WQ0028666_Monitoring - 06-2024_20240730

Monitoring Report Submittal
Permit Number#* wg0028666
Name of Facility:* Cannons Gate at Bogue Sound
Month: * June Year: * 2024
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR 2024 06 CannonsGate DMR.pdf 3AMB
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: * Joel Mingus
Signature:
Date of submittal: 7/30/2024
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* wg0028666
Is the monitoring report accepted?* Yes NO
Regional Office* Wilmington
Reviewer: _anonymous
Review Date: 8/13/2024

FORM: NDAR-2 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Z
Page
of
Permit No.: W00028666
Facility Name:
Cannons Gate at Bogue Sound
Did infiltration
occur at
County; Carteret
Month:
June
Year:
2024
this facility?
Site Name:
1
Site Name:
2
Site Name:
3
Site Name:
4
�Itdo
Area (acres):
1.66
Area (acres):
0.67
Area (acres):
1.32
Area (acres):
0.36
Rate (GPD/ft2):
1.145
Rate (GPD/ft2):
1.145
Rate GPD/ft2
( )
1.145
Weather
Freeboard
Site Infiltrated?
[jYEs
❑NO
Site
Rate (GPD/ft2):
1.145
c
�,
Infiltrated?
[]Yes
Crac
Site Infiltrated?
[IYEs
NO
Site Infiltrated.
[;1YEs
�. °a
y
o>�
m
z'o
�rac
a
m
e
ea)
Qo
n
°
°
'
op
E
ot
m m
~
2
> 4
y>
Q
m
m
E
N
11
m
m
�
>a C
OLL
J
F in
t
gal min
GPD/ft2
ft
gal min
GPD/ft2
ft
�m
m0�C>U
�
1
C 76
2.7
11,500
0.16
2.70
11,500
al
9 min
GPD/ft2
ft
gal min
GPD/ft2
ft
2
C 80
2.7
11,500
0.16
2.70
11.500
0.39
2.60
11,500
0.20
2.20
11.500
0.73
2.90
3
C 81
2.7
9,500
0.13
2.70
9,500
0,39
2,60
11,500
0.20
2.20
11,500
0.73
2.90
4
C 83
2.7
7,750
0 11
270
7,750
0.33
2.60
9,500
0.17
2.20
9,500
0.61
2.90
5
C 82
2.7
10,300
0.14
2,80
10,300
0 27
260
7,750
0.13
2.20
7,750
049
2.90
6
R 84 0,4
2.7
032
2.80
23,250
0,35
2.80
10,300
0.18
2,20
10,300
0.66
2.90
7
R 87 0.81
2.7
11,667
11,667
0.16
2.80
11.667
0.80
2.80
23250
0.40
2,20
23,250
1,48
2.g0
8
C 83
2.7
11,667
0.16
2,80
11,667
0A0
2.80
11,667
0.20
2.20
11,667
074
2.80
9
C 79
2.7
11,667
0,16
2.80
11,667
0.40
2.80
11, 667
Q20
2.2Q
11,667
0 J4
2.80
10
R 84 0.1
2.5
10,000
0.14
2.70
10,000
0.40
2.80
11,667
0.20
2.20
11,667
0.74
2.80
11
C 84
2.5
9.250
0.13
2.70
9,250
0.34
2.80
10,000
0.17
240
10,000
0-64
2.90
12
C 83
2.5
11,750
0.16
2J0
11,750
0,32
2.90
9,250
0.16
2,40
9.250
0.59
2.90
13
C 88
25
10,750
0.15
2 70
10,750
0.40
2.90
11,750
0.20
2,40
11,750
0.75
290
14
C 91
2.5
11,916
0.16
2J0
11,916
0.37
2.90
10,750
0.19
2.40
10,750
0.69
2.90
15
C 86
2.5
11,916
0.16
2.70
11,916
0.41
2.90
11,916
0.21
2.40
11,916
0.76
2,90
16
C 84
2.5
11,916
016
2.70
11,916
0.41
2.90
11.916
0.21
2.40
11,916
076
2.90
17
C 84
2.5
9,000
0.12
2,70
0
0.41
2.90
11,916
0,21
2.40
11,916
0.76
2.90
18
C 84
2.5
5,000
Q07
280
5,000
0.00
2.80
0
0,00
2.50
0
000
2.90
19
CL 83
2.5
14,750
0.20
2.80
14,750
0.17
2.80
5,000
009
2.50
5,000
032
3.00
20
C 85
2.6
15,000
021
280
15,000
0.51
2.8Q
14.750
0,26
2.50
14,750
C.94
3.00
21
C 87
2.6
13,000
0 .18
2,80
13,000
0.51
2.80
15,000
0.26
2.50
15,000
0.96
3,00
22
C 85
2.6
13,000
0.18
2.80
13,000
0.45
2.80
13,000
0.23
2.50
13,000
0 83
3.00
23
C 86
2 6
13,000
0.18
2.80
13.000
0-45
2.SQ
13,000
0.23
2.50
13,000
0,83
300
24
R 87 1 28
2.7
6,250
0,09
2,90
6,250
0,45
2,80
13,000
0.23
250
13,000
0,83
3.00
25
C 86
2.5
10,250
0,14
2.80
10,250
0.21
2,90
6,250
0.11
260
6,250
040
3A0
26
CL 86
2.5
11,500
0,16
2,80
11,500
0.35
2 80
10,250
0.18
2 50
10,250
0,65
3.00
27
R 87 0.44
2,5
9,000
0.12
2.80
9.000
0.39
2,80
11,500
U.
2.50
11,500
0,73
3,10
28
C 87
2,5
12,750
0.18
2-80
12.750
0.31
2.70
9,000
0.16
2,50
9,000
057
3.10
29
C 89
2.5
12,750
0,18
2.80
12,750
0.44
2.70
12,750
0.22
2.50
12,750
0,81
3.10
31
C 88
2.5
12,750
0.18
2.80
1275 0
0.44
2.70
12,750
0.22
2.50
12,750
0.81
3.10
31
0 44
2.70
12, 750
Q.22
2.50
12 750
0.81
3.14
Monthly Loading (GPD/ft2):
0.16
Year to Date Loadin
GPD/ft):
2 14
0.38
0.19
0.71
5.3C
2.68
3.05

