HomeMy WebLinkAboutWQ0015931_Monitoring - 08-2024_20240918Monitoring Report Submittal
..................................................
Permit Number#* WQ0015931
Name of Facility:* Trump National Golf Club Charlotte WWTP
Month: * August Year: * 2024
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address: *
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Upload Document*
Trump August 2024.pdf 17.34MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Logan@tcwwastewater.com
Logan Harlan
'�*" �?I"?'tla r
Reviewer: Wanda.Gerald
9/18/2024
This will be filled in automatically
Is the project number correct?* W00015931
Is the monitoring report accepted?* Yes NO
Regional Office* Mooresville
Reviewer: _anonymous
Review Date: 10/14/2024
FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: W00015931
Facility Name: Trump National Golf Club Charlotte WWTP
County: Iredell
Month: August
Year: 2024
PPI: 001
Flow Measuring Point: ❑ Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point: ❑ Influent C Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code 0
60050
00310
50060
31616
00610
00625
00620
00600
00400
00665
00530
00076
>
�
O
O
d
O
YUO
E
6
LL O
g
O
Z
,
O
Z
3
i
z
g
O Q
Q
a
0. _n
0to1£ c IaQ
wQ3
F
24-hr
hrs
GPD
mg/L
mg/L
#/100 mL
mg/L
mg/L
mg/L
mg/L
su
mg/L
mg/L
NTU
1
12:00
2
0
7.6
0.246
2
09:45
0.5
0
7.6
0.272
3
0
0.254
4
0
0.249
5
08:00
3
0
7.6
0,254
6
1 09:00
1 0.75
0
1
7.8
1
1
0.249
7
12:30
1 0.75
5,821
7.7
0.386
8
08:00
1
13,871
7.7
0.737
9
08:00
4.5
12,724
7.6
1.979
10
9,904
0.445
11
7,065
1
1
0.512
121
09:45
1.5
7.339
7.4
0.638
13
12:30
0.75
6,465
_
7.7
0.657
14
12:15
0.75
6.568
7.6
0.492
15
13:45
1
6,779
7.6
0.41
16
12:15
1
6,795
7.5
0.367
17
6.647
0,321
181
1
6,639
0,324
191
15:30
1 0.5
6,633
8
0.247
20
13:30
1
4,847
7.8
0.22
21
10.30
0.75
3,912
7.7
0.306
22
13:30
1
5,481
7.6
0.289
23
07:15
1.5
5,267
7.7
0.334
24
4,763
0.366
251
5.481
0.378
26
13:00
1
5.083
7.6
0.407
27
13:30
1
4,281
7.7
0.409
28
10:00
1.5
4,440
7.8
0.44
29
12:00
1
4,950
7.9
0.346
30
12:00
1
4,893
7.8
0.374
311
1
6.305
0.356
Average:
5,257
0.43
Daily Maximum:
13,871
8.00
1.98
Daily Minimum:
0
1
7.40
0.22
Sampling Type:
Recorder
Grab
Grab
Grab
Grab
Grab
I Grab
Grab
Grab
Grab
Grab
Recorder
Monthly Limit:
25,000
10
14
4
5
Daily Limit:
15
25
6
10
10
Sample Frequency:
Continuous
Quarterly
I
Quarterly
Quarterly
Quarterly
Quarterly
Quarterly
5 X Week
Quarterly
Quarterly
Continuous
FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) Certified Laboratories
Name: Logan Harlan Name: Waypoint Analytical
Name: Brian Stephens Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? E 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: Logan Harlan
Permittee: Trump National Golf Club Charlotte, LLC
Certification No.: WW 1014576
Signing Official: Charles Brandon Long
Grade: WW 2 Phone Number: 704-900-9191
Signing Official's Title: Owner - TCW Wastewater Mgmt., Inc.
Has the ORC changed since the previous NDMR? ❑ Yes 121 No
Phone Number: 704-351-4049 Permit Expiration: 5/31/2023
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 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: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Permit No.: W00015931
Facility Name: Trump National Golf Club Charlotte WWTP
County: Iredell
Month: August
Year: 2024
Did irrigation
Field Name:
D-1
Field Name:
D-2
Field Name:
D-3
Field Name:
D-8
occur
Area (acres):
--
0.35
Area (acres):
0.35
Area (acres):
0.35
Area (acres):
•--
0.35
at this facility?
