WQ0022870_Monitoring - 11-2016_20170104

I
NON DISCHARGE WASTEWATER MONITORING REPORT
PERMIT NUMBER: WQ0022870 MONTH: November YEAR: 2016
FACILITY NAME: Buck Mountain Development COUNTY: Chatham
Flow Monitoring Point:
Effluent:
Influent:
...............
11
..................................................................................
.............
....
.............................
............................
......
...........
......
.
.........
Parameter Monitoring Point:
Effluent:
Influent:
Surface Water (SW):
SW Cade/Name:
Was There Effluent Flow For This Month Generated At This Facility:
Yes:
No:
..
..............
50050
00400
50060
00310
00610
00530
31616
00545
00076
00620
00615
70295
00680
00940
00681
Opera
D Operator for
A Arrival Time ORC
T Time 2400 On on
E Clock Site Site?
Daily Rate
(Flow) into
Treatment
System
pH
Residual
Chlorine
BOD -5
20°C
NH3-N
TSS
Fecal
Coliform
(Geo-
metric
Mean*)
Settable
Matter
Turbidity
Nitrate
Nitrogen
Nitrite
Nitrogen
Total
Disolved
Solids
Total
Organic
Carbon
Chlorides
Dissolved
Organic
Carbon
HRS Y/B/N
MGD
UNITS
MG/L
MG/L
MG/L
MG/L
/100ML
MI/I
NTU
mg/I
mg/I
mg/l
mg/I
mg/I
mg/l
1 1345 1 1.00 Y
0.007680
1 7.30
0.4
1
1.56 1
2 1130 1.00 Y
0.007200
7.52
0.32
<2.0
<0.045
<2.5
<1.0
1.72
30
<0.017
3 1030 1.00 Y
0.007940
7.17
0.50
1.50
4 930 1.00 Y
0.011200
7.20
0.42
2.00
5 N
0.011200
0.20
2
6 N
0.011200
0.2
2.00
7 800 1.00 Y
0.010510
7.13
0.19
1
1.6
1
8 1130 1 1.00 Y
0.010890
1 7.20
0.22
1.4
9 1330 1.00 Y
0.010300
6.82
0.43
1.84
10 1400 1.00 Y
0.009180
6.71
0.29
1.90
11 1000 1.00 Y
0.010390
7.00
0.19
1.50
12 N
0.010390
0.10
1.5
13 N
0.010390
0.1
1.5
14 1200 1.00 Y
0.011640
6.57 1
0.2
2.15
1
15 1300 1 1.00 Y
0.009600
6.75
0.33
<2.0
<0.045
<2.5
<1.0
2.10
42
<0.017
1
16 1230 1.00 Y
0.008610
6.80
0.15
2.00
17 1300 1.00 Y
0.008120
6.92
0.40
2.05
18 1030 1.00 Y
0.008230
6.85
0.33
2.00
19 N
0.008230
0.2
2.00
1
20 N
0.008230
0.20
2.00
21 800 0.75 Y
0.009540
7.33
0.50
1.76
22 800 0.50 Y
0.011020
6.74
0.26
1.84
23 800 0.50 Y
0.013125
6.67
0.77
2.11
24 N
0.013125
H
0.5
2.11
25 800 0.50 Y
0.012113
6.89
0.27
2.13
26 N
0.012113
0.2
2.00
27 N
0.012113
0.20
2.00
28 1200 1.001 Y
0.009070
7.50
0.1
2.40
29 830 2.50 Y
0.010160
7.55
0.4
2.00
30 1000 1.001 Y
0.009280
7.77
0.32
2.05
31 1 1 1
Average
0.010093
7--
29633
-U-
o
777
7777
1,89
36
#DIV/01
#DIV/O!
#DIV101
#DIV/01
Daily Maximum
0.013125
7.77
0.77
0
0
0
2.4
42
0
0
#DIV/01
#DIV/0!
_
Daily Minimum
0.00720
6.57
0.1
0
0
0
<1
1.4
30
0
0
#DIV/01
#DIV/01
Monthly Limit(s)
270,000
>6<9
NL
1 10
4
1 5 1
14
NL
NL
NL
NIL
NL
NL
NL
NA
Comp/Grab
Recording
G
G
C
C
C
G
G
RECORDING
C
C
G
G
G
G
Daily Limit
NL
NL
NIL
15
6
10
25
NL
10
NL
NL
NL
NL
NL
NA
Quarterly Limit
NL
NL
NL
NL
NL
NL
NL
NIL
NL
NL
NL
NL
NL
NL
NA
Monitoring Frequency
Cont.
Daily
I
Daily
2/month 2/month 2/month
2/month
NIA
:t.�Q.arterly
Cont.
Quarterly
Quarterly,
Quarterly
Compliant
Yes
Yes
Yes
Yes I
Yes
Yes
Yes
Yes
Yes I
Yes
I Yes
NA
NA
I NA
NA
Total Monthly Flow 10.302789 I
Operator in Responsible Charge (ORC): Eric Riggins Grade:
Check Box if ORC Has Changed:ORC Certification Number:
Certified LaboratorioENCO 591
V_& -
Mail ORIGINAL a
DENR
Division of Water'
ATTN: Informatioi
1617 Mail Service
RALEIGH, NC 276
11 Phone: [phone]
1000135
/71 - 7- 11�
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

NON DISCHARGE WASTEWATER MONITORING REPORT
Facility Status:
Please answer the following question:
Compliant ,N)
1. Does all monitoring data and sampling frequencies meet permit requirements?
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance
with its permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s)
taken. Attach additional sheets if necessary.
