 837,0W 32.25 18.7 63.3 832,5W 32.25 18.6 58.2 364,500 32.25 8.1 58.3 297,000 32.25 6.6 44.3 252,000 32.25 8.4 35.9 May 747,000 29.6 15.3 78.6 883,100 29.6 14.0 72.2 469,800 29.6 9.6 67.9 486,000 29.6 %0 54.3 477,ODO 29.6 11.2 47.1 June 521,100 26.8 9.7 88.2 485.100 26.8 9.0 81.2 639,ODO 26.8 11.9 79.8 414,900 2e.8 7.7 02.0 512,100 26.8 10.9 57.9 July423,000 22A 8.5 94.7 MOO 22.1 12.3 93.6 864,900 22.1 13.2 93.0 747,900 22.1 11.4 73A 431,100 22.1 7.6 65.5 August 270,000 22.95 4.3 99.0 =900 22.95 8.3 101.9 715,50D 22.95 11.4 104A 554.400. 22.95 8.8 82.2 868,500 22.95 15.8 81,3 September 1,035,000 15,75 11.3 110.3 $",ON 15.75 9.6 111.4 562,500 15.75 6.1 110.5 0 15.75 0.0 $2.2 540,000 15.75 6.7 88.0 October 769,500 31.2 16.6 126.9 522,000 312 11.3 122.7 805,500 31.2 17.4 127.9 405,000 31.2 8.8 91.0 810,000 31.2 20.0 108A November 760,500 34.05 17.9 144.9 M,500 34.05 17.3 140.0 738 O00 34.0k17.4 145.3 882,000 34.05 20.8 111.8 652,500 34.05 17.6 125.1 December 774,000 35.8 12 Month Floating PAN Load Annual PAN Load Limit tbala 19.2 164.1 3Q0 164A eel rrOD 35.6 16.4 158.4 300.00 150.4 585,000 35.159.8 387 000 36A 9.8 121.4140.8 300.00 121.4 531,OD0 35.8 15.1 300.D0 140.8 FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDULR) Page Z of S Permit No.: WQ0002005 Facility mama: House of Raeford Farms, Inc. County: Duplin Month: April Year. 2024 Field Name: L6 Field Neese: L7 Field Name: L8 Field #lame: L9 Field Name: L10 Arta (acres): 8.66 Area (acme): 12.04 Area (acres): 12.04 Arse (win): 12.04 Area (scrr s): 10.52 Cover Crop: Cowr Crap: Cover Crop: Cow crw. Cover Crop: Load Type: PAN Load Type: PAN Load Type: PAN load Type: PAN Load Type: PAN Field Loaded? [ YES © No Field loaded? [] VU ❑ NO Field Loaded? YEs ❑ No Field Lwmbd? YES ❑ No Field Loaded? ❑ YES ( NO 3 y e t� �+ z (j d t s p' < a , s 9L Z � ` a I IL a. _ P i s O. -+ • ` Monts Ibslac itlNac ad mgfL ftWw ftin gal mg1L HWac Ibslac e M& lLreNdsc NWw m RWac Ibefac January 378,000 1 36.3 13.2 13.2 234,000 36.3 519 5.9 526,500 36.3 13.2 13.2 472,5W 36.3 11.9 11.9 382,500 36.3 11.0 11.0 Febnj&Ty 342,000 1 37.4 12.3 26.5 571,500 37.4 14.8 =7 634,500 37.4 16.4 29.7 787,500 37.4 204 32.3 382,500 37.4 11.3 22.3 March 490,5W 44.2 20.9 46.4 724 UM 44.2 22.2 42.9 488,000 44.2 14.3 44.0 337,500 44.2 10.3 42.5 288,000 44.2 10.1 32A April 346,600 32.25 10.8 57.2 50,500 32.25 13.4 $6.2 441,000 32.25 9.9 53.9 502,604 32.25 12.0 55.2 508,500 32.25 13.0 45.4 314,100 31.4 9.5 66.7 790,2W 31.4 17.2 73.4 768,600 31.4 16.7 70.6 W8,500 31.4 1&0 68.2 319,500 31.4 8.0 53.4 June 345,600 26.8 8.9 75.6 591,3W 26.8 11.0 84A 493,200 26.8 9.2 79.7 266,4d3 26.8 4.9 73.i 880,200 26.8 18.7 72.1 ,luty 333,000 22.1 7.1 82.7 774,000 22.1 11.8 96.3 731.700 22.1 11.2 90.9 612,000 22.1 9A 82.5 639,000 22.1 11.2 83.3 August 678,600 22.95 16.0 97.7 W7,800 22.95 eA 104.3 423,000 22,95 6.7 97.7 487,800 22.95 7.8 90.3 337,W0 22.95 6.1 89A September 643,500 15,75 