WQ0033325_Monitoring - 07-2023_20230801

Monitoring Report Submittal
Permit Number#* WQ0033325
Name of Facility:* Bladen County Water District - Tobermory
Month:* July Year: 2023
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR NDMR TOBERMORY JULY 2023.pdf 716.71 KB
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: 8/1/2023
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: 8/10/2023

FORM: NDMR 03-12 NON -DISCHARGE MONFORING REPORT (NDMR) Page of_ —a-
Sampling Person(s) Certified Laboratories
Name: ITI,tiAi �� c Name:
Name:
Dares -nII ri(04lii1i erina data and SaB4' nItIP ni Ehim rr, mni6recm mn)$n Rrn t ❑ Non-Comoliant
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
artinnrcl ttalepn Gtlonh ­4AW-1 .1 o +o ;+,.e..­­
{ Operator in Responsible Charge (ORC) Certification
Permiiiee Certification
ORC: 4Z4hi C �
Permittee: / j4 de,CV. $j+ �'Br G0
u
f Certification No.: 4176 2-1?3
Signing Official: AlAt)
Grade: �`�iSifl�� Q�tjTrGct Phone Number: 4ln _ CJgp/2
Signing official's Title:
/Zl
Yes .r
Has the ORC changed since the previous NDMR?
Phone Number: q10 —(?64 - 64Wo Permit Expiration:
k
-6-33
-�-23
Signature bate
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Icertify, under penalty of law, that this document and all attachments were prepared under p p p tin er 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, tricluding the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division or Water Resources
:ntormation Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FbRM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page d of
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
Compliant ElNon-Compliant
R/.mpliant ❑ Non -Compliant
51,"CCompliant ❑ Non -Compliant
L�Compliant ❑ Nan -Compliant
[RfCompliant ❑ 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: A1,*0V Permittee: �� lc� 4_4. �
Certification No.: g17641?X Signing Official: A�
Grade: . ,d.`iZ ww Phone Number: L?{O p67_ Signing Official's Title:
CW,CA� -
Has the ORC changed since the previous NDAR-1? I] yes No Phone Number: q`O - �6 �. 6�� Permit Exp.:
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 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. 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
[nforrnation Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page A of ;7—