"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, in luding the possibility/of fines and imprisonment for knowing violations."
Dennis Mahaffey
nature fPe ittee)* Date (Name of Signing Official -Please print or type)
Aqua North Carolina
(Permittee -Please print or type)
202 MacKenan Ct
Cary NC 27511
(Permittee Address)
Parameter Codes -
Regional Supervisor
(Position or Title)
653 -5768 9/30/2017
(Phone Number) (Permit Exp. Date)
01002 Arsenic
31504 Coliform, Total
00600 Nitrogen, Total
00929 Sodium
01022 Boron
00094 Conductivity
00630 NO2&NO3
00931 SAR
00310 BOD5
01042 Copper
00620 NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxyger
00556 011 -Grease
70295 TDS
00916 Calcium
31616 Fecal Coliform
WQ09 PAN Plant Available
00010 Tem eratun
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Total
Residual
00927 Ma neslum
71900 Merou
32730 Phenols
00665 Phosphorus, Total
00680 TOC
00530 TSSIISR
01034 Chromium
00610 NH3asN
00937 Potassium
00076 Turbidity
00340 COD
01067 Nickel 1
00545 Settleable Matter
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Land Application Unit at [phone].
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only the units designated in the
reporting facility's permit for reporting data.
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).

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NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00022870 MONTH: Nov YEAR: 2016
FACILITY NAME: Buck Mountain Development COUNTY:
Chatham
Formulas:
Daily Loading (Inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)l
Maximum Hourly Loading (Inches) = Daily Loading (inches) / [Time Irrigated (minutes) 150 (minutes/hour)] Monthly Loading (inches)
12 Month Floating Total (Inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
..nit., t cad!n rinnheE% = nnthly i nndinn nnohn lrnonth) ( M.,mhor of days in the month (days/month)] x 7 (days/week)
Did Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: No: x
FIELD NUMBER: F1
A SPRAYED (acres); 11.4
COVER CROP: turf rass
ITTED HOURLY RATE (inches): 0.1
FIELD NUMBER: F2
REA SPRAYED (acres): 5.56
COVER CROP: turfg rass
ZMITTED HOURLY RATE (inches): 0.1
D
A
T
E
WEATHER CONDITIONS
Temper- Storage
Weather atureat Precipita- Lagoon
code• application tion Free -board
ITTED YEARLY RATE (inches);
Volume Time Dally
Applied Irrigated LoadingLoadingApplied
20.47
Maximum
Hourly
IRMITTED YEARLY RATE (inches): 20.47
Maximu
Volume Time Daily m Hourly
Irri ated LoadingLoadin
(°F) Inches feet
gallons minutes
Inches
inches
gallons minutes
inches inches
1
loft
2
3
4
5
6
7
8
9
10
11
NO
IRRIGATION
APPLIED
12
13
14
15
16
AT
THIS
TIME
17
18
19
20
ALL
FIELDS
21
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)l
0
0.00
0
0.00
12 Month Floating Total (inches)j`
2.90
1.90
Average Weekly Loading (Inches)
:::::::::•:: :::::::::::::
0.00
0.00
. Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow,
Spray Irrigation Operator in Responsible Charge (ORC): Brian Peters Phone: [phone]
ORC Certification Number: 987582 Check Box if C Has hang d:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Compliant Y,Nj
1. The application rate(s) did not exceed the limit(s) specified in the permit. LY
2. Adequate measures were taken to prevent wastewater runoff from the site(s). 0
3. A suitable vegetative cover was maintained on the site(s) in accordance with the pFY-71
4. All buffer zones as specified in the permit were maintained during each applicatioFy---]
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limitO
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 r owing violations."
lir� - ?!/� v Roger B. Tupps
19natur f ermittee)` D to (Name of Signing Official -Please print or type)
Aqua North Carolina Waste Water Supervisor
(Permittee -Please print or type) (Position or Title)
919-467-8712
202 MacKenan Ct (Phone Number)
Cary NC. 27511
(Permittee Address)
. If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER:
W00022870
MONTH: Nov YEAR: 2016
FACILITY NAME: Buck Mountain Development COUNTY: Chatham
Formulas:
Daily Loading (inches) = (Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] /[Area Sprayed (acres) Y43,560 (square feet/acre)]
= Volume Applied (gallons) / (Area Sprayed (acres) x 27,152 (gallona/acre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / [Time Irrigated (minutes) /60 (minutes/hour)lnthly Loading (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (inches) = [Monthly Loading (inchestmonth) / Number of days in the month (days/month)] x 7 (days/week)
Did Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: No: x
FIELD NUMBER: FB
A SPRAYED acres): 4.22
COVER CROP: turf raSs
ITTED HOURLY RATE (inches): 0.1
FIELD NUMBER: F3
A SPRAYED (acres): 10.66
COVER CROP: turf rass
ITTED HOURLY RATE (inches): 0.1
D
ATemper-
T
E
WEATHER CONDITIONS
Storage
Weather
atureat Precipita- Lagoon
Code application tion Free -board
ITTED YEARLY RATE (inches): 7.43
Maximum
Volume Time Daily Hourly
Applied Irrigated ated Loadin Loadin
ITTED YEARLY RATE (inches): 20.47
Maximum
Volume Time Daily Houry
A lied Irri ated Loadin Loadin
(°F) inches feet
gallons minutes
Inches inches
gallons minutes
inches Inches
1
2
3
4
5
6
7
8
9
10
11
NO
IRRIGATION APPLIED
12
13
14
15
16
AT
THIS
TIME
17
18
19
20
ALL
FIELDS
21
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
Q
0.00
0 .......'