9.8 107.4 886,5W 15.75 9.7 114.0 355,500 15.75 3.9 101.5 472,5W 16.75 6.2 96.4 0 15.75 0.0 89.4 October 283,500 31.2 8.5 116.0 198,000 31.2 4.3 118.3 598,500 31.2 12.9 114.5 6MAW 31.2 13.6 109,0 252.000 31.2 6.2 95.7 November 400,5W 34.05 13.1 129.1 643,500 34.05 15 133.6 643,500 34.05 16.2 129.6 612,0W 34.03 14A 123.5 1,228,500 34.05 33.2 128.8 December 527,400 35.8 12 Month Floating PAN Load (Hwaclyr): Annual PAN Load Limit (Thal k 18.2 147.3 300 147.3 77310Q . 35.8 19.2 352.8 300.00 152.E 733,500 35.8 18.2 147.$ 300.00 147.8 531,000 ' .8 13.2 136.6 300.00 136.E 270,000 35.8 7.7 136.5 300.00 136.5 FORM: NDWR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) page .l of Permit No.: W00002005 Facility Name: House of Raeford Farms, Inc. County: Duplin Month: Apd1 Year: 2024 Field Name: CP4 Fidel Name: 5A Reid Name: 5AA Fhad Name: 5B Field Nance SA Area (acres): 23 Area (corer as Area (acres): 5.5 Area (mcrse): 6.9 Area (acme): 16.02 Cover Cry: Cover crop: Cover Crop: com Croon Cover Crop: Load Type: PAN L O*d Type: PAN Load 'type: PAN LOW Type: PAN Load Type: PAN Field Loaded? YES ❑ No FhW L*~j El YLS C) No Field Loaded? ❑ YES 0 No Field Loaded? El YES ❑ NO Field Loaded? El YES ❑ No °z z m IL C 4 Month 1pi m IlWac IbelaC sm m9FL Ibdae ftlec am mom wac "WaC MOIL IbNao mfac lbelae IW= Jana 2,736,OD0 36.3 36.0 35.0 721,033 36.3 31.7 31.7 0 36.3 0.0 0.0 565,761 36.3 24.8 24.8 370,671 36.3 7.0 7.0 February-733,500 37.4 9.9 46.0 818,714 37.4 28.0 $9.8 0 37.4 0.0 0.0 4$4,938 37.4 21.9 40.7 317,716 37.4 6.2 13.2 March 1,426,500 44.2 22.9 68.8 721,&13 44.2 30.8 96.2 0 44.2 0.0 0.0 585,761 44.2 30.2 77.0 37%871 44.2 8.7 21.9 1,062,D00 32.26 12.4 81.2 606,713 32.25 19.8 1180 0 32.25 0.0 0.0 390,721 32.25 15.5 92.5 261,231 32.25 4.4 28.3 May 1,748,700 29.6 18.8 100.0 711,510 29.6 25.5 143.5 0 29.6 0.0 0.0 557WO 29.6 =0 112.E 360,370 29.6 5.6 31.9 June 3,208,500 28.8 31.2 131.2 596,388 26.8 19.3 'iWA 0 264 0.0 0.0 499,757 26.8 16.2 128.7 306,242 26.8 4.3 36.1 July 2,979,000 22.1 23.9 155.1 W,847 22.1 22.9 185.7 0 22.1 0.0 0.0 670,799 22.1 17.9 146.6 4391489 22.1 5.1 41.2 A ust 2,218,500 22.95 18.5 173.5 801JW 22.95 16.7 202.4 0 22.95 0.0 0.0 411,453 22.95 13.1 1598 308,883 22.95 3.7 44.9 September 1,953,000 15.75 11.2 184.7 8t18,391 15.75 11.8 213.9 0 16.76 0.0 0.0 476,847 15.75 9.1 108.7 312,417 15.75 2.6 47.4 October 1,750,500 31.2 19.8 204.5 402,153 31.2 15.2 229.1 0 31.2 0.0 0.0 315,201 31.2 11.9 180.E 206,511 31.2 3.4 50.8 November 2,893,500 34.05 35.7 24D.2 18.2 124531 0 1 34.05 0.0 0.0 1308,473 34.05 12.7 1933 202,103 34.05 3.6 $4.4 December 2,439,00D 35.8 12 Month Floating PAN Load (lbel Annual PAN Load Limit r: 31.7 271.9 300 271.9 803 35.8 25.1 2714 300.00 1 271 A 0 35.8 0.0 0.0 3DO.00 0.0 1 472 816 35.8 20.5 213.8 300:00 1 213.8 309,776 35.8 5.8 60.2 300A0 60.2 FORM: NOMi.R 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of-5- Permit No.: WO0002005 Facility