WQ0035049_Monitoring - 03-2022_20220428

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DWR - NonDischarge Monitoring Report Submittal
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NORTH CAROLINA
Erwlranmenlcl QHaflly
Monitoring Report Submittal
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Permit Number#* WQ0035049
Name of Facility:* Maple Hill WWTP
Month:* March Year:* 2022
Report Information
................
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR March2022 NDMR NDAR... 8.56MB
PDF Only
GW-59 March2022 GroundwaterR... 6.7MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2,NDMLR,GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* Kenny Keel
Signature:
Date of submittal: 4/28/2022
This will be filled in automatically
Initial Review
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Reviewer: Gerald,Wanda
Is the project number correct?* WQ0035049
Is the monitoring report accepted?* Yes No
Regional Office* Wilmington
Accepted Date: 5/10/2022

FORM:NDMR 10-13 NON-DISCHARGE MONITORING REPORT(NDMR) Page_1_of 2_
Permit No.: WQ0035049 Facility Name: Maple Hill WWTF County: Pender Month: March Year: 2022
PPI: 001 Flow Measuring Point: 0 influent ❑ Effluent ❑ No flow generated Parameter Monitoring Point: D Influent 7 Effluent 7 Groundwater Lowering ❑ Surface Water
Parameter Code 50050 00400 00310 00530 00610 00620 00625 31616 00600 00665 00940 70300
c LEa
To CS ° ua co ° a
w m
c _ c m
d Orr
in
l- _
24-hr hrs GPD su mg!L mg/L mg/L mg/L mg/L #/100 mL mg/L mg/L mg/L mg/L
1 08:00 6 9,347 7.8
2 08:30 6 9,101 7.6 9 3.5 <0.2 0.29 <0.5 5 0.29 7.62 379
3 08:30 7 9,135 7.6
4 08:00 6 7,642 7.7
5 08:00 2 9,426
6 08:00 2 8,742
7 08:00 7 7,060 7.5
8 08:00 6 8,019 7.6
9 08:00 6 7,790 7.4
10 08:00 7 8,718 7.4
11 08:00 5 8,204 7.4
12 09:00 2 9,817
13 09:00 2 10,310
14 08:00 6 8,345 7.4 _
15 08:00 7 8,234 7.4 _
16 08:00 5 7.805 7.3
17 08:00 6 9,287 7.3
18 08:00 7 9,558 7.4 _
19 02:00 2 9,352
20 08:00 2 8,871 _ _
21 08:00 6 9,363 7.3
22 08:00 5 6,638 7.3
23 08:00 6 8,555 _ 7.3 _
24 09:00 7 14,263 7.3 _
25 08:00 4 12,123 7.3 _
26 09:00 2 11,439
27 08:00 2 11,565
28 08:00 6 9,193 7.3
29 08:00 7 7,141 7.3 _ _ _
30 08:00 6 5,614 _ 7.3
31 08:00 6 11,758 7.3
Average: 9,110 9.00 3.50 0.00 0.29 0.00 5.00 0.29 7.62 379.00
Daily Maximum: 14,263 7.80 9.00 3.50 0.20 0.29 0.50 5.00 0.29 7.62 379.00
Daily Minimum: 5,614 7.30 9-00 3.50 0.20 0.29 0.50 5.00 0.29 7.62 379.00
Sampling Type: Recorder Grab Composite Composite Composite Composite Composite Grab Composite Grab Composite Composite
Monthly Avg.Limit: 42,000 n/a 30 30 15 n/a n/a 200 n/a n/a n/a n/a
Daily Limit: n/a 6 to 9 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a
Sample Frequency: Continous 5XWK Weekly Weekly Weekly Weekly Weekly Weekly Monthly Montly 3XYR 3XYR