0.00
12 Month Floating Total (inches)
,;,; ;;; ; ; ; ; ;;; ; ;;
2.03
2.92
Average Weekly Loading (inches);:
0.00
0.00
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, 51 -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Brian Peters Phone: [phone]
ORC Certification Number:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
987582 Check Box if ORC H hange
I&
(SIGNATOR OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. ly
2. Adequate measures were taken to prevent wastewater runoff from the site(s). YO
3. A suitable vegetative cover was maintained on the site(s) in accordance with
4. All buffer zones as specified in the permit were maintained during each apply Y�
5. The freeboard in the treatment and/or storage lagoon(s) was not less than th9�
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 fo owing violations."
L— -3 GSL Roger B. Tupps
(SigKture ofP ttee)' Date (Name of Signing Official -Please print or type)
d9Z;0
Aqua North Carolina Waste Water Supervisor
(Permittee -Please print or type) (Position or Title)
919-467-8712
202 MacKenan Ct (Phone Number)
Cary NC. 27511
rmittee Address)
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00022870
FACILITY NAME: Buck Mountain Development
MONTH: Nov YEAR: 2016
COUNTY: Chatham
Formulas:
Dally Loading (Inches) _ (Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] /(Area Sprayed (acres) x43,560 (square feeV.cre)]
= Volume Applied (gallons) /(Area Sprayed (acres) x 27,152 (gallone/acre-Inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / [rime Irrigated (minutes) /60 (minutes/hour))nthly Loading (Inches)
12 Month Floating Total (Inches) = Sum of this month's Monthly Loading Cinches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (Inches) = )Monthly Loading (inches/month) / Number of days in the month (days/month)) x 7 (dayshxeek)
Did Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
FIELD NUMBER: F313
A SPRAYED (acres): 3.01
COVER CROP: turk rass
TTED HOURLY RATE (inches): 0.1
FIELD NUMBER: F4
A SPRAYED (acres): 7.18
COVER CROP: turf rasS
ITTED HOURLY RATE (inches): 0.1
WEATHER CONDITIONS
ITTED YEARLY RATE (inches); 7.43
JITTED YEARLY RATE (inches): 20.47
D
A
T
E
Temper- storage
Weather gluteal Precipita- Lagoon
code• application lion Free -board
Maximum
Volume Time Daily Hourly
Applied Irrigated Loading Loading
Volume Time
Applied Irrigated.
Maximum
Daily Hourly
Loading Loading
(°F) Inches feet
minutes Inches Inches
gallons minutes
inches inches
1
2
3
4
5
6
7
6
9
10
11
NO IRRIGATION
APPLIED
12
13
14
15
16
AT THIS
TIME
17
18
19
20
ALL FIELDS
21
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
0 0.00
01..:..'::':'
0.00
12 Month Floating Total (inches)
.; 2.00
3.80
Average Weekly Loading (inches)
:: 0.00
0.00
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC):
ORC Certification Number:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
Brian Peters Phone: [phone]
987582 Check Box i OR Ha nged:
(SIGNATURE OF OPEF MTOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. I Y
2. Adequate measures were taken to prevent wastewater runoff from the site(s).0
3. A suitable vegetative cover was maintained on the site(s) in accordance with
4. All buffer zones as specified in the permit were maintained during each appli�
5. The freeboard in the treatment and/or storage lagoon(s) was not less than th�
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
Drought conditions during summer required extra irrigation to maintain healthy turfgrass.
"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."