FORM: NDAR-2 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Page .2 of 2
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 f th
Compliant ❑Non -Compliant
Compliant []Non -Compliant
"Jill a sites . Compliant ❑Non -Compliant
If a basin, were there any instances of breakout from the berms?
Compliant []Non -Compliant
Was the onsite automatically activated standby power source tested and operational?
Compliant QNon-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
ORC: Raymond Lacy Braxton
Certification No.: 999895
Grade: IV Phone Number: 910 431-9248
Has the ORC changed since the previous NDAR-2? ❑Yes ONo
Signature
Date
By this signature. I certify that this report is accurrate and complete to the best of my knowledge
Permittee Certification
Permittee:
Aqua, North Carolina INC
Signing Official: Katie Sickens
Signing Official's Title: Coastal Regional Supervisor
Phone Number: 910 779-0794 Permit Exp.: 8/31/24
V ! v _ & _1ZS 21-
Signature Date
I certify, udder 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. NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page ` of 10
Permit No.: VVQ0028666
Facility
Name:
Cannonsgate
at Bogue
Sound
County:
Carteret Month: June Year: 2024
P {nundv, ater Lowering urface water
PPI: 001
Flow MeasurinHine,nt
9Parame
L_.tfluent
_ !o Flow
generated
er
n pue:-r
Moni ring
Parameter Code --►
50050 00310
00940
31616
00610
00625
00620
00600
00400
00665
70300
OD530
00076
)
o
F
O
c
O
°
li
2
�
°
U
s
0
=
a,a
of
c
_
In
CL
0
a
? a
HU
l o
`C
F n. o
0V)0
1
m
46.000
mg/L
#/100 mL
mg/L
mg/L
mg/L
mg/L
su
mg/L
mg/L
mg/L
NTU
2
46,000
<10
3 070.0 3
4 07:00 2
5 0700 5
6 0600 4
7 07:00 3
8
38.000
31,000 <2
41,200
93.000
46,667
46,667
-1
<0.2
<0,5
16.8
168
7.51
7.1
728
7 34
<10
0.092
7.33
<2 5
0.072
0 07
0-076
9
46,667
<10
10 06.00 3
40.000 1<10
7.41
11 0700 2
12 07:00 1
37,000
47,000
2
<0.2
14.5
<0.5
14 5
7 31
0.058
5 S1
<25
0,058
13 0700 1
43,000
7.35
0.059
14 07'00 1
15
47,666
47,666
7.42
0.062
<1C
16 47,666
17 1430 1
18 12:00 1
9.000
20,00
7,45
< 10
0 061
19 0700 2
59.000
7.38
0AS?
20 0700 1
21 06:00 2
22
60,000
52,000
52,000
7.4
7,37
26
0.049
p.Ofi'r
0.079
23
52,000
<10
24 06:00 2
25 06:00 2
26 07:00 1
27 0700 1
28 07:00 1
25,000
41,000
46,000
36,000
51.000
7.29
7.32
7.35
7 32
<10
0 082
0.073
0 081
0,079
29
51,000
7.43
0.091
30
51,000
<10
31
<10
Average: 45.007 1 100
Daily Maximum: 93,000 2.00
Daily Minimum: 9,000 2.00
Sampling Type: Recorder Composite Composite
Monthly Avg. Limit: 200,000 10
1.00 0,00 725 8,40 15.65
1.00 0 20 14.50 16.80 16.80
1 00 0.20 050 0.50 1450
Grab Composite Composite Composite Composite
14 4
7.51
7,10
Grab
6.57
D,00
0,05
Z33
2 50
10A0
5, 81
250
0 OS
Composite
Composite Composite
Recorder
Daily Limit: 15 25 6 6 to 9
Sample Frequency: Continuous 2 x Piton;h 3 x Year 2 x Month 2 x Month 2 x h4onth 2 x PAorrth 2x Month 5 x bti'eek
5
10
10
2 x Pfonth
3 x Year 2
x Month Continuous

