WQ0033325_Monitoring - 09-2023_20231004

Monitoring Report Submittal
.....................................................
Permit Number#* WQ0033325
Name of Facility:* Bladen County Water District - Tobermory Road
Month: * September Year: * 2023
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address: *
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Upload Document*
NCDMR TOB sept 2023.pdf 697.13KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Alan Edge
�lar 6 S�' *
Reviewer: Wanda.Gerald
10/4/2023
This will be filled in automatically

Is the project number correct?* W00033325
Is the monitoring report accepted?* Yes NO
Regional Office* Fayetteville
Reviewer: _anonymous
Review Date: 10/5/2023

FORM. NDMR 03-12 MON-DISCHARGE MONITORING REPORT (NDMR) Page of�
Sampling Person(s) Certified Laboratories
?dame: ��i e Name:
Name: ���®!/�fJ �Si� �2 name:
;loss aH monitoring date and sampling fteq ences meet the requirements in Aittach ment A our your psrr¢u t? omplant Cl 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 additionai sheets if neressa v
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC; ®-cl�� Permittee: /314deot C6. W �q s
et.etr G� f 3iFi2d Li
Certification Nd.: �.i c� p
g L 6 Signing Official: ®"741,44)
01- &1 c-
Grade: R-��S%AQ, h&E+s ®tie Phone Number: �� � — � 6�� Signing Official's Title: 04ac- 014
�A®ss— ���i-BVAJ �Tl �%lo—d'6z-64��
Has the ORC changed since the previous NDMR? D yes "I Phone Number: Permit Fxp'sration:
43
i
I Signature Date Signature Date
lr 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 supewlsion in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on
my inquiry ofthe person or persons who manage the system, orthose 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
penailles for submitting false information, including the possibility offines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, forth Carolina 27699-1617

"JRM: 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?
R�// mpiiant ❑ Non -Compliant
I�'./Compliant ElNon-Compliant
MJ Compliant ❑ Non -Compliant
L*'1 Compliant ❑ Non -Compliant
(Compliant ❑ Nan -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: e4GJiv G gr
Permittee: 64�
Certification No.: IM2,9.?
Signing Official:
Grade:.4 �� � - Phone Number: file �- Arz -- 41Q��
Signing Official's Title:
Has the OORC changed since ee the previous NDAR-1? ❑ Yes 3a-N-*,
Phone Number q t,9 — p 6 z.— 491,6 Permit Exp.:
Signature Date
Signature Date
By this signature, [ car* 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 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page o7% of .7—
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