Roger B. Tupps
ature ofer ittee)* Date (Name of Signing Official -Please print or type)
Aqua North Carolina Waste Water Supervisor
(Permittee -Please print or type) (Position or Title)
919-467-8712
202 MacKenan Ct (Phone Number)
Cary NC. 27511
(Permittee Address)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00022870 MONTH: Nov YEAR: 2016
FACILITY NAME: Buck Mountain Development COUNTY: Chath
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 Qnches/foot)] /[Area Sprayed (acres) x43,560 (square feet/acre)]
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (inches) - Daily Loading (inches) / [Time Irrigated (minutes) /60 (minutes/hour)],nthly Loading (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
A eann tMee41.. I oed!nn rtnchoel ='Monthly Loading (innhae/month) / Number of days in the month (days/month)l x 7 (days/week)
Did Irrigation Occur At This Facility:
Yes: x No:Yes:
Did Irrigation Occur On This Field:
x No:
Did Irrigation Occur On This Field:
Yes: x No:
:
FIELD NUMBER: F-5
A SPRAYED (acres): 13.22
COVER CROP: turfr rass
ITTED HOURLY RATE (inches): 0.1
FIELD NUMBER: F-6
A SPRAYED (acres): 4.94
COVER CROP: turf rass
ITTED HOURLY RATE (inches): 0.1
D
A
T
E
WEATHER CONDITIONS
Temper- Storage
Weather
Code• ature at Precipita- Lagoon
application tion Free -board
4ITTED YEARLY RATE (inches): 20.47
Maximum
Volume Time Dail Hourly
Y Y
Applied Irrigated LoadingLoadingApplied
ITTED YEARLY RATE (inches): 20.47
Maximum
Volume Time Dail Hourly
Y
Irrigated LoadingLoading
(°F) inches feet
gallons minutes inches Inches
gallons minutes
Inches inches
1
2
3
4
5
6
7
8
9
10
11
NO IRRIGATION
APPLIED
12
13
14
15
16
AT THIS
TIME
17
18
19
20
ALL FIELDS
21
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
0 0.00
0 :::::':':':
0.00
12 Month Floating Total (inches)
4.57
3.12
Average Weekly Loading (inches)
;: 0.00
0.00
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow,
Spray Irrigation Operator in Responsible Charge (ORC):
ORC Certification Number:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
Brian Peters
Phone: [phone]
987582 Check Box if ORC Ha nged-
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. Y
2. Adequate measures were taken to prevent wastewater runoff from the site(s). 0
3. A suitable vegetative cover was maintained on the site(s) in accordance with 4�
4. All buffer zones as specified in the permit were maintained during each appli�
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the YO
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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." /
3rCe Roger B. Tupps
gnature of ittee)* Date (Name of Signing Official -Please print or type)
Aqua North Carolina Waste Water Supervisor
(Permittee -Please print or type) (Position or Title)
919-467-8712
202 MacKenan Ct (Phone Number)
Cary NC. 27511
(Permittee Address)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 26.0506 (b)(2)(D).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0022870
MONTH: Nov YEAR: 2016
FACILITY NAME: Buck Mountain Development COUNTY: Chatham
Formulas:
Dally Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feet/acre)]
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-Inch)]
Maximum Hourly Loading (inches) = Daily Loading (Inches) / [Time Irrigated (minutes) /60 (minutes/hour)bnthly Loading (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches;
Average Weekly Loading (inches) = [Monthly Loading (inches/month) / Number of days in the month (days/month)) x 7 (dayshveek)
Did Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
......................................
FIELD NUMBER: F-7
A SPRAYED (acres): 16.48
COVER CROP: turfr rass
ITTED HOURLY RATE (inches): 0.1
FIELD NUMBER: F-8
A SPRAYED (acres): 4.06
COVER CROP: turfic rass
ITTED HOURLY RATE (inches): 0.1
WEATHER CONDITIONS
AITTEDYEARLYRATE (inches): 20.47
ITTED YEARLY RATE (inches): 20.47
D
A
T
E
Temper- Storage
weather
Code' .lure at Precipi[a- Lagoon
application tion Free -board
Maximum
Volume Time Dail Hourl
Y Y
App lied Irrigated LoadingLoadingApplied
Volume Time
Irrigated
Maximum
Dail Hourly
Y Y
LoadingLoading
(°F) inches feet
gallons minutes inches Inches
gallons minutes
inches inches
1
2
3
4
5
6
7
8
9
10
11
12
NO IRRIGATION
APPLIED
13
14
15
16
17
AT THIS
TIME
18
19
20
21
ALL FIELDS
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
0 0.00
0::::::::
0.00
12 Month Floating Total (inches)
;: 1,49
2.13
Average Weekly Loading (inches)[:::
0.000.00
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, 9i -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Brian Peters Phone: [phone]
ORC Certification Number: 987582 Check Box if ORC Has
Mail ORIGINAL and TWO COPIES to: \
ATTN: Non -Discharge Compliance UnitJ\
DENR 1,l1if\j
Division of Water Quality (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
NON -DISCHARGE APPLICATION REPORT

SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
compliant (y N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. ly
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
3. A suitable vegetative cover was maintained on the site(s) in accordance with 1
4. All buffer zones as specified in the permit were maintained during each appli Yc�
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the YO
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with it:
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 imprisonme t f knowing violations."
?I:;-- G Roger B. Tupps
ignatu"C"
of rmittee)* Date (Name of Signing Official -Please print or type)
Aqua North Carolina Waste Water Supervisor
(Permittee -Please print or type) (Position or Title)
919-467-8712
202 MacKenan Ct (Phone Number)
Cary NC. 27511
(Permittee Address)
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(1)).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITES)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00022870 MONTH: Nov
FACILITY NAME: Buck Mountain Develo
YEAR: 2016
COUNTY: Chatham
Formulas:
Dally Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (Inches/foot)] / [Area Sprayed (acres) x43,560 (square feetlacre)] OI
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)i
Maximum Hourly Loading (Inches) = Daily Loading (inches) / [Time Irrigated (minutes)/60 (minutes/hour)',nthly Loading (inches)
12 Month Floating Total (Inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (Inches
Averaae Weekly Loadina finchesl = [Monthly Loadino Cinches/month) / Number of days in the month (days/month)] x 7 (daystweek)
Did Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: No: x
:
FIELD NUMBER: F-9
A SPRAYED (acres): 10.11 JA
COVER CROP: turff rass
ITTED HOURLY RATE (inches): 0.1
FIELD NUMBER: F-10
SPRAYED (acres): 5.76
COVER CROP: tuff rass
WITTED HOURLY RATE (inches): 0.1
D
A
T
E
WEATHER CONDITIONS
Temper- Storage
Weather afore at Precipita- Lagoon
code• application tion Free -board
1ITTED YEARLY RATE (inches): 20.47
Maximum
Volume Time Daily Hourly
Applied Irrigated Loadin Loadin
MITTED YEARLY RATE (inches): 20.47
Maximum
Volume Time Daily Hourly
Applied Irrl ated LoadingLoadin
(°F) Inches feet
gallons minutes
Inches Inches
gallons minutes
inches Inches
1
2
3
4
5
6
7
8
9
10
11
NO
IRRIGATION APPLIED
12
13
14
15
16
AT
THIS
TIME
17
18
19
20
ALL
FIELDS
21
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (Inches)
0
0.00
0 ::::•::::
0.00
12 Month Floating Total (inches);;;;;;;;;;;;;;;;
;;;;;;;;;;;;;;;;
2.63
3.96
Average Weekly Loading (inches)
::::::::::::::::::::::::::::::::
0.00
0.00
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Brian Peters
ORC Certification Number:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Phone: [phone]
987582 Check Box if ORC Chan d:

Division of Water Quality (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Comp�,Ilant Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s)�
3. A suitable vegetative cover was maintained on the site(s) in accordance with �J
4. All buffer zones as specified in the permit were maintained during each appli�
5. The freeboard in the treatment and/or storage lagoon(s) was not less than th
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 or nowing violations."
