WQ0003299_Signature Authority_20230516

North Carolina Department of Environmental Quality
Division of Water Resources
Permit Number: WQ0003299
Permit Type: Wastewater Irrigation
Facility Name: Town of Seaboard WWTF
Facility Addressl: 130 Williams St
Facility Address2:
City, State & Zip: Seaboard, NC 27876
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 Seaboard
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: Geraldine Langford Title: Mayor
Addressl: PO Box 327
Address2:
City, State & Zip: Seaboard, NC 27876
Work Phone: [phone] Fax:
Email Address: [e-mail]
*** Permit Annual Fee Billing ***
Billing Month: August
Invoice Number Invoice Date Invoice Due Date Invoice Amount Invoice Status
Owner Contact Person(s)
Contact Name Title Address Phone Fax Email
Facility Contact Person(s)
Contact Name Title Address Phone Fax Email
Permit Contact Person(s)
Contact Name Title Address Phone Fax Email
Permit Billing Contact Person(s)
Contact Name Title Address Phone Fax Email
Town of PO Box 327, Seaboard, NC 27876 252-589-5061 [e-mail]
Seaboard
Persons with Signatory Authority
Type ObataSLARMe Title Address Phone Fax Email
Permit ]o rues PO Box 327, Seaboard, NC 252-589-5061 252-589-1099 [e-mail]
27876
5/15/2023 Page 1
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Permit Number: WQ0003299
Permit Type: Wastewater Irrigation
Facility Name: Town of Seaboard WWTF
Facility Addressl: 130 Williams St
Facility Address2:
City, State & Zip: Seaboard, NC 27876
Designated Operators
ifthe designated operators listed below are incorrect or no longer associated with the collection system, the information can be updated by sc
a completed 'Operator Designation Form"( Here for ORC Designation Form). Please provide speciFc details as to the changes requested,
the addition/removal of designated operators. For all other operator questions or issues, please cal/ 919-807-6353.
Facility Classification: SI
Operator Name Role Cert Type Cert Status Cert # Effective Date
Jeffrey Carl Long ORC SI Active 993135 9/1/2022
Johnny G Young Backup SI Active 23129 7/17/2006
5/15/2023
Page 2

May 15, 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 Seaboard's Sewer Systeru (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 Tyre
or Permit
Number
ORC
Jeffrey C. Long
WQ0003299
If you have any questions, please contact me at the following:
Permittee/Applicant name (please print): Lie,�a�
Title: MAC o F2
Complete mailing address:
City: ��'3cr�2+"� State: AC. Zip:
Telephone number: (ZFL) "4 --Sb4 / Email: St own ha—1 t e m c-A s i . Corgi
Sincerely,
/r
signature