Cover Crop:Cover
Crop:
p�
Cover Crop:
p:
Cover Crop:
p:
E YES ❑ NO
Hourly Rate (in):
0.12
Hourly Rate (in):
0.12
Hourly Rate (in):
0.12
Hourly Rate (in):
0.12
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
D YES = No
Field Irrigated?
❑ YES ❑ No
Field Irrigated?
D YES ❑ No
Field Irrigated?
❑ YES O No
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°F
in
I ft
I ft
gal
I min
in
in
gal
I min
in
in
I gal
I min
I in
in
gal
I min
in
in
1
C
91
0
3
3.75
0
0
0.00
0.00
0
0
0.00
0.00
0
60
1 0.00
0.00
0
0
0.00
0.00
2
C
78
0
3
3.75
0
0
0.00
0.00
0
0
0.00
0.00
0
60
1 0.00
0,00
0
0
0.00
0.00
3
0
0
0.00
0.00
0
0
0.00
0.00
0
60
1 0.00
0,00
0
0
0.00
0.00
4
0
0
0.00
0.00
0
0
0,00
0.00
0
0
1 0.00
0.00
0
0
0.00
0.00
5
C
81
0.5
2.75
3
1 600
30
0.06
0.06
0
0
0.00
0.00
600
30
0.06
0.06
0
D
0.00
0.00
6
CL
1 78
0
3
3
11200
1 60
0.13
0.13
1,200
1 60
0.13
0.13
1,200
60
0.13
0.13
0
0
0.00
0.00
7
CL
79
0.25
3
3
600
1 30
0.06
0.06
1,200
1 60
0.13
0.13
1,200
60
0,13
0.13
0
0
0.00
0.00
8
R
79
1.25
3
3
600
1 30
0.06
0.06
600
1 30
0.06
0.06
0
0
0.00
0.00
0
0
0.00
0.00
9
PC
85
4
3
3
0
0
0.00
0.00
0
1 0
0.00
0.00
0
1 0
0.00
0.00
0
0
0.00
0.00
10
0
0
0.00
0.00
0
1 0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
11
1
0
0
0.00
0.00
0
1 0
0.00
0.00
0
0
0.00
0.00
0
1 0
0.00
0.00
121
CL
77
0.5
3
3
1 600
30
0.06
0.06
600
30
0.06
0.06
0
0
0.00
0.00
0
1 0
0.00
0.00
13
R
74
0.25
3
3.5
1,200
60
0.13
0.13
600
30
0.06
0.06
1,200
60
0,13
0.13
0
1 0
0.00
0.00
14
C
82
0
3.25
3.5
1,200
60
0.13
0.13
1,200
60
0.13
0.13
1,200
60
1 0.13
0.13
0
1 0
0.00
0.00
15
PC
84
0
3
3.25
1,200
60
0.13
0.13
1,200
60
0.13
0.13
1,200
60
0.13
0.13
0
0
0.00
0.00
16
C
85
0
3
3.75
1,200
60
0.13
0.13
1,200
60
0.13
0.13
1,200
60
0.13
0.13 1
0
0
0,00
0.00
17
0
0
0.00
0.00
0
1 0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
181
1
0
0
0.00
0.00
0
0
0.00
0.00
1 0
0
0,00
0.00
0
0
0.00
0.00
19
CL
83
0.5
2.75
3.25
0
1 0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
20
C
79
0.25
2.75
3
0
1 0
0.00
0.00
0
0
0.00
0.00
0
0
1 0.00
0.00
0
1 0
0.00
0.00
21
C
72
0
3
3
11200
1 60
0.13
0.13
1,200
60
0.13
0.13
1,200
60
0.13
0.13
0
1 0
0.00
0.00
22
C
76
0
3.25
3
1,200
1 60
0.13
0.13
1,200
60
0.13
0.13
1,200
60
0.13
0.13
0
1 0
0.00
0.00
23
C
60
0
3.25
3 1
1,200
60
0.13
0.13
1,200
1 60
0.13
0.13
1,200
60
0.13
0.13
0
1 0
0.00
1 0.00
241
1,200
60
0.13
0.13
1,200
60
0.13
0.13
1,200
60
0.13
0.13
0
0
0.00
0.00
25
1
1,200
60
0.13
0.13
1,200
60
0.13
0.13
1 1,200
1 60
0.13
0.13
0
0
0.00
0.00
26
C
87
0
3.5
3
1.200
60
0.13
0.13
1,800
90
0.19
0.13
1,200
60
0.13
0.13
0
0
0.00
0.00
27
C
90
0
3.5
3
1,200
60
0.13
0.13
1,200
60
0.13
0.13
1,200
60
0.13
0.13
0
0
0.00
0.00
28
C
84
0
3.75
3.25
1.200
1 60
0.13
0.13
1,200
60
0.13
0.13
1,200
60
0.13
0.13 1
0
0
0.00
0.00
29
C
89
0
4
3.5
1,200
60
0.13
0.13
1,200
60
0.13
0.13
1,200
60
0.13
0.13
0
1 0
0.00
0.00
30
C
88
0
4
3.5
1,200
60
1 0.13
1 0.13
1,200
60
0.13
0.13
1 1,200
60
0.13
0.13
0
0
0.00
0.00
31
1,200
0
0.13
1 0.13
1,200
0
0.13
0.13
1,200
0
0.13
0.13
0
0
0,00
0.00
Monthly Loading:
21,600
°
2.27
21,600
2.27
21,000
2.21
0
i
0.00
12 Month Floating Total (in):
?''
j P;
19.81
18.54
19.04
0.00
FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Wage