FORM: NDMR 10-13 NON-DISCHARGE MONITORING REPORT(NDMR) Page_2_of_2_
Sampling Person(s) Certified Laboratories
Name: Samples were collected by the Certified Laboratory Name: Environmental Chemists, Inc.
Name: Name: Jay Baker
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? C Compliant E 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: Christopher K. Pickett Permittee: Pender County Utilities
Certification No.: 995432 Signing Official: Kenneth Keel
Grade: WW2 Phone Number: 910-259-1570 Signing Official's Title: Director
❑Yes Gi No Phone Number: 910-259-1570 Permit Expiration: 8/31/2026
f-Cf/4 ce73/7Z
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

Environmental Chemists, Inc.
envirochem 6602 Windmill Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
710 Bowsertown Road,Manteo,NC 27954 • 252.473.5702 Lab/Fax
sM 255-A Wilmington Highway,Jacksonville,NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL&CONSULTING CHEMISTS info a environmentalchemists.corn
Pender County Utility Operations Revised Report: Mar 22, 2022
Post Office Box 995 Original Report Date: Mar 11, 2022
Burgaw NC 28425 Report#: 2022-03878
Attention: Chris Pickett Customer ID: 08100095
Project ID: Maple Hill WWTP
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
22-09187 Site: Effluent 3/2/2022 9:30 AM Water JCB/Envirochem
Test Method Results Date Analyzed
Ammonia Nitrogen EPA 350.1,Rev.2.0,1993 <0.2 mg/L 03/08/2022
Total Kjeldahl Nitrogen (TKN) EPA 351.2,Rev.2.0,1993 <0.5 mg/L 03/09/2022
Total Dissolved Solids (TDS) SM 2540 C-2015 379 mg/L 03/18/2022
Residue Suspended (TSS) SM 2540 D-2015 3.5 mg/L 03/04/2022
BOO SM 5210 B-2016 9 mg/L 03/03/2022
Chloride SM4500 CI E-2011 38 mg/L 03/21/2022
Nitrate Nitrogen(Calc)
Nitrite Nitrogen EPA 353.2,Rev.2.0,1993 <0.02 mg/L 03/02/2022
Nitrate+Nitrite-Nitrogen EPA 353.2,Rev.2.0,1993 0.29 mg/L 03/08/2022
Nitrate Nitrogen Subtraction Method 0.29 mg/L 03/10/2022
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
22-09188 Site: Effluent-Grab 3/2/2022 9:40 AM Water JCB/Envirochem
Test Method Results Date Analyzed
Fecal Coliform Idexz Colilert-18 5 MPN/100m1 03/02/2022
Temperature SM 2550 B-2010 13.9 C 03/02/2022
pH SM 4500 H B-2011 7.3 units 03/02/2022
Total Phosphorus SM 4500 P(F-H)-2011 7.62 mg/L 03/09/2022
Comment: Amended 3/22/2022 to a Chloride and TDS results
Reviewed by:
Report#:: 2022-03878 Page 1 of 1