FORM NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 0— of to
Sampling Person(s)
Name: Raymond Lacy Braxton
Name:
Certified Laboratories
Name: Environmental Chemists, INC
11 Name:
[-IlCo nphant ❑Non Compliant
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(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: Raymond Lacy Braxton vt r. rd.
Permittee: Aqua, NC. INC
Certification No.: 999895
Signing Official: Katie DlekerTs / r + GL ec, -
Grade: IV Phone Number: 910-431-9248
Signing Officials Title: Coastal Regional Supervisor
Has the ORC changed since the previous NDMR?
Phone Number: 910 779-0794 Permit Expiration: 8/31/2024
�✓
7`22 44
7 /'Z5/2y
Signature
Date 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 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 passibility 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: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR)
Page 3 or,' [ G
�Vrrna NO.: VVUUUZbbbb Facility Name: Cannons ate at Bo ue Sound
9 9
ffI�777
PPI: 002 Flow Measuring F'U ntrnt Effluent No flcw generate
Parame
county: Carteret
n Effluen` ,, O.,nd,roater Lrnverfng
er Mol rtri nng P t
Month:
Surface
June
Water
Year:
2024
Parameter Code -b
50050
>
c
6 O
< _E E ;;
U ~ U
U
O O
24-hr hrs
3
_o
LL
GPD
I
-
1
32,667
2
32.667
3
07:00 3
21,000
4
07:00 2
27,000
5
6
07:00 5
06:00 4
30.000
31,000
-
7
07:00 3
22,250
8
22.250
9
22,250
10 06:00 3
29,000
11 07:00 2
23.000
12 07:00 1
13 07:00 1
14 07:00 1
30.000
29.000
33.666
15
16
17 14:30 1
33.665
33.666
28,000
18 12:00 1 18.000
19 07,00 2
28.000
20 07:00 1
25,000
21 06:00 2
30.000
22
30.000
23
30,000
24 06:00 2
23.000
25 06:00 2
26 07:00 1
28,000
31,000
27 07:00 1 29,000
28 07:00 1
33.000
- -
29
33.000
30
33,000
31
Average:
28,403
Daily Maximum:
33,666
Daily Minimum:
18,000
Sampling Type: Recorder
Monthly Avg. Limit: 80,000
Daily Limit:
Sample Frequency: continuous,