Permit No.: WQ0015931
Facility Name: Trump Nabona� Golf Club Charlotte WWTP
County: Iredell
Month: August
Year: 2024
Did irrigation
Field Name:
D-9
Field Name:
D-10
Field Name:
S-1
Field Name:
S-2
occur
Area (acres):
0.35
Area (acres):
0.35
Area (acres):
0.34
Area (acres):
0.71
at this facility?
Cover Crop:Cover
Crop:
P�
Cover Crop:
P�
Cover Crop:
P:
C! YES ❑ No
Hourly Rate (in):
0.12
Hourly Rate (in):
0.12
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
'D YES FIE N0
Field Irrigated?
0 YES ❑ No
Field Irrigated?
❑ YES [A NO
Field Irrigated?
❑ YES 2 No
❑
a
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in
I ft
I ft
gal
I min
in
I in
gal
I min
in
in
I gal
min
in
I in
gal
I min
in
I in
1
C
91
0
3
3.75
0
0
0.00
0.00
0
0
0.00
0.00
2
C
78
0
3
3.75
0
0
0.00
0.00
0
0
0.00
0.00
3
0
0
0.00
0.00
0
0
0.00
0.00
4
0
0
0.00
0.00
0
0
0.00
0.00
5
C
81
0.5
2.75
3
0
0
0.00
0.00
600
30
0.06
0.06
6
1 CL
78
0
3
3
0
1 0
0.00
1 0.00
1,200
1 60
0.13
1 0.13
7
CL
79
0.25
3
3
0
0
0.00
6.00
1,200
60
0.13
0.13
8
R
79
1.25
3
3
0
0
0.00
0.00
0
0
0.00
0.00
9
PC
85
4
3
3
0
0
0.00
0.00
0
0
0.00
0.00
10
0
0
0.00
0.00
0
0
0.00
0.00
11
0
0
0.00
0.00
0
0
0.00
0.00
121
CL
77
0.5
3
1 3
0
1 0
0.00
1 0.00
600
1 30
0.06
1 0.06
13
R
74
0.25
3
3.5
0
1 0
0.00
1 0.00
1,200
60
0.13
0.13
14
C
82
0
3.25
3.5
0
1 0
0.00
1 0.00
1,200
60
0.13
0.13
15
PC
84
0
3
3,25
0
0
0.00
0.00
1,200
60
0.13
0.13
16
C
85
0
3
3.75
0
0
0.00
0.00
1.200
60
0.13
0.13
17
0
0
0.00
0.00
0
0
0.00
0.00
181
1
1
0
0
0.00
0.00
0
1 0
0.00
0.00
19
CL
83
0.5
2.75
3.25
0
0
0.00
0.00
0
0
0.00
0.00
20
C
79
0.25
2.75
3
0
0
0.00
1 0.00
0
0
0.00
0.00
21
C
72
0
3
3
0
0
0.00
1 0.00
1,200
60
0.13
0.13
22
C
76
0
3.25
3
0
0
0.00
1 0.00
1,200
60
0.13
0.13
23
C
60
0
3.25
3
0
0
0.00
0,00
1,200
60
0.13
0.13
241
1
0
0
0.00
0.00
1,200
60
0.13
0.13
25
0
1 0
0.00
0.00
1,200
60
0.13
0.13
26
C
87
0
3.5
3
0
0
0.00
0.00
1,200
60
0.13
0.13
27
C
90
0
3.5
3
0
0
0.00
0.00
1,200
60
0.13
0.13
28
C
84
0
3,75
1 3.25
0
0
0.00
1 0.00
1,200
60
0.13
0.13
29
C
89
0
4
3.5
0
0
0.00
0.00
1,200
60
0.13
0.13
30
C
88
0
4
3.5
0
0
0.00
0.00
1,200
60
0.13
0.13
31
0
1 0
0.00
0.00
1,200
60
0.13
0.13
Monthly Loading:
0
0.00
21,600
1
2.27
0
0.00
0
0.00
12 Month Floating Total (in):
0.00
17.81
_
FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Permit No.: WQ0015931
Facility Name: Trump National Golf Club Charlotte WWTP
County: Iredell
Month: August
Year: 2024
Field Name:
S-3
Field Name:
S-4
Field Name:
S-5
-
Field Name:
S-6
Did irrigation occur
Area (acres):
---
1.03
Area (acres):
0.77
Area (acres):
0.44
Area (acres):
0.74
at this facility?
Cover Crop:
p;
��
Cover Cro p;
_
Cover Cro p:
Cover Cro p:
121 YES ❑ NO
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
❑ YES CNO
Field Irrigated?
❑ YES Ell NO
Field Irrigated?
❑ YES 21 NO
Field Irrigated?
❑ YES O NO
❑
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1
C
91
0
3
3.75
2
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78
0
3
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4
5
C
81
0.5
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3
6
CL
78
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79
