WQ0013398_Monitoring - 12-2020_20210209

FORM. NDMR 10-13 NON -DISCHARGE MONITORING REP*T (NDMR) Pa le __ of
Permit No.: WQOO 13398
1 Facility Name: Sandpiper Bay WWTF
o,inty: Bruns c
-
I Month: December
I Year: 2020
Ppl: 001
Flow Measuring Point: C3 Influent[Z Effluent 0 No flow generated
-
Parameter Mon4oring Point: 111 Ifluent 2 Effluent C I Groundwater Lowering ❑ Surface Water
Parameter
Code
I,
5T050
00310
00665
75R_'
31616
00625
00400
"01
00076
t
2
0
C
0
0
LL
LO
0
ca
0 ,
1,- =
z
0
l.- 0
0
Q
E
U.
E
32
�o . ?
2�
z
- -
CL
i Z
NTU
24-hr
hre
GPD
mg/L .--mq/L
mg/L
m it
#/100 mL
MVI
mg/L
n-f IL
su
I c ig/L
1
07:00
4
0,5
6.9
2
07:00
4
52,01D0
0,5
6.9
6.9
3
07:00
4
61,00o
0 5
4
07:00
4
57,000
0.5
5
07:00
4
61,GC0
0,5
6.9
6.9
6,9
6
07:00
4
61,00
7
07:00
4
52,000
0.5
8
07:00
4
61 o(o
0.5
9
07:00
4
61,000<2
2 11;
3.46
0.5
&S
<1
1
-05
2
6.9
:2 5
1
10
07:00
4
0
6.9
ill
07:00
4
61,000
6.9
12
07:00
4
61,X0
0.5
6.9
6.9
8.9
6.9
6.9
6,9
13
07:00
4
0,5
14
07:00
4
61 X0
15
07:00
4
61,000
05
16
07:00
4
57cio­
0.5
1
-9
17,
07:00
4
52,0c0
0:5
18
07:00
4
61.000
6.9
19
07:00
4
52,000
Q.5
6.9
20
07:00
4
61,000
0 5
69
1
21
07:00
4
61,000
0,5-
609
6.9
1
22
07:00
4
57,000
0L5
231
07:00
4
61,00
<2
25.3
5.04
0.5
0,5
0 5
11
<0 2
-:0.5
:-E 3
6.9
2.5
1
24
07:00
4
61,000
6.9
25
26
07:00
07:00
4
4
52,000 1 '0C101
6.9
6.9
-1
1
1
27
07:00
4
61.000
0.5
6.9
28
07:00
4
97.00
0.6
6.9
29,
07:00
1 4
52,0(o
6.9
30
07:00
- 4
61o0o
0.5-'
0 5
6.9
31
07:00
4
59,OCiO
6.9
1
Average:
58,258
0.00
25, 15
4.25
0.50 ­
1.00
0.! 0
0.00
E 15
),00
1.00
Daily Maximum:
61,000
2.00
15�0z
5.04
0.50
1.00
1rc
0.50
25 TO-
6.90
_100
Daily Wnimum:
52,OOQ_A 2.00
25 00
3.46
0.50
Gral-,
1.00
0:(
0.50
ill.)o
6.90
150
1.00
Sampling Type:
Record A Composite
Corrposoe
Composite
Grab
ComF? te 1
Composite
h
Month
Ccwnr ),site
2 X Wth+t
Grab
6 to 0
Cr,
10
Recorder
10
Contft-t_
Monthly Avg. Limit:
150,00 10
0
�', a
14
Daily Limit:
js 1 5
25
SampleY:
Frequency:
ConfinAff 2 X Month
2 X Month
2 X Month
5 X week
2 X Month
2 X P�

R
1
Certified Laboratories
Name: Sunny Wright Vame: Environmental Chemist / Wilimington NC
Name: Eiqame:
Does all monitoring data and sampRing frequencies meet the requirements in Attachment A of your permit? Compliant _X_ Not Compliant
1
If the facility is non -compliant, plea explain in the space below the reason(s) the facility was not it compliance. Provide in your e4)lanar:ion the date;:s) of the non-compliance
and desc;•ibe the corrective action(s) taken. Attach additional sheets if n
Operator in Responsible Charge (ORC) Certification
Perrnittee Certification
ORC: Sunny'Wright
Permittee:
Certification No.: 28813
Signing Official: Timothy Tilma
Grade: II Phone Numbei 910-880-4178
Signing Official's Title: General Manager
Has th ORC changed since t" previous NDMR? No
Phone Nu r: 910-470-8 84 Permit Exp 5/20/20
Signature Data
Sign re Date
By this signature, I certify that this report is accurrate to best of my
I certify, under penalty of law, that this document and all attachments were prepared under my
knowledge
direction or supervision in accordance with a system designed to assure t!aat all qualified personnel
properly gatherA and evaluated the information submitted.