�aU Roger B. Tupps
nature o rmittee)* Date (Name of Signing Official -Please print or type)
Aqua North Carolina
(Permittee -Please print or type)
202 MacKenan Ct
Cary NC. 27511
(Permittee Address)
Waste Water Supervisor
(Position or Title)
919-467-8712
(Phone Number)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(2)(D).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00022870
FACILITY NAME: Buck Mountain Development
MONTH: Nov YEAR: 2016
COUNTY: Chatham
Formulas:
Dally Loading (Inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)) /[Area Sprayed (acres) x 43,560 (square feet/acre)]
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (Inches) = Daily Loading (inches) / rrime Irrigated (minutes) 160 (minutes/hour)}nthly Loading (inches)
12 Month Floating Total (Inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (Inches) = [Monthly Loading (inches/month) /Number of days in the month (days/month)] x 7 (days/week)
Did Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
.. •....................
::
•... •.. •.. •. •.. •... •... .
FIELD NUMBER: F-1 OB
A SPRAYED (acres): 5.69
COVER CROP: turfr rass
TTED HOURLY RATE (Inches): 0.1
FIELD NUMBER: F-11
A SPRAYED (acres): 4.69
COVER CROP: turf rass
ITTED HOURLY RATE (inches): 0.1
WEATHER CONDITIONS
ITTED YEARLY RATE (inches): 7.43
ITTED YEARLY RATE (inches): 20.47
D
ATemper-
T
E
Storage
Weather
atureat Precipita- Lagoon
Code' application tion Free -board
Volume Time
Applied Irrigated
Maximum
Daily Hourly
Loading Loading
Volume Time
Applied Irrigated
Maximum
Daily Hourly
Loading Loading
(°F) Inches foot
gallons minutes
Inches Inches
gallons minutes
Inches Inches
1
2
3
4
5
6
7
8
9
10
11
NO
IRRIGATION APPLIED
12
13
14
15
16
AT
THIS
TIME
17
18
19
20
ALL
FIELDS
21
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
0
0.00
0 ::::::::
0.00
12 Month Floating Total (inches)
:::::::::::: ::::::::::::::::::
2.06
0.79
Average Weekly Loading (inches)
::::::::::::::: ::::::::::::::::
0.00
0.00
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Brian Peters Phone: [phone]
ORC Certification Number:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
987582 Check Box if ORC Has Changed:
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Com liant Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. ly
2. Adequate measures were taken to prevent wastewater runoff from the site(s). YO
3. A suitable vegetative cover was maintained on the site(s) in accordance with
4. All buffer zones as specified in the permit were maintained during each appli�
S. The freeboard in the treatment and/or storage lagoon(s) was not less than th1,T____1,
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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..""