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79
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85
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11
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77
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131
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18
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CL
83
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79
0.25
2.75
3
211
C
72
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3
3
22
C
76
0
3.25
3
23
C
60
0
3.25
3
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25
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C
87
0
3.5
3
271
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3.5
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84
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89
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Monthly Loading:
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1
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12 Month Floating Total (in):
`"''
FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: VVQ0015931
Facility Name: Trump National Golf Club Charlotte WWTP
County: Iredell
Month: August
Year: 2024
Did irrigation
Field Name:
S-7
Field Name:
S-8
Field Name:
S-9
Field Name:
S-10
occur
Area (acres):
1.06
Area (acres):
0.22
Area (acres):
0.66
Area (acres):
0.81
at this facility?
Cover Crop:
p�
Cover p�
Cover p�
CoverCro P:
G Yes ❑ rvo
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
El YES L=i No
Field Irrigated?
El YES 7 do
Field Irrigated?
❑ Yes ❑ Rio
Field Irrigated?
❑ YE5 O No
o
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1
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91
0
3
3.75
2
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78
0
3
3.75
3
4
5
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81
0.5
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3
6
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78
0
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7
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79
0.25
3
3
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R
79
1.25
3
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PC
85
4
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10
11
121
CL
77
0.5
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1 3
13
R
74
0.25
3
3.5
14
C
82
0
3.25
3.5
15
PC
84
0
3
3.25
16
C
85
0
3
3.75
17
18
19
CL
83
0.5
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20
C
79
0.25
2.75
3
21
C
72
0
3
3
22
C
76
0
3.25
3
23
C
60
1 0
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24
25
26
C
87
0
3.5
3
27
C
90
0
3.5
3
28
C
84
0
3.75
3.25
29
C
89
0
4
3.5
30
C
88
0
4
3.5
31
Monthly Loading:
0.00
0
0.00
0
0.00
0
0.00
_
12 Month Floating Total (in):
L0
!�
1
FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Permit No.: VVQ0015931
Facility Name: Trump National Golf Club Charlotte WWTP
County: Iredell
Month: August
Year: 2024
Field Name:
S-11
Field Name:
S-12
Field Name:
S-13
Field Name:
S-14
Did irrigation occur
Area (acres):
0.97
Area (acres):
0.91
Area (acres):
1.01
Area (acres):
1.06
at this facility?
