WQ0002520_Signature Authority_20230419

April 19, 2023
Division of Water Resources
Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Subject: Signature Authority Designation
To Whom It May Concern:
As an appropriate signing official for _Town of Bath (city/town/ county or
business name) as designated by 15A NCAC 2T .0106, I hereby delegate authority to sign and certify all
permit applications, reports or other permit related documents to the following staff for the following permit
types (sewer, spray, land application) and/or permit numbers:
Position
Person
Currently in
Position
Permit Tyne
or Permit
Number
ORC
Garland S. Grant III
WO0002520
Backup ORC
Steven Randall Merrill
WO0002520
Town
Administrator
M. C. "Bubs" Carson
WO0002520
If you have any questions, please contact me at the following:
Permittee/Applicant name (please print): M. E. "Bubs" Carson
Title:
Complete mailing address:
City:
State: NC Zip:
Telephone number: (_252 ) 923-0212 Email: townofbath(a embargmail.com
Sincerely,
signature

North Carolina Department of Environmental Quality
Division of Water Resources
Permit Number:
W00002520
Permit Type:
Wastewater Irrigation
Facility Name:
Town of Bath WWTP
Facility Addressl:
Possum Hill Rd
Facility Address2:
City, State & Zip:
Bath, NC 27808
Owner Information Details:
MUST submit a Change of Name/Ownership form to DWR to make any changes to this Owner information.
(Click here for "Change of Name/Ownership" form)
Owner Name:
Town of Bath
Owner Type:
Government - Municipal Owner Type Group: Organization
*** Legally Responsible for Permit ***
(Responsible corporate officer/principle executive officer or ranking elected official/general partner or proprietor;
or any other person with delegated signatory authority from the legally responsible person.)
Owner Affiliation:
James G Latham Title: Mayor
Addressl:
PO Drawer6a
Address2:
City, State & Zip:
Bath NC 27808
Work Phone:
Fax:
Email Address:
*** Permit Annual Fee Billing ***
Billing Month: December
Invoice Number
Invoice Date Invoice Due Date Invoice Amount Invoice Status
Owner Contact Person(s)
Contact Name Title Address Phone Fax Email
Bubs Carson 103 S King St, Bath, NC 27808 252-923-0212 townofbath@embargmail
Facility Contact Person(s)
Contact Name Title
Permit Contact Pf
Contact Name Title
M E Carson
Address
Address
PO Drawer 6a, Bath, NC 27808
Phone Fax Email
Phone Fax Email
252-923-0212 252-923-0212 [e-mail]2.n
Permit Billing Contact Person(s)
Contact Name Title Address Phone Fax Email
Town of Bath PO Box 1006, Bath, NC 27808 252-923-0212 252-923-0212 townofbath@embarqmail
Persons with Signatory Authority
Type Contact Name Title Address Phone Fax Email
4/19/2023 --age 1

Permit Number: W00002520
Permit Type: Wastewater Irrigation
Facility Name: Town of Bath WWTP
Facility Addressl: Possum Hill Rd
Facility Address2:
City, State & Zip: Bath, NC 27808
Designated Operators
If the designated operators listed below are incorrect or no longer associated with the collection system, the information can be updated by so
a completed "Operator Designation Form" fClick Here for ORC Designation Form). Please provide specific details as to the changes requested, j
the addition/removal of designated operators. For all other operator questions or issues, please call 919-807-6353.
Facility Classification: SI
Operator Name
Garland Samuel Grant
Facility Classification: WW3
Role Cert Type Cert Status Cert # Effective Date
ORC SI Active 1007284 12/1/2018
Operator Name
Role
Cert Type
Cert Status
Cert #
Effective Date
Garland Samuel Grant
ORC
WW-3
Active
995733
10/1/2018
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Steven Randall Merrill
Backup
WW-3.
Active
23529
10/1/2018
4/19/2023 Paw 2