/,)-7 r/r ` Roger B. Tupps
ignature rmittee)* Date (Name of Signing Official -Please print or type)
Aqua North Carolina
Waste Water Supervisor
(Permittee -Please print or type)
(Position or Title)
919-467-8712
202 MacKenan Ct
(Phone Number)
Cary NC. 27511
(Permittee Address)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 26.0506 (b)(2)(D).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00022870
FACILITY NAME: Buck Mountain Development
MONTH: Nov YEAR: 2016
COUNTY: Chatham
Formulas:
Daily Loading (Inches) -[Volume Applied (gallons) x 0.1336 (cubic feettgallon) x 12 (inches/foot)] /(Area Sprayed (acres) x 43,560 (square feet/acre)]
= Volume Applied (gallons) / (Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (Inches) -Daily Loading (Inches)! (Time Irrigated (minutes) /60 (minutes/hour)lnthly Loading (Inches)
12 Month Floating Total (Inches) =Sum of this month's Monthly Loading (Inches) and previous 11 month's Monthly Loadings (inches)
Aver -nn Week! I oadMn linchwcl = rmn fibly I oadlnn finches /month) /Number of days in the month (days/month)! x 7 (daysMeok)
Did Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: No: x
Did Irrigation Occur On This Field:
Yes: No: x
FIELD NUMBER: F -11B
A SPRAYED (acres): 4.2
COVER CROP: turfr rays
TTED HOURLY RATE (inches): 0.1
FIELD NUMBER: F -11C
A SPRAYED (acres): 9.37
COVER CROP: turfc rays
ITTED HOURLY RATE (inches): 0.1
D
A
T
E
WEATHER CONDITIONS
Temper- Storage
Weather
Code' azure at Precipita- Lagoon
application tion Free -board
ITTED YEARLY RATE (inches): 20.47
Maximum
Volume Time Dail Houd
Y Y
Applied Irrigated LoadingLoadingApplied
I.TTED YEARLY RATE (inches): 7.43
Maximum
Volume Time Daily Hourly
Irrigated Loading.Loading
(°F) Inches feet
gallons minutes
Inches Inches
gallons minutes
Inches Inches
1
2
3
4
5
6
7
8
9
10
NO
IRRIGATION APPLIED
11
12
13
14
15
AT
THIS
TIME
16
17
18
19
ALL
FIELDS
20
21
22
23
24
25
26
27
2B
29
30
31
Total Gallons/Monthly Loading (inches)
0
0.00
0 :'.':':' ':':':
0.00
12 Month Floating Total (inches)
Average Weekly Loading (inches)
;:
0.00
0.00
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -ram, sn-snow, Si -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Brian Peters Phone: [phone]
ORC Certification Number:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
987582 Check Box if ORC Chan ed:
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, 1 CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Com 1, ant Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. NN
2. Adequate measures were taken to prevent wastewater runoff from the site(s). YC]
3. A suitable vegetative cover was maintained on the site(s) in accordance with
4. All buffer zones as specified in the permit were maintained during each appli�
5. The freeboard in the treatment and/or storage lagoon(s) was not less than th�
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with it:
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
Drought during the summer required extra irrigation to maintain healthy turgrass.
"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 hat there are significant penalties for submitting false information, including the possibility of fines
and imprisonment r wing violations."
�, 3d L Roger B. Tupps
Signature ermittee)- to (Name of Signing Official -Please print or type)
Aqua North Carolina
(Permittee -Please print or type)
202 MacKenan Ct
Cary NC. 27511
(Permittee Address)
Waste Water Supervisor
(Position or Title)
919-467-8712
(Phone Number)
` If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(2)(D).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00022870 MONTH: Nov YEAR: 2016
FACILITY NAME: Buck Mountain Development COUNTY: Chatham
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / (Area Sprayed (acres) x 43,560 (square feet/acre)]
=Volume Applied (gallons) / [Area Sprayed (acres) x27,152 (gallons/acre-inch)]
Maximum Hourly Loading (Inches) = Daily Loading (inches) / [Time Irrigated (minutes) / 60 (minutes/hou0lnthly Loading (inches)
12 Month Floating Total (Inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Aye . Weakly I ..ding (inches) = (Mnnthly Loading (inches/month) / Number of dave In the month (days/month)l x 7 (daysAveek)
Did Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: No: x
Did Irrigation Occur On This Field:
Yes: x No:
FIELD NUMBER: F-12
A SPRAYED (acres): 2.62
COVER CROP: turfr rass
ITTED HOURLY RATE (inches): 0.1
FIELD NUMBER: F -12B
A SPRAYED (acres): 1.54
COVER CROP: turfrass
ITTED HOURLY RATE (inches): 0.1
WEATHER CONDITIONS
ITTED YEARLY RATE (inches): 20.47
ITTED YEARLY RATE (inches): 7.43
D
A
T
E
Temper- Storage
weather Precipita- LagoonVolume
code•
application tion Free -board
Time
Applied Irri ated
Maximum
Daily Hourly
Loading Loadin
Volume Time
Applied Irri ated
Maximum
Daily Hourly
Loading _Loading
(°F) inches feet
gallons minutes
inches Inches
gallons minutes
inches inches
1
2
3
4
5
6
7
8
9
10
11
NO
IRRIGATION APPLIED
12
13
14
15
16
AT
THIS
TIME
17
18
1s
20
ALL
FIELDS
21
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
0
0.00
0 .::.....
0.00
12 Month Floating Total (inches)
;,;,; ; ; ; ; ; ; ; ; ;
3.10
2.51
Average Weekly Loading (inches)
;.
0.00
0.00
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Brian Peters Phone: [phone]
ORC Certification Number: 987582 Check Box if ORC Ha a ed:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality (SIGNATURE OF OPERATOR IN RESPONSIB E CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. I N
2. Adequate measures were taken to prevent wastewater runoff from the site(s). YO
3. A suitable vegetative cover was maintained on the site(s) in accordance with Y�
4. All buffer zones as specified in the permit were maintained during each applicy----].
5. The freeboard in the treatment and/or storage lagoon(s) was not less than th5�
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
Drought during the summer required extra irrigation to maintain healthy turfgrass.