Cover Crop:Cover
Crop:
p�
Cover Cro p�
Cover Cro P:
O YES ❑ NO
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Weather
Freeboard
Field Irrigated?
:1 YES E NO
Field Irrigated?
❑ YES D NO
Field Irrigated?
❑ YES 1 NO
Field Irrigated?
❑ YES C NO
m
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1
C
91
0
3
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2
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0
3
3.75
3
4
5
C
81
1 0.5
2.75
3
6
CL
78
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79
0.25
3
3
8
R
79
1.25
3
3
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PC
85
4
3
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10
11
12
CL
77
0.5
3
3
131
R
74
0,25
3
3.5
14
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82
1 0
3.25
3.5
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PC
84
0
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3.25
16
C
85
0
3
3.75
17
18
191
CL
83
0.5
2.75
3.25
20
C
79
0.25
2.75
3
21
C
72
0
3
3
22
C
76
0
3.25
3
23
C
60
0
3.25
3
24
25
26
C
87
0
3.5
3
27
C
90
0
3.5
3
28
C
84
0
3.75
3.25
29
C
89
0
4
3.5
30
C
88
0
4
3.5
31
Monthly Loading:
0
0.00
0
0.00
0
0.00
0
0.00
12 Month Floating Total (in):
FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0015931
Facility Name: Trump National Golf Club Charlotte WWTP
County: Iredell
Month: August
Year: 2024
Did irrigation
Field Name:
S-15
Field Name:
S-16
Field Name:
S-17
Field Name:
occur
Area (acres):
0.91
Area (acres):
0.71
Area (acres):
1.04
Area (acres):
at this facility?
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
O YES ❑ NO
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
0.33
Hourly Rate (in):
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
52
Annual Rate (in):
Weather
Freeboard
Field Irrigated?
❑ YES L NO
Field Irrigated?
❑ YES _, NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YES G NO
T
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OF
in
ft
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gal
I min
in
I in
gal I
min
in
I in
gal
I min
in
I in
gal I
min
in I
in
1
C
91
0
3
3.75
2
C
78
0
3
3.75
3
4
5
C
81
0.5
2.75
3
6
CL
78
0
3
3
7
CL
79
0.25
3
3
81
R
79
1.25
3
3
9
PC
85
4
3
3
10
11
12
CL
77
0.5
3
3
13
R
74
0.25
3
3.5
141
C
82
0
3.25
3.5
15
PC
84
0
3
3.25
16
C
85
0
3
3.75
17
18
19
CL
83
0.5
2.75
3.25
201
C
79
0.25
2.75
3
21
C
72
0
3
3
22
C
76
0
3.25
3
23
C
60
1 0
3.25
3
24
25
I
26
C
87
0
3.5
3
27
C
90
0
3.5
3
28
C
84
0
3.75
3.25
29
C
89
0
30
C
88
0
LjL
31
Monthly Loading:
0
0.00
0
0.00
0
0.00
0
V
0.00
I
12 Month Floating Total (in):
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?
n compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
O Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
El Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
O Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
i] 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: Logan Harlan
Permittee:
Trump National Golf Club Charlotte, LLC
Certification No.: SI- 1015353
Signing Official: Brandon Long
Grade: SI Phone Number: 704-900-9191
Signing Official's Title: Owner - TCW Wastewater Mgmt., Inc.
Has the ORC changed since the previous NDAR-1? ❑ Yes O No
Phone Number: 704-351-4049 Permit Exp.: 5/31 /23
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 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