Facility Name:
Date: 3 1 2-1 2--2- KCA- '''al. Certification 0 94
e Hit i
Analyst: 'Jay Baker Permit 4: \./\-)CQ eX)3-5049
PH
Reference Method SM4500 H il3-2011 Instrument ID:
Calibration Time Cal Buffer 4 0 s.0 Cal Buffer 10.0 s.u. Check Buffer 7 0 s.u. Comments •
.
*pH check buffer must read within±al pH units of the buffer's true value.
4 su buffer Lot///: RICCA 4112869 Exp 11/22 7 su buffer Lodi/: RICCA 21 12A38 Exp. 12/23 10 su buffer Lott RICCA 2112750 Exp 5/23
Sample Collection Sample Analysis pH Result 10.Post-analysis Buffer
Sample location
Comments Data Qualifiers
Time. Time* i s:u Check value s,u, .
43
li• Post analysis buffer check is required when performing analyses at multiple sampling locations and must be within a 0.1 units of the buffer's true value
All pH values in pH units(i.e,,sit.) Record all data to the nearest 0.01 s.u,and report to the nearest 0.1 a u.
Total Residual Chlorine(TRC)
Reference Method:SM 4500 CI-G201 I: Hach 8167 BR: (Please circle applicable Method Instrument ID:Post-analysis 1
Daily Check Timc cheek Sample Sample
Check Standard Result StandardTRC R
Std.
esult
Collectionmpe Analysis Comments/Data Qualifiers
WI.
(when analyzing Location nit.or mg/4
or mg/1. at multiple sites) Analyzed Time Time
TRC Daily Check Standard true value_ 240 pgfI.or mgrL, acceptance range 150.330 i,,t1.,or mei.
Check standards must recover within I:10%of the check standard's true value
Annual Calibration Curve Verification Date. 2-2022 LOT 4 IDEXX 210792 Exp.Date: 08/31/22
Reagent Blank Value: (When applicable,Analyze and document a reagent blank when standards,sample dilutions or PT Samples are prepared)
Dissolved Oxygen(DO)
Reference Method:SM 4500 0 0,-2011 Instrument ID:
•Post-analysis calibration
Calibration/ , Calibration variable Meter reading
verification(when necessary)
Verification I or%efficiency Comments
Time Barometric after calibration ' Theoretical Calculated
Temperature
pressure Value mg I. Value mg/L
L---- ...
Use this row when performing a verification instetal of
ea I ib ra lion ___
..........— _
1 Sample Collection 'Sample Analysis I DO reading
Time Time mg/I. Comments/Data Qualifiers
,..e When performing analyses at multiple locations,the meter must be recalibrated at each site before analysis or a post-analysis calibration verification must be performed
•If sample is measured directly in the stream and/or onsite,only time analyzed would be recorded with a note that they are measured in situ or immediately
Temperature
Reference Method'SM 2550 B-2010 instrument JD: _ .
Sample *Sample Temperature
Sample Location Collection Analysts vc
Comments Data Qualifiers
Time Time
_
•If sample is measured directly in the stream and/or on site,only time analyzed would be recorded,with a note that they are measured in situ or immediately
Annual Verification Date 2-21
Field Personnel Note:
QA.001
Rev 1-2022 .
1

Environmental Chemist, Inc., Wilmington, NC Lab#94
6602 Windmill Way
Wilmington,NC 28405
Sample Receipt Checklist 910.392.0223
Client:ftpa.— C,0 •_LA.._11.__I--_. , Date. /4_12--
Report Number:_ 2022- U 3 8
0
Receipt of sample: __ ECHEM Pickup V� Client Delivery 0 UPS ❑ —
❑ YES 0 NO A 1. Were custody seals present on the cooler? FedEx❑ Other❑
O YES 0 NO � N/AT�----
2. If custody seals were present, were they intact/unbroken?
Original temperature upon receipt , • `C
How temperature taken: 0 Temperature Blank Corrected temperature upon receipt °C
Against Bottles _IR Gun ID:Thomas Traceable S/N:210835468 IR Gun Correction Factor°C: 0.0❑ YES 0 NO ---
3. If temperature of cooler exceeded 6°C, was Project Mgr./QA notified?
MEMMal 0 NO 4. Were proper custody procedures(relinquished/received)followed?
0 NO 5. Were sample ID's listed on the COC?
A$' YES 0 NO 6. Were samples ID's listed on sample containers?
�'� YES 0 NO
7. Were collection date and time listed on the COC?
YES 0 NO 8. Were tests to be performed listed on the COC?
►i YES 0 NO 9. Did samples arrive in proper containers for each test?
it YES 0 NO in nrn,4,-,.....,i,- — —
Yf i e� r r� r,
'f -S (❑ NO I11 Was ad_e uate sample volume
111.
YES 0 NO 12. Were samples received within proper holding time for requested tests?
IV YES ❑ NO 13. Were acid preserved samples received at a pH of<2? * —
❑ YES 0 NO 14. Were cyanide samples received at a pH>12?
❑ YES ❑ NO 15. Were sulfide samples received at a pH>9?
!i YES ❑ NO 16. Were NH3/TKN/Phenol received at a chlorine residual of<0.5 m/L? ;, `
❑ YES 0 NO 17. Were Sulfide/Cyanide received at a chlorine residual of<0.5 mL
❑ YES 0 NO 18. Were orthophosphate samples filtered in the field within 15 minutes?
* IOC/Volati es are pH checked at time of analysis and recorded on the benchsheet.
** Bacteria samples are checked for Chlorine at time of analysis and recorded on the benchsheet
Sample Preservation: (Must be completed for any sample(s) incorrectly preserved or with headspace)
Sample(s) were received incorrectly preserved and were adjusted accordingly
by adding (circle one): H2SO4 HNO3 HCI NaOH
Time of preservation:
If more than one preservative is needed, notate in comments below
Voe hpt fy cLstoTer serr.ce irrnedlately for ircorrect:y preserved samples.Obta'n a nen;sample o-
no:"ry the sate lab i°d rected to ana'yzed by the customer.Who was notif,ed,date and t me:
Volatiles Sample(s)
were received with headspace
COMMENTS:
DOC. QA.002 Rev 1

