WQ0033325_Monitoring Reports_20180126

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of
Facility Name: Tobermory Road
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FROM

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _of
4
1
Sampling Person(s) Certified Laboratories
Name:
Name:
Name: Name:
woes all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? D 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
lRmcn dUUlnOnal snee[s IT
Operator in Responsible Charge (ORC) Certification Perm ittee Certification
ORC: Permittee:
Certification No.: Signing Official:
NIT, •1
Grade: Phone Number: Signing Official's Title: Has the ORC changed since the previous NDMR? O Yes ❑ No Phone
NuWO n�(t,2Q�n � / / i" Permit Expiration: V - 3
Signature Date k-J Signature Date
By this signature, I cenlry that this report is accumale 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 berief, We, accurate, and complete. I am
aware that there are significant penalties for submitting false Information, including the possibly of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ of
• irrigation occur
®®-
. i
®Field
-
irrigated?

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page_ 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 ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Nan -Compliant
❑ Compliant O 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:
Permittee:
`tJ
Certification No.-
Signing Official:
Grade: Phone Number:
�
Signing Official's Title:
Has the ORC changed since the previous NDAR_1? p Yes ❑ No
n
Phone Number: C/lG 4-2 Lr �f' ,. Permit Exp.:
Signature Date .
Signature Date
By Ihls signature, I certify That This report Is accurmle and complete to the best of my knowledge.
l;
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 orpersons who manage the system. or those persons due tly responsible forgathering the information, the .
Information submitted is, to the best of my knowedge and belief, We, accurate, and complete. I am awar6 that them are significant
penalties for submitting false Information• including the possiblity of fines and imprisonment for knoydng violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of
•11Facility
Name: Tobermory, -.-• Well
-•-
' - '-

FORM: NDMR03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page —of _ #e
Sampling Person(s) Certified Laboratories
Name: Name:
Name:
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? O 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 additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification 11, ` Permittee Certification
ORC:
Certification No.:
Grade: Phone Number:
Has the ORC changed since the previous NDMR? 13 Yes ❑ No
N
Permittee: /3,f— Lc�
Signing Official:
Signing Official's Title: Io kl�C,rL
Phone Number: +4 7 ff/ Permit Expiration: J
Signature Date u Signature Date
By this signature. I certify that this report Is accurate 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 Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ of _
- oil
Facility Name: •bermory Road
• irrigation occu
�®

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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 ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ 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
Pennittee:
Certification No.:
Signing Official:
Grade: Phone Number:
Signing Official's Title:
Has the ORC changed since the previous NDAR_1? yes ❑ No
ElT
1
Phone Number: / Li) ^ o It/�r��r % yC Permit Exp.:
JLl
Signature Date „
' Signature Date
By this signature, l certify that this report is accunato 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 accord
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based an my
inquiry of the person or persons who manage the system, or those persons dmcfly responsible forgathering the information, the .
information submitted is, to the best of my knowledge and beget, Me, 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 Resources
Information Processing Unit
1617 Mail Service Center

FORM: NOMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of
•11JM
F,,11ityName: TobermoryRoad
-.-
• ..-
•• 11
■ Influent o ■ No Raw generated■
o ■ •
Parameter Code

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of n, . ...
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 0 Compliant ❑ Nan-Compllant
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 dates) of the non-compliance and describe the corrective
mnen. nuacn auwuouai bneets m necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Permittee: a c_U38
Certification No.:
Signing Official:
Grade: Phone Number:
Signing Official's � cg_ 'J ko
Title: . )
Has the ORC changed since the previous NDMR? O Yes ❑ No
Phone Number: 910 S,62_41 y � Permit Expiration:
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 quaffied 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 passibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1 G17 Mail Service Center

MF ?tM: NDARA 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _of_
_ as
•'
D irrigation .
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Area (acres):
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FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _ of it, f . 4'.
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 D Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant D Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the feason(s) the facility was not in compliance: Provide in your explanation the date(s) of the non-compliance and describe the corrective
acuuulsf iene.u, nuaw auumuuet sneers a necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
(n� •
Permittee: FJ� ice/ p
Certification No.:
Signing Official:
Grade: Phone Number:
�(
Signing Official's Title: (,.OA ACI, 01,d CC*)A_
Has the ORC changed since the previous NDAR _1? ❑ yes ❑ No
Phone Number. � �i •` %�f Permit Exp.:
Signature Date „
u'
Signature Date
By this signature, I certify that this report is accunale 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 an quaffed 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 forgathering 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 mowi29 violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

