WQ0005790_Monitoring - 04-2020_20200603

+ FpORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page __ of
Permit No.: WO0005790
Facility Name: Fish Factory Road Water Reclamation and Treatment Facility
County: Brunswick
Month: April
Year: 2020
PPi: 003
Flow Measuring Point: ❑Influent El Effluent [I No flow generated
Parameter Monitoring Point: ❑Influent []Effluent❑Groundwater Lowering ❑Surface Water
Parameter Code -►
50050
m
Ta
t m
Q E
U ~
O
y
E
U c
Ix Q
V
24-hr
hrs
GPD
1
07:30
4
0
2
07:30
4
0
3
07:30
4
0
4
0
5
0
6
1 07:30
j 4
0
7
07:30
4
0
8
07:30
4
0
9
07:30
4
0
10
07:30
4
0
11
0
121
1
0
13
07:30
4
0
14
07:30
4
0
15
07:30
4
0
16
07:30
4
0
17
07:30
4
0
181
0
191
0
20
07:30
4
0
21
07:30
4
0
22
07:30
4
0
23
07:30
4
1 0
24
07:30
4
0
251
0
26
0
27
07:30
4
0
28
07:30
4
0
29
07:30
1 4
0
30
07:30
4
0
31
Average:
0
Daily Maximum:
0
Daily Minimum:
0
Sampling Type:
Recorder
Monthly Limit:
180,000
Daily Limit:
Sample Frequency:
Continuous

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s)
Name: Kenneth Von Voigt
Name:
Certified Laboratories
Name: Environmental Chemists
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
ElCompliant ❑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
actionlsl takwn Attarh arirliti-I i;----- ­-,
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Kenneth Von Voigt
Permittes: Town of Oak Island
Certification No.: 1006360
Signing Official: Lisa Stites
Grade:
2 Phone Number: 9103521435
Signing Official's Title: Town Clerk
Has the ORC changed since the previous NDMR? ❑Yes ElNo
Phone Number: 910) 201-8004 Permit Expiration: 7/31/2021
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, 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
Raleigh, North Carolina 27699-1617
s

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: WQ0005790
Facility Name: Fish Factory Road Water Reclamation and Treatment Facility
County: Brunswick
Month: April
Year: 2020
PPI: 002
Flow Measuring Point: ❑Influent [,]Effluent El No flow generated
Parameter Monitoring Point: ❑Influent [I Effluent []Groundwater Lowering ❑Surface water
Parameter Code 0
WQ01
>
> .�
¢ E
0
E ;;
Q
O
y m
N
0
24-hr
I hrs
gallons
1
07:30
4
0
2
07:30
4
0
3
07:30
4
0
4
0
5
0
6
07:30
4
0
7
07:30
4
0
8
07:30
4
0
9
07:30
4
0
10
07:30
4
0
11
0
12
0
131
07,30
1 4
0
14
07:30
4
0
15
07:30
4
0
16
07:30
4
0
17
07:30
4
0
18
0
191
0
20
07:30
4
0
21
07:30
4
0
22
07:30
4
0
23
07:30
4
0
24
07:30
4
0
251
0
26
0
27
07:30
4
0
28
07:30
4
0
29
07:30
4
0
30
07:30
4
0
31
Average:
0.00
Daily Maximum:
0.00
Daily Minimum:
0.00
Sampling Type:
Recorder
Monthly Limit:
225,951
Daily Limit:
Sample Frequency:
Continuous