"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
ag violations."
r� Roger B, Tupps
4_01Ignature o mittee)* Date (Name of Signing Official -Please print or type)
Aqua North Carolina Waste Water Supervisor
(Permittee -Please print or type) (Position or Title)
919-467-8712
202 MacKenan Ct (Phone Number)
Cary NC. 27511
(Permittee Address)
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 26.0506 (b)(2)(D).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0022870 MONTH: Nov YEAR: 2016
FACILITY NAME: Buck Mountain Development COUNTY: Chatham
Formulas:
Daily Loading (Inches) _ [Volume Applied (gallons) x 0.1336 (cubic feettgallon) z 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feet/acre)]
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallonslacre-Inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) /[rime Irrigated (minutes) /60 (minutes/hour)}nthly Loading (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weeklv Loadinc (inches) = [Monthly Loadina (inches/month) /Number of days in the month (days/month)] x 7 (daysAveek)
Did Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: No: x
FIELD NUMBER: F-13
A SPRAYED (acres): 8.49
COVER CROP: turfr rass
ITTED HOURLY RATE (Inches): 0.1
FIELD NUMBER: F -13B
A SPRAYED acres : 2.2
COVER CROP: turf rass
ITTED HOURLY RATE (Inches): 0.1
WEATHER CONDITIONS
ITTED YEARLY RATE (inches): 20.47
ITTED YEARLY RATE (inches): 7.43
D
A
Tatureat
E
Temper- Storage
Weath
Precipita- Lagoon
Code" application tion Free -board
Volume Time
A lied Irri riga
Daily
Loadin
Pinches
Volume Time
A lied Irri ated
Maximum
Daily Hourly
Loading Loading
(°F) Inches feet
gallons minutes
Inches
gallons minutes
Inches Inches
1
2
3
4
5
6
7
8
9
10
11
NO
IRRIGATION APPLIED
12
13
14
15
16
AT
THIS
TIME
17
18
19
20
ALL
FIELDS
21
22
23
24
25
26
27
28
29
30
31
Tota[ Gallons/Monthly Loading (inches)
0
0.00
0 ::::::::
0.00
12 Month Floating Total (inches)
:::::::::::::::::::::::::::::::
2,23
1.86
Average Weekly Loading (inches),:::::::::::::::
:::::::::::::::
0.00
0.00
' Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC)
ORC Certification Number:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
Brian Peters
Phone: [phone]
987582 Check Box if ORC Has Changed:
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. Y
2. Adequate measures were taken to prevent wastewater runoff from the site(s). YO
3. A suitable vegetative cover was maintained on the site(s) in accordance with
4. All buffer zones as specified in the permit were maintained during each appli�
5. The freeboard in the treatment and/or storage lagoon(s) was not less than th Y�
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 or nowing violations."
Ignature o rmittee)* Date
Aqua North Carolina
(Permittee -Please print or type)
202 MacKenan Ct
Cary NC. 27511
(Permittee Address)
Roger B. Tupps
(Name of Signing Official -Please print or type)
Waste Water Supervisor
(Position or Title)
919-467-8712
(Phone Number)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 26.0506 (b)(2)(D).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER:
W00022870
FACILITY NAME: Buck Mountain Development
MONTH: Nov
YEAR: 2016
COUNTY: Chatham
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/fool)] /[Area Sprayed (acres) x 43,560 (square feet/acre)] 0
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (inches) =Daily Loading (inches) / [Time Irrigated (minutes) /60 (minutes/hour)'Aonthly Loading (inches)
12 Month Floating Total (inches) =Sum of this month's Monthly Loading (Inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (inches) = )Monthly Loading (inches/month) /Number of days in the month (days/month)] x 7 (days/week)
bid Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
........................... :
FIELD NUMBER: F-14
A SPRAYED acres : 9.91
COVER CROP: turfr rass
IITTED HOURLY RATE (inches): 1 0.1
FIELD NUMBER: F-15
EA SPRAYED (acres); 4.79
COVER CROP: turf rass
MITTED HOURLY RATE (inches): 0.1
D
A
T
E
WEATHER CONDITIONS
Temper- Storage
Weather atureat Precipita- Lagoon
Code' application tion Free -board
1ITTED YEARLY RATE (Inches):1 20.47
Maximum
Volume Time Dally Hourly
Applied Irri ated Daily
Loading
WITTED YEARLY RATE (inches): 20.47
Maximum
Volume Time Dally Hourly
Applied Irrigated Loading Loadin
(°F) Inches feet
gallons minutes
inches inches
gallons minutes
Inches Inches
1
2
3
4
5
6
7
8
9
10
11
12
NO
IRRIGATION APPLIED
13
14
15
16
17
AT
THIS
TIME
18
19
20
21
ALL
FIELDS
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (Inches)
0
0.00
0
0.00
12 Month Floating Total (Inches)
:::::::::::::::::::::::::::::::
3.30
1.16
Average Weekly Loading (inches)
::::::::::::::::::::::::::::::::
0.00
0.01
. Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Brian Peters Phone: [phone]
ORC Certification Number:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
987582 Check Box if ORC Has Changed:

Division of Water Quality (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Com llant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. Y
2.Adequate measures were taken to prevent wastewater runoff from the site(s). Y�
3. A suitable vegetative cover was maintained on the site(s) in accordance with It 1
4. All buffer zones as specified in the permit were maintained during each applic
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the L J
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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."