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 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Permit No.: W00013398
Facility Name: Sandpiper Bay WWTF
County: Brunswick
Month: December
Year: 2020
Did irrigation occur
Field'W ie:
B-FW
Field Name:
B-GR
`Field Name'
'B PER
Field Name:
B-RGH
tI11S facility?
Area (acres):
23
Area (acres):
2.5
Area (acres):
5:5
Area (acres):
21
at
Cover Crop;.Cover
'
Crop:
P�
Cover Cro `
p.
Cover Crop:
p:
YES ❑ NO
Hourly Rate (iri):
1
Hourly Rate (in):
1
Hourly Rate (in):
1
Hourly Rate (in):
1
Annual Rate (In):
' 51
Annual Rate (in):
51
Annual Rate (in);
51
Annual Rate (in):
51
Weather
Freeboard
Field Irrigated!
[) YES NO
Field Irrigated?
YES E NO
Field Irrigated?
[71 YES I , NO '
Field Irrigated?
❑ YES NO
oT
v
U
ca
g
-a
mrn
❑Q)-m m au
a m
,
CL
Ln
+v
m
E
i=
rn
ro
O
_j,
Ec y
=o
Ea
a
v
c
O
EE 'vrn
oo
=
E2
a
E
..
Er
t.c
E
o
O
c
E v
o
1
>,
oIx
Eo rn
vc
°ocCLo>
°F
in
ft
ft
gal
thin
in
in
gal
min
in
in
gal
min
In
in
gal
min
in
in
1
C
68
1.5
3,5
2,5
651000
65'
0,10'
0;10
5,000
5
0.07
0.07
2
C
58
3.5
2.7
3
4
C
86
3.8
2,5
6
C
68
0.5
3,5
2.6
7
5,000
5
0.07
0.07
8
10
C
70
3.8
2.6
55
0.09
0,09
11
'
12
PC
77
3.9
2,3
13
14
CL
67
0.1
3.7
2
15
16
R
52
0.1
3.7
2
5,000
5
0.07
0.07
17
.
18
19
20
21
CL
56
t2
3.7
1.4
22
23
C
61
3.7
1.7
24
r yam'
•'
5,000
5
0.07
0.07
25
0 09'
0,09 ,,
26
27
_.
28
29
30
CL
73
0.4
3.8
2.2
5,000
5
0.07
0.07
31
0.j0.1
Monthly Loading:
1,75 000';
0,28 "
4 99 %`
25,000
0.37
23.73
0
0 Dtl' `
0 5b
0
12 Month Floating Total (in):

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
❑ Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
❑� Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
0 Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
❑� Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
D 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: Wilbur Allen Williams
Permittee:
Timothy P. Tilma
Certification No.: 15664
Signing Official:
Grade: S1 Phone Number: [phone]
Signing Official's Title: General Manager
Has the ORC changed since the previous NDAR-1? ❑ Yes 0 No
Phone Number: [phone] Permit Exp.: 5/31/�ll
Signature Date
Signature Date
By this signature, I certify that this report is accurrale and complete to the best of my knowledge.
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel property gathered and evaluated the information submitted. Based on my
Inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. 1 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FURM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.:
Facility Name: Sandpiper Bay WWTF
County: Brunswick
Month: December
Year: 2020
Did irrigation occur
Field,Name
B-TEE
Field Name:
P-1
Fielti Natfiel
P-2
Field Name:
P-3
at this facility?