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of_
Sampling Person(s) Certified Laboratories
Name: Kenneth Von Voigt Name: Environmental Chemists
Name: Name:
woes all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 2Compliant ❑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: Kenneth Von Voigt
Permittee: Town of Oak Island
Certification No.: 1006360
Signing Official: Lisa Stites
Grade: 2 Phone Number: 9103521435
Signing Official's Title: Town Clerk
Has the ORC changed since the previous NDMR? ❑Yes ONo
Phone Number: 910) 201-8004 Permit Expiration: 7/31/2021
k� aoad
� 5 '7-�
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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: WQ0005790
Facility Name: Fish Factory Road Water Reclamation and Treatment Facility
County: Brunswick
Month: April
Year: 2020
PPI: 001
Flow Measuring Point: ❑Influent El Effluent El No flow generated
Parameter Monitoring Point: ❑Influent DEffluent []Groundwater Lowering El Surface water
Parameter Code -0
50050
00310
00940
50060
31616
00610
00625
00620
00600
00400
00665
70300
00530
00076
>
0
>
`
Q E
U
O
E y
~
Q
O
o
LL.
u)
m
G7
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t
U
Fa c
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U
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z
2
- L
i- O
z
0.
o m
-rz 0°
I- N fn
-o N
i° y a
~ N (A
7
24-hr
hrs
GPD
mg/L
I mg/L
mg/L
#/100 mL
mg/L
mg/L
mg/L
mg/L
I su
mg/L
mg/L
1 mg/L
NTU
1
07:30
4
60,500
4
1.34
1
0.2
0.5
28.2
28.2
6.8
4.68
2.5
1.597
2
07:30
4
37,500
1.27
6.8
1.92
3
07:30
4
85,100
1.11
6.8
3.765
4
36,500
1.29
7.4
0,199
5
62,200
1.59
7.3
1.686
6
1 07:30
4
67,600
1.38
1 7
1.68
7
07:30
4
75,300
0.16
7
1.706
8
07:30
4
69,800
0.41
6.9
2.349
9
07:30
4
81,900
0.36
7
1
2.668
10
07:30
4
66,800
1.01
6.9
2.134
11
1 79,300
1 1.21
6.9
3.826
121
73,800
1.23
6.9
5.001
13
07:30
4
99,200
1.08
6.9
0.309
14
0730
4
64,400
0.91
7
0.426
15
07:30
4
66,600
1.36
7
0.412
16
07:30
4
59,000
1.55
1 7
0.604
17
07:30
4
76,900
0.16
6.9
2.486
181
78,500
0.33
7.2
2,027
19
60,100
0.35
7.1
1,602
20
0730
4
67,800
1.17
7
2.899
21
07:30
4
90.300
1.2
7
1.162
22
07:30
4
67,500
3
1 1.56
1
0.2
0.5
35.6
35.6
1 7
3.47
2.5
2.5
1.201
23
07:30
4
77,400
1.41
7
0.965
241
07:30
4
114,400
1.15
6.9
0.84
25
96,700
1.2
7
0.799
26
127.800
1.15
7
0.698
27
07:30
4
103,900
1.26
7
0.686
28
07:30
4
74,900
1.07
7
1.196
29
07:30
4
81,700
1.17
7
1.213
301
07:30
4
88,200
1.29
6.8
1.106
31
Average:
76,387
3.50
1.06
1.00
0.20
0.50
31.90
31.90
4.08
2.50
2.50
1.64
Daily Maximum:
127,800
4.00
1.59
1.00
0.20
0.50
35.60
35.60
7.40
4.68
2.50
2,50
5.00
Daily Minimum:
36,500
3.00
0.16
1.00
0.20
0.50
28.20
28.20
6.80
3.47
2.50
2.50
0.20
Sampling Type:
Recorder
Composite
Composite
Grab
Grab
Composite
Composite
Composite
Composite
Grab
Composite
Composite
Composite
Recorder
Monthly Limit:I
400,000
10 1
14
4
1
5
Daily Limit: 11
25
6
6-9 1
10
10
Sample Frequency: 1
Continuous
See Permit 1
3 X Year 1
5 X Week
See Permit
See Permit
See Permit
See Permit
See Permit
5 X Week I
See Permit
3 X Year
See Permit
Continuous

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) Certified Laboratories
Name: Kenneth Von Voigt Name: Environmental Chemists
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? I]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: Kenneth Von Voigt
Permittee: Town of Oak Island
Certification No.: 1006360
Signing Official: Lisa Stites
Grade: 2 Phone Number: 9103521435
Signing Official's Title: Town Clerk
Has the ORC changed since the pr vious DMR? ❑Yes pNo
Phone Number: 910) 201-8004 Permit Expiration: 7/31/2021
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, 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
Raleigh, North Carolina 27699-1617