flame: House of Raeford Farms, Inc. County- ©uplin worth: April Year: 2024 Field Name: 6B Field Narw. Field Name: FW Marne: Field Name: Area (acres}: 0.7 Ana (awn). Arse (acresr Ana (acnea]: Arw (acnsk Cover Crop: Cones cfqx Cover Crop: Cover orw cover crop: Load Typa: PAN Load Type: Load Type: Loud 7yw Load Type: Fktid Loaded?, El YES ❑ No RM Loaded? ❑ YM ❑ No Field Loaded? ❑ YES ❑ No Fw Lawwo: ❑ YES ❑ No Fish Loaded? ❑ YES ❑ No •Z > a� dV a • > r • > > r Month gal m Ibelac ltmlaG S& lbelac Robe ow rr1 "Jae fwaG am AIVL bubo ftftc gm mg#L Ibelac Uwac January 390,180 38.3 17.5 17.6 February 334,440 37.4 15.6 33.2 March 390,180 44.2 21.5 54.7 AprR 274,980 32.25 11.0 65.7 May 384,600 29.6 14.2 79.9 June 322,380 26.8 10.8 90.6 July 462,620 22.1 12.7 103.4 LuEst 325,140 22.95 9.3 112.6 September 328,860 15.75 6.4 119.1 October 217,380 31.2 8.4 127.5 November 212,740 34.05 9.0 136.6 Decerrrber 326,OW 35.8 12 Month Floaft PAN Load Annual PAN Load Lkn Ibsl 14.5 151.1 300 151.1 0.0 0.0 0.0 0.0 FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page S of 5 Did the mass loading rates exceed the limits in Attachment B of your permit? Compliant ❑ Nan -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 JORC) Certification Permittee Certification ORC: Joseph Teachey Permittee: House of Raeford Certification Number: 14930 Signing Official: Nicole Reynolds Grade: S1 Phone Number: (910) 284-0148 Signing Official's Title: Plant Manager Has the ORC changed since the previous NDMLR? ❑ yes 0 No Phone No.: (910) 223-1894 Permit Exp.: 10/31/31 Signature gate Slg tune Date By this signature, I certdy that this report is accurratvand complete to the best of my knowledge. I certify, under pena4y of law, that this 4onimerA and all attachments were prepared under my direction or supervision in accordance with it 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 dlrectty responsible for gathenrg the information, the mfonnaWn submitted is, to the hest of my knowledge and belief, true, accurate, and complele- I am aware that There are significant pena}ties for submitting false information, including the possibility of fines and imprisonment for knowing viotations Mail Original and Two Copies to: Division of Water Resources Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Pegs -j- of - Permit No.: WQ0002005 Facility Name: House of Raeford - Rose Hill WWTF County: Duplirt Month: Aprif Year 2024 PPI: 001 Flow Measuring Point: ❑ Influent 0 Effluent ❑ No now generated Parameter Monitoring Point: ❑ Ir kmt ❑ Effluent ❑ Groundwater LowerkV ❑ Sirf&* water ParamsterCodQ 0 50050 00310 00681 00680 MO 50060 31616 00610 00625 00020 00600 00400 00666 WQ= T0300 00530 1 d w S 1*m a G m c G � � ac 4 ~ V E m z F '�i F. ` #� _ 3 E' rl 24-hr hrs APD mgIL nNOL m L ntWL m SHOO mIL m mg1L mg1L au mgfL 1 07:30 8 5NAW <0.1 7.8 2 07:30 8 WOOD 94 <0.1 41 58A 76.1 <0.02 78.14 7.83 5.19 34.5 145 3 07:00 7 =,000 <0.1 