envirocherny ENVIRONMENTAL CHEMISTS, INC OFFICE: 910- Wilmington, 5 392-0223FAX[phone]
Analytical&Consulting Chemists NCDENR: DWQ CERTIFICATION#94 NCDHHS: DLS CERTIFICATION#37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY
Client: Pender County Utilities (Wastewater) PROJECT NAME: Maple Hill WWTP (PPI 001) REPORT NO: is LA- - tY1Z t7
ADDRESS: CONTACT NAME: Chris Pickett, ORC PO NO:
REPORT TO: ORC PHONE/FAX:
COPY TO: email:
Sampled By: yC� SAMPLE TYPE: I=Influent, E=Effluent,W=Well,ST=Stream, SO=Soil,SL=Sludge, Other:
Collection PRESERVATION
Sample Identification .9.F E `o i� c `o `o rn m g i ' o 0 0 o El'
ANALYSIS REQUESTED
En o o a L E z o u 2 Z a = x
3iate Time Temp " z z = _ o
ij qf-7 C P
WVVTP PPI 001 (composite 3f,Lt 53.. 91Q- X BOD, TSS, NO2
C P
J _ X 42— NO3, NH3, TKN
WWTP PPI 001 _ C P
(composite) Triannuals X Chloride, TDS (March, July, Nov)
C P
G G
Ve.— 4 7111,1 , P /"7
WTP Effluent (grab) G 140 X W Total Phos
C P
pH (field) 33 G G i! X ,Fecal Coliform
C P
/3.9 G G I
C P i
Samples due 1/month G G
C P
G G
limits:BOD 30 mglL,TSS 30 mg/L,NH3 15 mgiL,Fecal 200 colonies/100 ml
Transfer Relinquished By: Date/Time Received By: Date/Time
1. 1 —12. _ - - -
Temperature when Received: (,1 c Accepted: Reje ted: Resample R sted:
Delivered By:
�p'1 Received By: _Date: s L°w Time: S+�p
Comments: / !!! """ T R AROUND:

FORM. NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page_1_of 4_
Permit No.: WQ0035049 1 Facility Name: l/ of 4 i R( itiun-F I County: Pender Month: March Year: 2022
1 Field Name: 1 Field Name: 2 1 Field Name: 3 Field Name: 4
Did irrigation occur Area(acres): 1.72 Area(acres): 1.72 Area(acres): 1.72 Area(acres): 1.72
at this facility? Cover Crop: Bermuda Cover Crop: Bermuda Cover Crop: Bermuda Cover Crop: Bermuda
p� P� p�
YES ❑ NO Hourly Rate(in): 0.41 Hourly Rate(in): 0.41 Hourly Rate(in): 0.41 Hourly Rate(in): 0.41
Annual Rate(in): 29.71 Annual Rate(in): 29.71 Annual Rate(in): 29.71 Annual Rate(in): 29 71
Weather Freeboard Field Irrigated? 0 YES ❑ NO Field Irrigated? ❑ YES n NO Field Irrigated? O YES ❑ NO Field Irrigated? O YES ❑ NO
a c -.
v 3 ° a m °t d o v rn E co am v •C rn E co a -a m a E a a -a •o a E w
T U s° .'. co o. c E E . a' •rd. T C 3 ` E E N a> ;; >. C 3 ` C E 07 a, ;; �+ C 3 ` C E m w $; a C 3 ` C
gi ` y 1 T. tl 3 a E a '� E 3 ' 3 a E a '- V E 3 'O 3 a E •7, 'O E 3 'i7 3 a E@ '7, 'i3 E 3 'O
y O O g x 0 g 2 K O 10 a' 10 . 22 2 f0 . 22
a) cn as oa i= oo = o oa i= oo n: so rpm i= oo m = o oa � •` oo A
E y rn �a a > a = > a = > Q L.
_ g -J > ¢ _
d - 0- o �o
lb
°F in ft ft gal min in in gal min in in gal min in in gal min in in
1 c 46 0 4.1
2 C 45 0 4.1
3 C 59 0 4
4 C 46 0 4
5
6
7 C 70 0 4
8 CL 64 0 4
9 CL 55 0 4
10 CL 46 0.3 4
11 CL 47 0 4
12
13
14 C 38 0.8 4
15 C 39 0 4
16 CL 47 0.2 4
17 C 60 0 4 _
18 C 60 0 4
19
20
21 C 39 0 4
22 C 46 0 4
23 CL 60 0 4
24 R 66 0.2 4
25 CL 54 1 4
26
27
28 C 38 0 4
29 C 38 0 4 _
30 CL 51 0 4
31 CL 70 0 4
Monthly Loading: 0 0.00 0 0.00 0 0.00 0 0.00
12 Month Floating Total(in): 9.21 9.67 9.62 9.35

FORM: NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page_2_of_4_
Permit No.: WQ0035049 I Facility Name: Maple Hill WWTF I County: Pender Month: March Year: 2022
Field Name: 5 Field Name: 6 Field Name: 7 Field Name: 8
Did irrigation occur
Area(acres): 1.72 Area(acres): 1.72 Area(acres): 1.74 Area(acres): 1.71
at this facility? Cover Crop: Bermuda Cover Crop: Bermuda Cover Crop: Bermuda Cover Crop: Bermuda
❑YES ❑ NO Hourly Rate(in): 0.41 Hourly Rate(in): 0.41 Hourly Rate(in): 0.41 Hourly Rate(in): 0.41
Annual Rate(in): 29.71 Annual Rate(in): 29.71 Annual Rate(in): 29.71 Annual Rate(in): 29.71
Weather Freeboard Field Irrigated? ❑YES ❑ NO Field irrigated? O YES ❑ NO Field Irrigated? O YES ❑ NO Field Irrigated? ❑YES ❑ NO
:.-
a)v
° 4, m ° v , E , a, a, E a, y ° E , a, ar, E co
>. , a) (4 v
n: U m a . v . ° 0 m : . E ` c
❑ (1,) . aa Ea, 0 E 3 v aa E Q1 F. .3 a v aa E g' r .E a 3a ►E a 0 v E• a v
t Ei ° > a o i_ • 0 g = o o F 00 = o . .ft I To o = •° o
.ftA = o
d• F a` ❑ a
°F in ft ft gal min in in gal min in in gal min in in gal min in in
1 C 46 0 4.1
2 C 45 0 4.1
3 C 59 0 4
4 C 46 0 4
,
5
6
7 C 70 0 4
8 CL 64 0 4
9 CL 55 0 4
10 CL 46 0.3 4 -
11 CL 47 0 4
12
13
14 C 38 0.8 4
15 C 39 0 4
16 CL 47 0.2 4
17 C 60 0 4
18 C 60 0 4
19
20 _
21 C 39 0 4
22 C 46 0 4 _
23 CL 60 0 4 _
24 R 66 0.2 4
25 CL 54 1 4
26
27
28 C 38 0 4
29 C 38 0 4
30 CL 51 0 4
31 CL 70 0 4
Monthly Loading: 0 0.00 0 0.00 0 0.00 0 0.00
12 Month Floating Total(in): 8.75 9.65 10.04 10.18