Roger B. Tupps
nature qtPmitteer Date (Name of Signing Official -Please print or type)
Aqua North Carolina
(Permittee -Please print or type)
202 MacKenan Ct
Cary NC. 27511
(Permittee Address)
Waste Water Supervisor
(Position or Title)
919-467-8712
(Phone Number)
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(2)(D).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00022870 MONTH: Nov YEAR: 2016
FACILITY NAME: Buck Mountain Development COUNTY:
Chatham
Formulas:
Dally Loading (Inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 Cinches/foot)] /[Area Sprayed (acres) x 43,560 (square feet/acre)]
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (Inches) = Daily Loading (Inches) / [Time Irrigated (minutes) /60 (minutes/hour)lnthly Loading (Inches)
12 Month Floating Total (Inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (Inches) = [Monthly Loading (inches/month) / Number of days In the month (days/month)] x 7 (days/week)
Did Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
:-:-:-:-:-A
FIELD NUMBER: F-16
SPRAYED (acres): 9.05
COVER CROP: turfr rass
ITT ED HOURLY RATE (inches): 0.1
FIELD NUMBER: F-17
A SPRAYED (acres): 5.37
COVER CROP: turf rasS
ITTED HOURLY RATE (inches): 0.1
D
A
T
E
WEATHER CONDITIONS
Temper- Storage
weather
Code' afore at Precipita- Lagoon
application tion Free -board
(TTED YEARLY RATE (inches): 20.47
Maximum
Volume Time Dail Hourly
Y y
Applied Irri Irrigate Loadin Loadin
ITTED YEARLY RATE (inches): 20.47
Maximum
Volume Time Dail axim
y y
A lied Irri ated Loading Loading
(°F) Inches feet
gallons minutes
inches inches
gallons minutes
inches Inches
1
2
3
4
5
6
7
8
9
10
11
NO
IRRIGATION APPLIED
12
13
14
15
16
AT
THIS
TIME
17
18
19
20
ALL
FIELDS
21
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
0
0.00
0 :< .:.:.:
0.00
12 Month Floating Tota[ (inches)
;;;;;;;;;;;; ; ;;; ;;; ;;;;;
3.72
3.03
Average Weekly Loading (inches)
::::::::::::::: :::::::::::::::
0.00
0.00
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Brian Peters Phone: [phone]
ORC Certification Number:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
987582 Check Box if OR Chang d:
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. ly
2. Adequate measures were taken to prevent wastewater runoff from the site(s). YO
3. A suitable vegetative cover was maintained on the site(s) in accordance with
4. All buffer zones as specified in the permit were maintained during each appli�
5. The freeboard in the treatment and/or storage lagoon(s) was not less than th�
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with it:
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 fo knowing violations."
` �- 7,-- Roger B. Tupps
gnature ermittee)* Date (Name of Signing Official -Please print or type)
Aqua North Carolina Waste Water Supervisor
(Permittee -Please print or type) (Position or Title)
919-467-8712
202 MacKenan Ct (Phone Number)
Cary NC. 27511
Permittee Address)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(13).

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00022870
FACILITY NAME: Buck Mountain Development
MONTH: Nov YEAR: 2016
COUNTY: Chatham
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/fooQ) / [Area Sprayed (acres) x43,560 (square feet/acre)) OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch))
Maximum Hourly Loading (inches) = Daily Loading (inches) / [Time Irrigated (minutes) / 60 (minutes/hour)) onthly Loading (inches)
12 Month Floating Total (Inches) April
A..emne week! I o=d{nn !inch=cl = [Monthly i nedinn (innheslmanth) / Numher at days in the month (days/month)l x 7 (days/week)
Did Irrigation Occur At This Facility:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
Did Irrigation Occur On This Field:
Yes: x No:
FIELD NUMBER: F-18
AREA SPRAYED (acres): 17.8
COVER CROP: turf[ toss
PERMITTED HOURLY RATE (inches): 0.1
FIELD NUMBER: DR
A SPRAYED (acres); 14.9
COVER CROP: turftoss
ITTED HOURLY RATE (inches): 0.1
D
A
T
E
WEATHER CONDITIONS
wTemper- storage
Weather
afore at Precipita- Lagoon
Code' application tion Free -board
PERMITTED YEARLY RATE (inches): 20.47
Maximum
Volume Time Daily Hourly
Applied Irrigated Loading Loading
ITTED YEARLY RATE (inches); 20.47
Maximum
Volume Time Daily Hourly
Applied Irrigated Loading Loading
(°F) inches feet
gallons minutes
inches inches
gallons minutes
inches inches
1
2
3
4
5
6
7
8
9
10
11
NO
IRRIGATION APPLIED
12
13
14
15
16
AT
THIS
TIME
17
18
19
20
ALL
FIELDS
21
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
0
0.00
0 ::::::::
0.00
12 Month Floating Total (inches)
::•;•;•;•::::::: •; ;•:::::
4.42
2.52
AVerage Weekly Loading (inches),:::::::::::
0.00
0.00
' Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC)
Brian Peters
Phone: [phone]
ORC Certification Number: 987582 Check Box if ORC Has Changed:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)

Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Com liant Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. Y
2. Adequate measures were taken to prevent wastewater runoff from the site(s). YO
3. A suitable vegetative cover was maintained on the site(s) in accordance with the I�
4. All buffer zones as specified in the permit were maintained during each applicatio0
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the IimiO
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 k 'ng violations..,
3G~� Roger B. Tupps
ignature of mittee)* Date (Name of Signing Official -Please print or type)
Aqua North Carolina Waste Water
(Permittee -Please print or type) (Position or Title)
202 MacKenan Ct
NC. 27511
(Permittee Address)
919-467-8712
(Phone Number)
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(2)(1)).