FORMS NDMR 10-13
NON -DISCHARGE MONITORING REPORT (NDMR)
Page 11 of /0
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?
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: Raymond Lacy Braxton Permittee: Aqua, NC. INC
Certification No.: 999895 Signing Official: Katie 9 ekens MGLec,,_
Grade: IV Phone Number: 910-431-9248 Signing Officials Title: Coastal Reginal Supervisor
Has the ORC changed since the previous NDMR? Phone Number: 910 779-0794 Permit Expiration: 8/31/2024
Signature Date 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 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 NDMR 10-13
NON -DISCHARGE MONITORING REPORT (NDMR) Page �_ of
t'G
Permit No.: WQ0028666 Facility Name: CannonSgate at Bogue Sound County: Carteret::j: Month: June Year:
PPI: 003 Flow Measuring j� uent Effluent �No Flow generated n n Eftluen
Param erlo ring rP°''n'�"'ater towering Usurtace Water
Parameter Code ► 50050 31616 00600 00400
2024
c
O
'- a, E c
m
O U F- ~ i o o
W U LL t
O � V
O
a
24-hr hrs
1
GPD
282,667
#1100 mL mglL
su
2
282,667
3 OT00 3
3,000
4 07:00 2
5 07:00 5 p
6 0600 4
p
7 07:00 3
0
8
0
9 0
10 06:00 3 0
11 07.00 2
0
12 OTOO 1
0
13 OTOO 1
p
14 OTOO 1
0
15 p
16
p
17 14:30 1 0
181 12:00 1
0
19 07:00 2
0
20 07:00 1
0
21 06:00 2 0
22
0
23
p
24 06:00 2
0
25 06:00 2 0
26 07:00 1
0
27 07:00 1
0
28 OTOO 1 0
29
0
30
p
31
Average:
18,944,47
#REFI
1.gp
Daily Maximum:
282,667.00
#REF!
1.80
6.88
Daily Minimum: 0.00 #REF! 1.80
6.88 11
Sampling Type:
Recorder
Grab
Grab
Grab
Monthly Avg. Limit:
Daily Limit:
Sample Frequency:
Cont!nuous
Monthly
Monthly
r.11 ly

FORM: NDMR 10-13
Name: Raymond Lacy Braxton
Name:
NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) Certified Laboratories
Name: Environmental Chemists, INC
Name:
Page 6 of ! U
_;Compliant '._INon-Compliant
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(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: Raymond Lacy Braxton Dyes [1No
Certification No.: 999895
Grade: IV Phone Number: 910-431-9248
Has the ORC changed since the previous NDMR?
_22 -24
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge
Permittee Certification
Permittee: Aqua, NC. INC
Signing Official: Katie-04eheas Me-
Signing Officials Title: Coastal Regional Supervisor
Phone Number: 910 779-0794 Permit Expiration: 8-81-24
'KcJ�-" AQ, -7izs
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