_.a 176RK NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of
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Facility Name: Tobermory Road
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- IVVN-UIJCHARGE MONITORING REPORT (NDMR)
Page of
Sampling Person(s) Certified Laboratories
Name:
Name:
Name:
Name:
""•"M""U r`=MUWII�Mc MUM 111e requirements in Attachment A of your permit? U 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
_ _ .. ucwosaiy.
i
Operator in Responsible Charge (ORC) Certification `'
Permittee Certification
ORC:
Permittee: � �}
Certification No.:
Signing Official:
Grade: Phone Number:
Signing Official's Title: A f✓ 1 /l�CGr"'u�
Li--%G
O
Has the ORC changed since the previous NDMR? Yes D No
/�...
Phone Number: 9 �(7 a �� Y l Permit Expiration: f7'-3/ A0.)_Z
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 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, two, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the
possibility of fees and Imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

�a F&RM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _ of _
1111Facility
Name:••- a '•_•at
_e-
-• -I •-
Did irrigation
occu
this facility?
Area (acres):
Area (acres):
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Hourly Rate (in):
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®Hourly
Rate (in):
-
Annual Rate (in):�
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NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _of -.
Did the application rates exceed the limits in Attachment B of your permit?
❑ Compliant ❑ Non-com pliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
❑ Compliant ❑Noo-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
❑ Compliant ❑Non -Compliant
Were all setbacks listed in. your permit maintained for every application to each permitted site? ❑ Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ Compliant ❑ Nan-Compllant
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
- actlon(s) taken. Attach additional sheets if necessary" '
Operator in Responsible Charge (ORC) Certification
ORC:
Certification No.:
Grade: Phone Number:
Has the ORC changed since the previous NDAR_1? ❑ yes O No
' y Permittee Certification
Permittee: J3 �tJ✓,�
Signing Official:
Signing Official's Title: ��,1c4
Phone Number: 6110 44-V—v1_q � permit Exp: Vzz —C7
Signature t' /0 -z 7-1�
Date Signature
Date „ By this slgnaWre. I ceN(y that this report Is accurmte and complete to the best of my knowedge. I certify, under penalty of law. that this document and allatlachments were prepared undermy dlrection or supervislon In accordance
with a system designed to assure that all qualified personnel propetly gathered and evaluated the Information submitted. Based an my
inquiry Of the person orpemons who manage the system, arlhase persons dueclly responsible forgamedng the information. the . Information submitted Is, to the best of my knowledge and belief, We, accurate, and complete. ) am awaT6 that Nee are significant
penalties forsubmilling false Information. including the possiblllly of goes and Imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

r•.
FORM: NDMR 10-13
NON -DISCHARGE MONITORING REPORT (NDMR)
Page _ of _
•11Facility
Name: Tobermory '.a
-•-
'
-' 11
• Influent El Effluent •
■ Influent GI Effluent EI Groundwater Lowering 0 Surface Water
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,ter®�®�

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _of_ "
Sampling Person(s) Certified Laboratories
Name:
Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? O 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
Operator in Responsible Charge (ORC) Certification
ORC:
Certification No.:
Grade: Phone Number:
Has the ORC changed since the previous NDMR?, 13 Yes 0 No
Signature Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
Perm ittee Certification
Permittee: N (f— L-0
Signing Official:
11 ,��JJ/ r
Signing Official's Title: LC.i-r�!'�� /�� 1/YCCf d jz
Phonee�Number:9/b Ve�J/r/�/ � Permit Expiration: O--,3�>✓�Q,�Z
Signature Date
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, We, 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 Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _of_
Did irrigation occu
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FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _ 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 ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Nan -Compliant
❑ Compliant ❑ Non -Compliant
❑ 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
ueuentuf tanrnl. naacu euwuunal sneeze It necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Permittee: cl )'Clio ..
Certification No.:
Signing Official:
Grade: Phone Number: '
'Signing Official's Title:
Has the ORC changed since the previous NDAR-1? ❑ yes ❑ No
Phone Number: '77 /©'&(a �•(e, ��G- Permit Exp.: _)A"
Signature Date
tI '
Signature Date
By this signature, I certify that this report Is accurate 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 quardied personnel prepedy gathered and evaluated the information submitted. Based on my
Inquiry of the person or persons who manage the system, or those persons directly responsible forgathering the information, the .
information submitted is, to the best of my knowledge and belief, We, accurate, and complete. I am awar6 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 Resources
Information Processing Unit
1617 Mail Service Center