Ares
28
Area (acres):
4.59
Area (acres):
_
7.82
Area (acres):
1.16
Coil Ptlp,
Cover Crop:
CoverCrop:
Cover Crop:
❑ YES ❑ No
Hy"Rate (in):
1
Hourly Rate (in):
1
Hourly fate (in):
1
Hourly Rate (in):
1
Artii`ui Rath (in):
:ua �,
51
Annual Rate (in):
51
Anlival Rate,(in)t
51
Annual Rate (in):
51
Weather
Freeboard
<=ild`IPlaf�
[ ES "d
❑ tlfi; .
Field Irrigated?
9
YES No
❑ ❑
Firi Id Irrigated?
❑YES ❑ No
Field Irrigated?
❑ YES ❑ No
v
°
L
2
is
i
u
°
°❑
m
v
,
m
� di
E
Q)
>a
>
°
>>
�
p❑
E
°>
CIL°F
rn
M
E °
C"
E
in
ft
ft
.,gal
M.
Irl
id "'
gal
min
in
in
gal
.min
In
In
gal
min
in
in
1
C
68
1.5
3.5
2.8
2
3itf�b.`
C
58
3.5
2.7
0 05
0 05
4
C
86
3.8
2.5
6
C
68
0.5
3.8
2.7
8
9
101
C
70
3.8
2.6
11
12
PC
77
3.9
2.3
13
14
CL
67
0.1
3.7
2
15
161
R
52
0.1
3.7
2
17
18
19
20
21
CL
56
1.2
1 3.7
1.4
35,000
35
0,05
0,05 ;
22
23
C
56
1.2
3.7
1.7
�-
24
_
25
26
27
28
29
30
CL
73
0.4
3.8
2.2
31
Monthly Loading
12 Month Floating Total (in):?�+�'
70:`.00d,0ii)J:00
v:dn ul

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
0 Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
El 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?
E Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
Q 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: Wilbur Allen Williams
Permittee:
Timothy P. Tilma
Certification No.: 15664
Signing Official:
Grade: S1 Phone Number: [phone]
Signing Official's Title: General Manager
Has the ORC changed since the previous NDAR-1? ❑ Yes ❑✓ No
Phone Number: [phone] Permit Exp.: 5131/)4Z7
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 penally 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
VVQ0013398
Sandpiper Bay WWTF
County:December1
1
• irrigation • ur
at this facility
®
Area
•
.-
Cover Crop
Cover C
■ YFS
i�
Field Irrigated?
Y
Loacling-.'��
oil
12 Month FloatingMonthly

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit? El Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑� Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 0 Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 2 Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? Q 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:
Wilbur Allen Williams
Permittee:
Timothy P. Tilma
Certification No.: 15664
Signing Official:
Grade:
S1 Phone Number: [phone]
Signing Official's Title: General Manager
Has the
ORC changed since the previous NDAR-1? ❑ Yes ❑ No
Phone Number: [phone] Permit Exp.: 5/31IV X?
W
1
Signature Date
Signature Date
By this signature, I certify that this report is accurrale and complete to the best of my knowledge.
I certify, under penally 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. 1 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
PermitNo.: VV00013398
Facility Name: Sandpiper Bay WWTF
County: Brunswick
Month: December
• irrigation occur
1"EM
..
- • -
-®
at this facilil
.-
Cover Crop:
C*ver Crbo�
YES [J] NO
Hourly Rate (in):
Hourly Rate (in):
Annual Rate (in):
Fit -It Irrilated?]
s
EEL
ML
• •.• .
�
111
�
_
1 11
1
111
�
1 //

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit? ❑ Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? Q Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑� Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ❑✓ Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑� 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: Wilbur Allen Williams
Permittee:
Timothy P. Tilma
Certification No.: 15664
Signing Official:
Grade: S1 Phone Number: [phone]
Signing Officials Title: General Manager
Has the ORC changed since the previous NDARA? ❑ yes E] No
Phone Number: [phone] Permit Exp.: 5/31/1,,*-2
IN &Z, - -�L�lm
1 vV � ?z 14A,
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: W00013398
Facility Name: Sandpiper Bay WWTF
County: Brunswick
Month: December
Year: 2020
Did irrigation occur
Field Name:
S-2
Field Name:
S-3
Field Name!