7.67 4 07:30 8.5 6001000 0.07 7.74 5 0730 8.25 38D,00D 0.11 7.8 B 08:00 2 0 7 08:00 2 36D,000 8 07:30 8 610 000 0.08 7.87 9 07:30 8.6 6101000 0.05 7.99 10 0710 8 80D,000 102 0.09 1 41 51.6 84A 0,33 64.95 7.8 7.14 30 154 11 07:30 8.5 6=1000 <0.1 7.86 12 07:30 8 350,000 <0.1 7.62 13 08:00 2 0 14 08:00 2 390,00D 15 07:00 8.75 810.000 0.04 7.55 16 07:30 8.5 1 590,000 0.07 8 17 07:30 8.5 e0,000 0.04 8.03 18 07:00 8 6w,000 0.11 8.26 19 07:30 8 370,000 20 08:00 2 0 21 08:00 2 350,000 22 07:00 8.5 woOD 0.09 7.29 23 07:30 8 620,000 0.15 8.46 24 07:30 8 800.000 0.16 8.42 25 07:30 2 5W,000 0.12 8.43 26 07:00 2:00:00 350,000 0.1 8.45 27 08:00 2 0 .26 08:00 2 370,000 29 07:00 a em.000 0.09 8.14 30 07:30 8 610,000 0.1 8.33 31 Average: 468.000 98.00 0.07 41.00 54.85 70.36 0.17 70,56 6.17 32.25 149.50 Daily Maximum: 620,000 102.00 0.18 41.00 58.10 78.10 0.33 76.14 8.46 7.14 34.50 154.00 Qa minimum: Q 94.00 0.04 41.00 57.60 84.60 0.02 64.93 7.29 5.10 30.00 145.00 Sampling Type: ReaNds Grab Grab Grab Qmb Grab Offib Grab Grab Grab Grab Grab Onlib Grab (trap Grab Monthly Lim#: 800,000. Daily Lknit: Sample Frequet": f on*XOA 2 X Month Amumny Annually r S X Year 5 X Weak 2 X Moir 2 X Month 2 X Um * 2 X Month 1 2 X Month 6 X Week 2 X Monitr 2 X Month 3 X Year 2 X Month 7.10 7.10 7.10 Average: 19.20 5.00 1.60 0.00 0.03 Daily Maximum: 19.20 S. 1.00 0.20 0.03 Daily Minimum: 19.20 5.1.60 0.20 0.03 FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page g of g Sampling Person(s) Certified Laboratories Name: Jay Baker Name: Enviromental Chemist Name: Name: Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? El compliant ❑ Noncompliant 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: Joseph Teachey Permittee: House of Raeford Certification No,: 14930 Signing Official• Nicole Reynolds Grade: SI Phone Number: (910)284-0148 Signing Officials Title: Plant Manager Has the ORC changed since the previous NDMR7 ❑ Yes n� No Phone Number: (919)223-1894 Permit Expiration: 10/31/2031 Signature ate ignature Date By this signature, I certify that this report is accurrate and complete to the best of my knowledge 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 ail 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 sign cant 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-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page ! of -5 Permit No.: W00002005 Facility Name: House of Raeford Farms, Inc County: Duplin Month: April Year. 2024 Did irrigation occur at this facility? 0 Ye5 ❑ No FW Now Field Name: &AA F1Wth .- Field Name: s-A Area(mvesr 6.9 Area (acres): 5.5 Am {act). 