� I � v
"4`RM' NDMR 10-13
NON -DISCHARGE MONITORING REPORT (NDMR)
Page _ of
Facility Name: Tobermory Well
��
-. . •. • - ■uniiiiiiiiiiiiiii ■ . .- u. p
•. Te. V, I - U4 A VI 1,M]ON I•. ■ - ■ - ■ .. • .-

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of.
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 0Compliant ❑ 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
ate., „ter . r,.,—„ nuwuvua, Q„«.� „
Operator in Responsible Charge (ORC) Certification
._ Permittee Certification
ORC:
Permittee:
Certification No.:
Signing Official:
Grade: Phone Number:
JJ r�
(.i'hrCOL >d ! R
Signing Official's Title:
Has the ORC changed since the previous NDMR? O Yes ❑ No
/ 1
Phone 91�c, ���� `� �� Permit Expiration:
�Number:
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 Nose persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, We, accurate, and complete. I am
aware that there am 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 Resources
Information Processing Unit
1617 Mail Service Center

1I �
`kRM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _ of
•Tobermory
Well
County: Bladen
-Area
(acresy.®Area
(acres):
-
..��Hourly
Rate (in);
Hourly Rate (in):
�
E
Annual
��
Field Irrigated?•
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FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _ 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 ❑ Nan -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ 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
adtion(s) taken. Attach additional sheets if nareaxanr '
Operator in Responsible Charge (ORC) Certification
Pennittee Certification
ORC:
Permittee:
Certification No.:
Signing Official-
Grade: Phone Number.
h s
Signing Official's Title: Wh11 ak- N /, CCADA
Has the ORC changed since the previous NDAR _1? ❑ yes ❑ No
PhoneNu%mber: �(•� U^ S74 -) ^ Permit Exp.: 3 — J`% — d 2—
/)
Signature Date
"
Signature Date
By This signature, I certify That This report is accunate and complete to the best of my knowledge.
I,
1 certify, under penalty of law, that this document and of attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel propedy gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system• or those persons directly responsible forgathering 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 knDy6ug violations.
Mail Original and Two Copies to:
Division of water Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of
..
.. ��
■ o ■
■ Influent o Effluent • Groundwater LowerIng • Surface Water

FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page _ of _F
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 0Compliant ❑ Non-Ccmpliant
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
Operator in Responsible Charge (ORC) Certification
ORC:
Certification No.:
Grade: Phone Number:
Has the ORC changed since the previous NDMR? Yes ❑ No
Perm ittee Certification
Permittee:L��%
Signing Official:
Signing Official's Title:
Phone Number: L71L
OP
U `LC.�
Permit Expiration:
7 -a /.- / ?
Signature Date 1__l Signature Date
By this signature, I certify that this report is accurrale and complete to the best of my knowledge. I certify, under penally 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
more that mere are significant penalties for submitting false information, including the possibility of fines and Imprisonment for
knowing violations.
Mall Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _of
It 11Facility
Name: Tobermory '•.• Well
County: Bladen
Did irrigation
occur
Area (acres):0
-
�—
at this facility?�—
YES 11 NO
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in).-
®Annual
Rate (in):—
AnnualRate(in)::—
�—
Field Irrigated?■
• •
■ ■ •
• ■ •
I
• o
m
_—_
__
----
—_--
----
----
®MM
MM
®___
__
----
—_--
--�—
----

FORM: NDAR-1 10-13 m �'t
NON -DISCHARGE APPLICATION REPORT (NDAR-I) Page_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?
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Nan -Compliant
❑ Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance With the specified freeboard heights in your permit? ❑ 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 additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: -- -
�� C L) !�
Permittee: U
Certification No.:
Signing Official:
Grade: Phone Number:
/ I
Signing Official's Title: W ffTCj�_ b1P,(2C'1'!)A_
Has the ORC changed since the previous NDAR_1? ❑ yes ❑ No
?
Phone Number: / i (7%'"O -� 9� Permit Exp.: 3 — J ^>Z a
I
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
l
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 pmpedy gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or Nose persons directly responsible forgathering the information, the .
information submitted is, to the best of my knowledge and belief, tme, 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 Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of_.
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 13 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
uanmi. nuaui cuwuuuai aucou u
4;
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Permittee:
Certification No.: Signing Official: j f�
Grade: Phone Number: Signing Official's Title: �� r �� ^� %{��O "
Has the ORC changed since the previous NDMR?
El Yes O No Phone Number: 9'10 ^�� 2 .4 fy� Permit Expiration
(�;-,23- /7
Signature Date Signature Date
By this signature, I certify that this report is accunale 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, We, 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 Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _ of _
' fTobermory
Well
Did irrigation
®
®
-
13 YES 0 NO
�-
®-
- -'
®(-