FORM: NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page_3_of_4_
Permit No.: WQ0035049 I Facility Name: Maple Hill WWTF I County: Pender Month: March Year: 2022
Field Name: 9 Field Name: 10 Field Name: 11 Field Name:
Did irrigation occur
Area(acres): 1.75 Area(acres): 1.77 Area(acres): 1.72 Area(acres):
at this facility? Cover Crop: Bermuda Cover Crop: Bermuda Cover Crop: Bermuda Cover Crop:
YES ❑ NO Hourly Rate(in): 0.41 Hourly Rate(in): 0.41 Hourly Rate(in): 0.41 Hourly Rate(in):
Annual Rate(in): 29.71 Annual Rate(in): 29.71 Annual Rate(in): 29.71 Annual Rate(in):
Weather Freeboard Field Irrigated? o YES E NO Field Irrigated? O YES ❑ NO Field Irrigated? o YES ❑ NO Field Irrigated? J YES 7 NO
a) w c
2 o0 wa a) -a -a co E a' ev -o a E co 4) -0MI a) Eis Tc co .0
-10 a E T rn
m o P. gaa E me e 2, c E � �c E .e e °' �,•c a T�5 E .e e °' y, c a c E .e e ;; >, c a c
E m v o o a E co v E aa aa E e o '6 E '5 '5 aa E `0 •m '6 E a a❑ e a .ao o s i ❑ o a ci= •2) ❑ a Ro o a = rn 13 o c a F= .2 ❑ o R2cu cn ell'a > Q = > = > Q
— 2 . _ —I iJBC a ❑ CO
3 I—
a
°F in ft ft gal min in in gal min in in gal min in in gal min in in
1 C 46 0 4.1
2 C 45 0 4.1
3 C 59 0 4
4 C 46 0 4
5
6
7 C 70 0 4
8 CL 64 0 4
9 CL 55 0 4
10 CL 46 0.3 4
11 CL 47 0 4
12
13
14 C 38 0.8 4
15 C 39 0 4
_16 CL 47 0.2 4
17 C 60 0 4 -
18 C 60 0 4
19
20
21 C 39 0 4
22 C 46 0 4
23 CL 60 0 4
24 R 66 0.2 4
25 CL 54 1 4
26
27
28 C 38 0 4
29 C 38 0 4
30 CL 51 0 4
31 CL 70 0 4
Monthly Loading: 0 0.00 0 0.00 0 0.00 0 0.00
12 Month Floating Total(in): 8.81 9.68 9.27

FORM: NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page_4_of_4_
Did the application rates exceed the limits in Attachment B of your permit? O Compliant ❑ Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? O Compliant D Non-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? O Compliant ❑ Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 0 Compliant ❑ Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? O 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: Christopher Pickett Permittee:
Pender County Utilities
Certification No.: 1010919 Signing Official: Kenneth Keel
Grade: WW-SI Phone Number: 910-259-1570 Signing Official's Title: Director
Has the ORC changed since the previous NDAR-17 o Yes ❑ No Phone Number: 10-259-1570 Permit Exp.: 8/31/26
I
efAzZ fisD`io/r //r�IT �'-r�� .Z[.i%C- I / ZS/v
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 directty 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