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 7 of /0
Permit No.: WO0028666 Facility Name: Cannonsgate at Bogue Sound
PPI: 004 Flow Measuring in : t �Efflu�ni _ No flow generate
County: Carteret Month: June Year: 2024
n Nr effiuen :groundwater Lowering ✓'S rrface Water
Parameter XAo rmg P
Parameter Code -
s 31616
00600
00400
00480
O
Q E
�~
O
c
O
n
U�
W
O
w=
LLU
c
o 2
F Z
2
c
C
rn
24-hr
1
2
3 07:00
hrs
3
#1100 mL
mg/L
su
mg/L
I-
4 OTOO
2
5 07:00
5
6 06:00
4
7
8
07:00
3
9
10
06:00
3
11
12
07:00
07:00
2
1
13
14
15
07:00
07:00
1
1
16
17
14:30
1
18
12:00
1
19
0700
2
20
OT00
1
21
06:00
2
22
23
24
06:00
2
25
0600
2
26
07:00
1
27
28
07:00
07:00
1
1
29
30
31
Average:
Daily Maximum:
Daily Minimum:
Sampling Type:
Monthly Avg. Limit:
Grab
Grab Grab
Grab
Daily Limit:
Sample Frequency:
Annual
Annual Annual
Annual

FORM' NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR)
Page IF of
Sampling Person(s) Certified Laboratories
EName:
Raymond Lacy Braxton Name: Environmental Chemists, INC
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? �compllant ]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 Perm ittee Certification
ORC: Raymond Lacy Braxton
Permittee: Aqua, NC. INC
Certification No.: 999895 Signing Official: Katie..B16i4a;gs I r l
Grade: IV Phone Number: 910-431-9248
Signing Official's Title: Coastal Reginal Supervisor
Has the ORC changed since the previous NDMR? ❑yes ONo Phone Number: 910 779-0794 Permit Expiration: 8/31/2024
7�sz
Signature Date
Signature Date
By this signature, I certity that this report is accurrate and complete to the best of my knowledge, 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 ail]
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: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR)
Pape 9 of o
Permit No.: VVQ0028666 Facility Name: Cannonsgate at Bogue Sound County: Carteret Month: June Year: 2024
PPI: 005 Flow Measuring jnfint Effluent No flow geaeratei J_ Effluent oundv,ater Lowe-ng Surface Water
[ Pararn2 e� . ��o ring
Parameter Code ► 31616 00600 00400 00480
c
1
2
3
4
5
6
7
8
`9 O
Q _E`_
0
O O
_
�o
LL
U
c
;ua
Z
CL
«_
rn
24-hr hrs #/100 mL mg/L su
mg/L
07:00 3
07:00 2
07:00 5
06:00 4
0700 3
9
10 06:00 3
11 0700 2
12 07:00 1
13 07:00 1
14 07:00 1
15
16
17 14:30 1
18 12:00 1
19 07:00 2
20 0700 1
21 06:00 2
22
23
24 06:00 2
25 06.00 2
26 07:00 1
27 07:00 1
28 07 00 1
29
30
31
Average:
Daily Maximum:
Daily Minimum:
Sampling Type:
Monthly Avg. Limit:
Daily Limit:
Sample Frequency:
Grab
Annual
Grab
Annual
Grab
Annual
Grab
Annual

FORM NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page r 0 of i`U
Sampling Person(s) Certified Laboratories
Name: Raymond Lacy Braxton Name: Environmental Chemists, INC
Name:
Name:
[]Compliant ❑Non -Compliant
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(s) the facility was not in compliance Provide in your explanation the date(s) of the non-compliance and describe the corrective actions)
taken. Attach additional sheets if necessary_
Operator in Responsible Charge (ORC) Certification
ORC: Raymond Lacy Braxton ElYes F-17INo
Certification No.: 999895
Grade: IV Phone Number: 910-431-9248
Has the ORC changed since the previous NDMR?
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: Aqua, NC. INC
Signing Official: Katie gi&ans YKC-L 2c,4^r _
Signing Official's Title: Coastal Regina] Supervisor
Phone Number: 910 779-0794 Permit Expiration: 8/31/2024
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