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _ 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 ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ 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 additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Permittee: 16G U—)
Certification No.:
Signing Official:
Grade: Phone Number:
.y, D
Signing Officials Title: %rJ A7'(,"/( /�/ (�C CU b/,
Has the ORC changed since the previous NDAR_1? ❑ Yes ❑ No
/ '1
Phone Number: 9l0 "0012, % 9Y Permit Exp.:
'Z C .
Signature Date „
u '
Signature Date
By this signature. I certify that [his 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 accordaece
with a system designed to assure that all qualified personnel property gathered and evaluated the information submitted. eased on my
inquiry of the person or persons who manage the system, or those persons directly responsible forgalhedng the information, the .
information submitted is, to the best of my knowledge and belief, We, accurate, and complete. I am awarb that there are significant
penalties for submitting false information, including the possibility of finesandimprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

„A _F�RM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of
Facility Name: Tobermory Well
•• ��
• o •
• o ■ •

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of
a'T
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? O 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 additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification II Permittee Certification
ORC:
Certification No.:
Grade: Phone Number:
Has the ORC changed since the previous NDMR? G Yes O No
Permittee: /S G W'a
Signing Official:
Signing Official's Title:
Phone Number: ! 'J L�"�'r2C%Permit Expiration:
c- 23-1 r%
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, We, 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 Resources
Information Processing Unit
1617 Mail Service Center

F:aRM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ of
Permit No.: WQ0033325
Facility Name: Tobermory Well
M-I 4��
•. • •
®
:
®e-
®
Annual Rate (in):
■
■ ■
■ ■
o .

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ 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 ❑ Non -Compliant
❑ Compliant ❑ Nan -Compliant
❑ Compliant ❑ Non -Compliant
❑ 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
aCtinnfsl tnkwn GRarh �driirinnel chmM if
Operator in Responsible Charge (ORC) Certification
, Permittee Certification
ORC:
-Permittee: G L
Certification No.:
Signing Official:
Grade: Phone Number:
q
Signing Official's Title:
Has the ORC changed since the previous NDAR _1? ❑ Yes ❑ No
9 Q
Phone Number: "7/O "p.�^ '/r'�Jr'� Permit Exp.: J — `i .1/
— J-)__
!3
Signature Date
Signature Date ; .
By this signature, I certify Nat his report is accu rele and complete to the hest of my knowledge.
if
1 certify, under penalty of law, that this document and ag attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel prepedy gathered and evaluated the information submitted. eased on my
Inquiry of the person or persons who manage the system, or these persons directly responsible forgathering the information, the .
information submitted is, to the hest of my knowledge and belief, [me, accurate, and complete-1 am aware that there are significant
penalties for submitting false information, including the possibifty of fees and imprisonment for knoyMg violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

JFORPQ NDMR 10-13, NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of
Faciff�r Name: Tobermory Road Well
Flow Measuring Polnt: 0 Influent El Effluent 0 No flow generated
M-, M-FiFil =.i
m
I • I
®
1 • I
®
111
-®-®-®---®-®-®-

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ ofF_,Y
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 13Compliant ❑ 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 dates) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary
I„
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Permittee:
Certification No.: Signing Official: / /�
Grade: Phone Number: Signing Official's Title: LA,; A f-C✓L to) YLC1' DiZ.
Has the ORC changed since the previous NDMR? O Yes O No Phone Number: r /0 -f4 )L. - 6 q Q lP Permit Expiration: J ' �• �-
�� -.2S• !?
,Signature Date Signature Date
By this signature, I certify that this report Is accurate 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 fees and Imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

_,,FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ of
•irrigationoccuat
this facility?
Area (acres):
Area (acres):
El YES 0
Hourly Rate (in):
Annual Rate (in):
Annual Rate (in),
Field Irrigated?
a
111immmm
r
•
111
%/////
%////////
j////j
111
j//////%A001
1