8-4
Field Name:
S-5
at this facility?
Area (acres.
1.82
Area (acres):
4.1
Area (acres):
4,16
Area (acres):
6.6
CdJ$8p:
Cover Crop:
Cover Crop;
Cover Crop:
❑ YES No
Hourl _l�' �ii
i'
i��i� ��i �ated`t
_..
1
Hourly Rate (in):
Annual Rate (in):
1
51
Hourly Rate (in)!
AnhUal Rate
1
Hourly Rate (in):
Annual Rate (in):
1
51
Weather
Freeboard
` d YES l� No
Field Irrigated?
❑ YES 7 No
Field irrigated!
_.
❑Yes [] No
Field Irrigated?
❑Yes � No
m
o
E
o
o
.� m
d—
w
M
d v
v
>
-_
rn
E
E �
m
°
E 0)
EE
o
J�
E
rn
J
_
_
oo
J
>
N
o7
J
C
2�' v0
o_
Eo°
'
J�
F
in
ft
ft
gal
min
in
in,
gal
min
in
in
gal
min
in
in,
gal
min
in
in
2
_.
3
4
5
6
7
—
8
10
11
12
13
14
15
16
17
18
19
20
—
21
22
23
24
25
26
27
28
--
29
30
31
0
Monthly Loading:
12 Month Floating Total (in):�'i�%,...
0
- 0,001,0
0.00tl,Od'^
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit? ❑� Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑� Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 0 Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ❑✓ Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? Q 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: Wilbur Allen Williams
Permittee:
Timothy P. Tilma
Certification No.: 15664
Signing Official:
Grade: S1 Phone Number: [phone]
Signing Official's Title: General Manager
Has the ORC changed since the previous NDAR-17 ❑ Yes ❑ No
Phone Number: [phone] Permit Exp.: 5/31/�4 L?
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0013398
Facility Name: Sandpiper Bay WWTF
County: Brunswick
Month: December
Year: 2020
Did irrigation occur
FW&Name:
S-6
Field Name:
S-7
Field Na'id!
5'-8
Field Name:
S-9
at this facility?
Ate�i(acres):
cou�t'
2:23
Area (acres):
cover Crop:
4.34
Area (acres):
Cover Crop`:
1 71
Area (acres):
Cover Crop:
4.83
❑ YES ❑ No
Nbtlri)rt'itl
Awfit)�I.F Er �ir1
1
51
Hourly Rate (in):
Annual Rate (In):
1
51
Hourly Rate (in):
Annual Rate (in j;
91
Hourly Rate (in):
Annual Rate (in):
1
51
Weather
Freeboard
Fibld ��i i(
❑ YES ` N0
❑
Field Irrigated?
❑YES No
❑
Field Irrigated9
❑ YE5 ❑ No :
Field Irrigated?
❑YES ❑ NO
o
va
u
Ln
�
oo_
E0
�
E=
-aa-
o
E
°'
'
oo
E
`
E
Xo
E.2
�
v ;
Ma
E
?Ed,'E
ro
JS
tM
,5
E vL°
aEa
>
°
�c_
�rn
J
_a
�
J0
°F
in
ft
ft
gel
m)ri
m
IN'`
gal
min
in
in
gal
min
ih
I
gal
min
in
in
2
3
4
5
_
6
7
9
10
_
11
Y
12
_
131
14
15
16
17
18
19
20
21
22
23
24
25
26
27
--
-
28
29
30
31
} C161
Monthl Loadin
Y g
12 Month Floating Total (in):
0
0
000
-
y 1r0yRy;
0.00
0
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
Q Compliant ❑ Non-Compliaht
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
El Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
❑✓ Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
Q Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
❑� 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: Wilbur Allen Williams
Permittee:
Timothy P. Tilma
Certification No.: 15664
Signing Official:
Grade: S1 Phone Number: [phone]
Signing Official's Title: General Manager
Has the ORC changed since the previous NDAR-1? ❑ Yes E] No
Phone Number: [phone] Permit Exp.: 5131114 7jf
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617