WQ0033325_Monitoring - 04-2023_20230605

Monitoring Report Submittal
Permit Number#* WQ0033325
Name of Facility:* Bladen County Water District - Tobermory Road
Month: * April Year: * 2023
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR DMR TOB APR 2023-corrected.pdf 745.41KB
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: * Alan Edge
Signature:
0/�
Date of submittal: 6/5/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* WQ0033325
Is the monitoring report accepted?* Yes No
Regional Office* Fayetteville
Reviewer: _anonymous
Review Date: 6/6/2023

FORWNDMR 03-12 I1 ON-MSCHARGE I!!OMT®RINC REPORT (NDMR) Page __I —of .71
Sampling Person(s) >111�VAII" eA Certified Laboratories
Name: ill It% Name: C/V L ��X
i� Home:`I��S f �� Name:
Does all monitoring data and sampHng frequencies meet the requirements in Attachment A of your peirmH? ompliant n 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
acdon(s) taken. Attach additional sheets if necessary
Operator in Responsible Charge (ORC) Certification
ORC: /+<�h� + tr
Certification No.: T74 2-17 J?
Grade: �1`�isS�Q> A44+1oda Phone Number:El Ya� f'�71�
Has th OP.,C changed since the previous NDMR?
t01
V �
Signature Dare
By this signature, I certify that this reporos accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: 131gde,,t Ctl. wet+eir- / is*z, cf
Signing Official:.41.4A) 6��
(1
Signing Official's Title: loteg-sc*A
Phone Number: dkio 6476 Permit Expiration:
.„4y
3
5lgnature Date
certify, under penalty of few, 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
ny nquiry of the person or persons who manage the system, or those persons ddrectly 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 offines and imprisonment for knowing violations.
Miail Original and Tlvo Copies to:
Division of Water Resources
Information Processing Unit
1 S117 Mail Service Center
(Raleigh, North Carolina 27599- i 617

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page i of
Did the application rates exceed the limits in Attachment B of your permit?
M,.cCompliant ❑ Non -Compliant
E?!
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? .mplfant El Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 91Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? FE Compiant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? M'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 arlrlitionnl cH..+e rf --
Operator in Responsible Charge (ORC) Certification Permittee Certification
C�
ORC: �l�%1/ r6—Permittee:
o
Certification No.: g76,W Signing Official:
Grade: y4 _ �Ztu�41ti phone Number: 1?67_ .- W/4p,j� Signing Official's Title: IOJIIA
Has the OORC changed s� previous NDAR-1? Yes Phone Number: j(O - p 6 Z — h9?,6 Permit Ex p..
16,
.01
.ZoZ 3
Signature Bate 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, 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 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page -7, of. .�
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