6.9 A(acres): rea 16.2 Cover cc Cover crop: C~ crop: Cover crop: Hourly Rail (in): Floury hate (in): Hourly Rats (6ny Hourly Rate (in): Annul Rate (In): OD Annual Rate (in): 60 AnaW Rabb 80 Annual Rate (in): 50 Weather Freeboard Field hrip %P ❑ Y0 ❑ w Field Irrigated? ❑ YES ❑ mo FlSid lrfteled? ❑ YS ❑ No Field Irrigated? ❑ YES ❑ No a. coa I� y 7! Z J 9` J! E ,J OF in ft ft gal min 101 61 gai ruin in In ow min In in gal min In in 1 CL 57 0 4.41 2 CL 64 0 4.54 3 CL 67 0 4.66 4 C 44 1.2 4.41 5 CL 40 0 4.25 61 C 46 0 4.04 7 C 59 0 3.79 8 C 47 0 3.83 103,119 300 0.55 0.11 80,11M 300 a43 0.09 52,953 300 0.12 0.02 9 CL 58 0 4 10 CL 56 1 0 14.16 11 CL 64 0 4.16 103,119 300 0:55 0.11 80,823 300 1 0.43 0.09 52,953 300 0.12 0.02 12 CL 65 0.2 4.25 103,119 300 0.55 0.11 80,823 300 1 0.43 0.09 52,953 300 0.12 0.02 13 C 65 0.1 4.33 96,237 280 0.51 0.11 75,429 280 a40 0.09 49,419 280 0.11 0A2 14 C 75 0 4.6 15 C 60 0 4.54 16 C 60 1 0 14.58 17 CL 61 0 i 4.5 18 C 59 0 4.41 19 C 60 0 4.33 20 C 60 0 4.33 21j CL 59 0.5 4.66 22 C 43 0.25 1 4.75 103,119 300 0.56 0.11 80,823 300 0.43 0.09 52,953 300 0.12 0.02 23 C 40 0 14,91 24 C 50 0 5 25 C 46 0 4.83 26 PC 52 Q 4.66 27 CL 72 0 4.41 28 CL 73 0 4.5 29 C 56 0 4.66 30 C 58 0 4.83 31 Monthly Loadtng:l 508;713 2.72 31,99 0 0.00 7,06 721 2.13 21.72 261,231 0.59 23.55 12 Month Floating Total (in): FORM: NOAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Paga Z of j Permit No.: Q00000 .d Farms, Inc County: Dupfin Did irrigation occur at this facility? YES 0 No r. i � _ Is ■ 'l:�.F �1:�" �{ lEalif c : t i - 1 �I _ I�Fii71r1Ti / I MEN�'___-I 1111IM1111 : 1 1 1 OEM 11 FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1 ) Page 3 of S Permtthlo.; WQ0002005 Faclifty Name: House of Raeford Farms, Inc County: Duphn Month: April 1irrigation occur at this Ucility? El YIES D No I U 0m, I MIM � MMM Imil j mmmm mmmm i ®_=-__-__�I__--'--��I__-- MMMMM 22.15 f=ORW NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page � of S Did the application rates exceed the limits in Attachment B of your permit? Were adequate measures taken to prevent effluent ponding in or runoff from the sites? Compliant ❑ Non -Compliant [ Compliant ❑ Non -Compliant Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑ Compliant ❑ Non -Compliant Were all setbacks listed in your permit maintained for every application to each permitted site? ❑ Compliant ❑ Non -Compliant Were all freeboards maintained in accordance with the specified freeboard heights in your permit? D Comptiarrc ❑ Non -Compliant If 1he 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: Joseph Teachey Certification No.: 14930 Grade: SI Phone Number: (910) 284-0148 Has the ORC changed since the previous NDAR-1? ❑ yes 7 No Permittee Certification Permittee: Mouse of Raeford Signing official: Nicole Reynolds Signing Officials Title: Plant Manager Phone Number: (919) 223-1894 Permit Exp.: 10/31/31 `.1 Signature 1 4 Date i, ' r Signature Date By this signature. I certify that this report is accurrate and complete to the best of my knowledge. I cer KY. 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 comptele. I am aware that there ate significant penalties for submifting 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