FORM: NDAR-2 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page of
Permit No.: WQ0005790
Facility Name: Fish Factory Road Water Reclamation and Treatment Facility
County: Brunswick
Month: April
Year: 2020
Did infiltration occur at
Site Name:
HR-1
Site Name:
Site Name:
Site Name:
this facility?
Area (acres):
1.61
Area (acres):
Area (acres):
Area (acres):
EYES ENO
Rate (GPD/ft):
2.57
Rate (GPD/ft):
Rate (GPD/ft):
Rate (GPD/ft):
Weather
Freeboard
Site Infiltrated?
❑YES ONO
Site Infiltrated?
❑YES El NO
Site Infiltrated?
DYES [I NO
Site Infiltrated?
EYES 01W
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a m
°F
in
ft
ft
gal
min
GPD/ft2
ft
gal
min
GPD/ft2
ft
gal
min
GPD/ft2
ft
gal
min
GPD/ftZ
ft
1
PC
62
0.4
3
4
0
0
0.00
2
C
65
0
3
4
0
0
0.00
3
C
72
0
3
4
0
0
0.00
4
C
69
0
3
4
0
0
0.00
5
C
67
0
3
4
0
0
0.00
6
C
1 74
0
3
4
0
0
0.00
7
C
1 82
0.2
3
4
0
0
0.00
8
C
77
0
3
4
0
0
0.00
9
C
79
0
3
4
0
0
0.00
10
C
70
0
3
4
1 0
0
0.00
11
C
62
0
3
4
0
0
0.00
12
C
68
0
3
4
0
0
0.00
131
R
1 73
0.4
1 3
4
0
0
0.00
14
C
72
0
3
4
0
0
0.00
15
CL
52
DA
3
4
0
0
0.00
16
C
70
0
3
4
0
0
0.00
17
C
70
0
3
4
0
0
0.00
18
CL
79
0
3
4
0
0
0.00
191
C
1 74
0
3
4
0
0
0.00
20
CL
64
0.5
3
4
0
0
0.00
21
C
73
0
3
4
0
0
0.00
22
C
69
0
3
4
0
0
0.00
23
CL
69
0
3
4
0
1 0
0.00
24
CL
75
1.5
3
4
0
0
0.00
251
PC
65
0
3
4
0
0
0,00
26
C
73
0
3
4
0
0
0.00
27
C
72
0
3
4
0
0
0.00
28
C
76
0
3
4
0
0
0.00
29
C
79
0
3
4
0
0
0.00
30
R
69
1
3
4
0
0
0.00
31
Monthly Loading (GPD/ft ):
Year to Date Loading GPD/ft2
0.00v,'
Ys1
#DIV/0!
#DIV/0!
#DIV/0'