FORM: NOAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR4) Page _o!p��.
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 ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ 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
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Permittee:
certification No.:
Signing Official:
Grade: Phone Number:
Signing Official's Title: • (.t�,%i�Cr� � /yQ � G
�1
Has the ORC changed since the previous NDAR-1? ❑ yes ❑ No
Phone Number: ��r&'-,� 3 - 3 / -a.� •�� f'y� Permit F�cp.:
Signature Date „
Signature Date
By this signature, I certify that this report is accumote 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 pmpedy gathered and evaluated the information submitted. Based an my
Inquiry of the person or persons who manage the system, orthose persons duecgy responsible forgathering the information, the .
information submitted is, to the best of my knowledge and belief, We, accurate, and complete. I am award 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 Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDMR 10-13
NON -DISCHARGE MONITORING REPORT (NDMR)
Page _ of
Sampling Person(s) 11 - Certified Laboratories
Name: Name:
Name: Name:
Ilnw�..ill w:�w J�a_ _� _ •
"-------"'a "' •-••-- .,w.•11+1111y 1l w4uwl 1W=0 111CCL lrle rCquiremerIIs in Attacnment A Of your permit? ❑ 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
anfinnfel fo4cn A*1 h addles.. i ..L....a,. :--__-_-__.
__.__.......__......................:...a„„owaae, Y.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Permittee: L Lit) I
Certification No.: . t
Signing Official:
r
9
Grade: Phone Number: Signing Official's Title:
Has the ORC changed since the previous NDMR? ❑ yes ❑ No Phone N9/umber" p ,) . le ! `'
_ �� 6 �. �r Permit Expiration:
LIP b a ° o
Signature Date Signature
Date
By this signature. I certify that this report is aocumile and complete to the best of my knowledge. I cerilly, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance wish a system designed to assure that an qualRed 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, We, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibiGly of fines and Imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

rumm: NUAK-1 iu-1-5 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _ of
�
•®
irrigationDid occur
®
®-
low=
at this facility?
'
Area (acres):
®-
Area (acres):
■ ■ •
Annual Rate (in):
• ■
Annual Rate (in)::
mm

FORM: NDAR-1 10-13
®R
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _of
Did the application rates exceed the limits in Attachment B of your permit?
❑ Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
❑ Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
❑ Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
❑ Compliant ❑ Nan -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
❑ 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 additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Permittee:
Certification No.:
Signing Official:
Grade: Phone Number:
/p
Signing Official's Title: ti,'�(fh A A ok
Has the ORC changed since the previous NDAR_1? ❑ yes ❑ No
'1
Phone Number: 17 Permit Exp.:
Signature Date ,. .
Signature Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
l
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accomance
Wit a system designed to assure that all qualthed personnel property gathered and evaluated the Information submitted. Based on my
Inquiry of the person or persons who manage the system, orthose persons directly responsible forgathering the information, the .
Information submitted is, to the best of my knowledge and belief, We, accurate, and complete. I am awar2 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 Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDMR 10-13
NON -DISCHARGE MONITORING REPORT,(NDMR)
Page _ of _
Sampling Person(s)
Certified Laboratories
Name:
Name:
Name:
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ 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 rnrrerrlva
�••w/ uauamuei sneers it necessary. - ---� --
Operator in Responsible Charge (ORC) Certification - 1�
i ^'/J `` �`` ,r� Permittee Certification
ORC: - irm KJ C `e-) pJ
Permiltee:
Certification No.: Signing Official: ,J/
Grade: Phone Number: Signing Official's Title: VV9q/A iet rt?e G/'11
d,1C
Has the ORC changed since the previous NDMR? ❑ Yea ❑ No Phone Number: 9/D, Q e j
,r r Permit Expiration:
Signature'•`" °moo
Date Signature Date
By this signature, I certify that this report is accurate 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 beget, two. accurate, and complete. I am
aware that there ma sigrificanl penalties for submilifng false Information, NGuding the pcssibigly of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ of
- k-
.WQ0033325
Facility Name: Tobermory. Road Well
County: Bladen
irrigationDid occur
�
Hit 7
Area (acres):
Area (acres):
—
El YES El .
Hourly Rate (in):
-Hourly Rate (in):®Hourly
Rate (in):
-
REM=
Annual Rate (in
lzm�®-
■ ■ .
• ■ •
■ • •
• o

FORM: NDAR-1 10-13
!A
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _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 ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
❑ 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 additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
q ^
Perrhittee: /�J r
Certification No.:
Signing Official:
Grade: Phone Number.
�L./I� r
Signing Official's W ' `q� 6
Title: /
Has the ORC changed since the previous NDAR_1❑
? Yes ❑ No
: � J U �j /
Phone Numberv" j °2 Permit Exp.:
al G'
Signature Date
Signature Date
By this signature, I certify that this report Is accurtate 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
vith a system designed to assure that all qualified personnel property gathered and evaluated the infarmation submitted. Based on my
inquiry of the person or persons who manage the system, ar Ihose persons directly responsible forgathering 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 knogdng violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center