FORM: NDAR-2 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page of
Did the application rates exceed the limits in Attachment B of your permit? ElCompliant ❑Non -Compliant
If not a basin, were the sites kept free of vegetation and raked? ElCompliant ❑Non -Compliant
If not a basin, were there any instances of effluent ponding in or runoff from the sites? ElCompliant ❑Non -Compliant
If a basin, were there any instances of breakout from the berms? pCompliant ❑Non -Compliant
Was the onsite automatically activated standby power source tested and operational? ElCompliant ❑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 necessarv.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Kenneth Von Voigt Permittee: Town of Oak Island
Certification No.: 1006360 Signing Official: Lisa Stites
Grade: 2 Phone Number: 9103521435 Signing Official's Title: Town Clerk
Has the ORC changed since the previous NDAR-2? El Yes EDNo Phone Number: [phone] Permit Exp.: 7/31/21
510%1"
Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge
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, 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
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0005790
Facility Name: Fish Factory Road Water Reclamation and Treatment Facility
County: Brunswick
Month: April
Year: 2020
Did irrigation occur
Field Name:
13
Field Name:
14
Field Name:
Field Name:
this facility?
Area (acres):
1.19
Area (acres):
0.98
Area (acres):
Area (acres):
at
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
EYES ENO
Hourly Rate (in):
0.2
Hourly Rate (in):
0.2
Hourly Rate (in):
Hourly Rate (in):
Annual Rate (in):
127
Annual Rate (in):
127
Annual Rate (in):
Annual Rate (in):
Weather
Freeboard
Field Irrigated?
EYES ENO
Field Irrigated?
EYES ONO
Field Irrigated?
❑YES ❑NO
Field Irrigated?
EYES ❑NO
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°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
PC
62
0.4
3
4
0
0
0.00
0.00
0
0
0.00
0.00
2
C
65
0
3
4
0
0
0.00
0.00
0
0
0.00
0.00
3
C
72
0
3
4
0
0
0.00
0.00
0
0
0.00
0.00
4
C
69
0
3
4
0
0
0.00
0.00
0
0
0,00
0.00
5
C
67
0
3
4
0
0
000
0.00
0
0
0,00
0.00
6
C
74
0
3
4
0
0
0.00
0.00
0
0
0.00
0.00
7
C
82
0.2
3
4
0
0
0.00
0,00
0
0
0.00
0.00
8
C
77
0
3
4
0
0
0.00
0.00
0
0
0.00
0,00
9
C
79
0
3
4
0
0
0.00
0.00
0
0
0.00
0.00
101
C
70
0
3
4
0
0
0.00
0.00
0
0
0.00
0.00
11
C
62
0
3
4
0
0
0.00
0.00
0
0
0.00
0.00
12
C
68
0
3
4
0
0
0.00
0.00
0
0
0.00
1 0.00
13
R
73
0.4
3
4
0
0
0.00
0.00
0
0
0.00
1 0.00
14
C
72
0
3
4
0
0
0.00
0.00
0
0
0.00
0.00
15
CL
52
0A
3
4
0
0
0.00
0.00
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FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
OCompliant ❑Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
QCompliant ❑Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
ElCompliant El Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
OCompliant ❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
2ICompliant ❑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
action(s) taken. Attach additional sheets if necessary
the non-compliance and describe the corrective
Operator in Responsible Charge (ORC) Certification
I ORC: Kenneth Von Voigt
Certification No.: 1006360
Grade: 2 Phone Number:
Has the ORC changed since the previous
Permittee Certification
Permittee:
Town of Oak Island
Signing Official: Lisa Stites
9103521435 Signing Official's Title: Town Clerk
7 Elves ONo Phone Number: [phone]
Permit Exp.: 7/31/21
J-,�;'%-.) o
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, 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
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
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FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
ElCompliant []Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
ElCompliant
❑Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
21Compliant
❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
(ZCompliant
❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
ElCompliant
❑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
acuonts) taKen. Httacn aaa tlonal sheets if necessary.
Operator in Responsible Charge (ORC) Certification
ORC: Kenneth Von Voigt
Certification No.: 1006360
Grade: 2 Phone Number: 9103521435
Has the ORC changed since the previous NDAR-1? Oyes ONo
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:
Town of Oak Island
Signing Official: Lisa Stites
Signing Official's Title: Town Clerk
Phone Number: [phone] Permit Exp.: 7/31/21
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 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
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Permit No.: WQ0005790
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FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
ECompliant ❑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?
QCompliant
❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
OCompliant
❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
OCompliant
❑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
actlonks) raKen. milacn auumuridi sneers u
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Kenneth Von Voigt
Permittee:
Town of Oak Island
Certification No.: 1006360
Signing Official: Lisa Stites
Grade: 2 Phone Number: 9103521435
Signing Official's Title: Town Clerk
Has the ORC changed since tpe previo ARA? ❑Yes [23No
Phone Number: [phone] Permit Exp.: 7/31/21
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, 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
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Permit No.: 11001 •I
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FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
OCompliant ❑Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
OCompliant ❑Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
OCompliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
OCompliant ❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
ElCompliant ❑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 necessarv.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Kenneth Von Voigt Permittee: Town of Oak Island
Certification No.: 1006360 Signing Official: Lisa Stites
Grade: 2 Phone Number: 9103521435 Signing Official's Title: Town Clerk
Has the ORC changed since t�vrevious Nf W1? El Yes ONo Phone Number: [phone] Permit Exp.: 7/31/21
J/
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, 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
Raleigh, North Carolina 27699-1617