WQ0015515_Monitoring - 02-2020_20200326

,FORM: NOMR 05-16
NON -DISCHARGE MONITORING REPORT INDMRi
Permit No.: WQ0015515
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Facility Name:Bear Pen Village WWTP
County: Watauga
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Measuring Point:
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of '
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name: %3 �S� w e T_ Se rvl�es
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? o pliant ❑Non -Compliant
If the facility is non -compliant, please explain in the space below the reasons) the facility was not in compliance. Provide in your explanation the date(s) of the non -co ince and describe the corrective action(s)
taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: SG G5 �GL SG( lC�l r�
Permittee: �LoGU y �/�(,•t �S / o/[ 'S SOC
Certification No.: l s 2l -!
Signing Official:
Grade: Phone Number:
02 2_,j76 ZJ `
Signing Official's Title:
Has the ORC changed since the previous NDMR?
El Yes ❑No
Phone Number: �z Q C L 3 I Permit Expiration:
ignature
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 direly 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-t 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1 ) Paw of
WQ0015515
Facility Name: Bear Pen Village WVvTP Watauga EMMM,
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Did irrigation occur
FieldPermitNo.:
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Field N�-�
at this facility?
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FORM: NDAR-1 (5-116 NON -DISCHARGE APPUCATION REPORT (NDAR-1)
Page of
Did the application rates exceed the limits in Attachment B of your permit? �
Were adequate measures taken toyprevent effluent ponding in or runoff from the sites?
Was at 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? 'If�
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
action(s) taken. Attach additional sheets if necessary.
o Non -comma
0 Nor -
❑N-Cmpk"
❑
describe the corrective
OP'-raan ResPonsiJblie Charge (ORC) Cerffiwj4on Pern*wo Cron
ORC: Scott Vasgaard Perm :
Heavenly Mnt. Residential Assoc.
Certification No.: 18595 signing OPicial: Scott Vasgaard
Grade: SI Phone Number: 828-2976234 signing official's %tie: ORC
Has the ORC changed since the previous NDAit-1? 0 rrs p No Phone Number: 828-2976234 Permit Ex 11i OW
p..
ignature Date Signature Date
- this rtnatwe, I cerKy #ot this report Is acounate and complete to the bed of my tawwirdge. I certify, Under pwwk or taw, tW Mk dmlmatd and ai dlu faclmerwere prepared Under my direction or supervision in accordance
wth a ryr6em desoM to aerie the ai quaNl(ed pow ral property gatin ed aM evaksried the k*m dion eubm tad, &wed on my
Inquiry of the person or parsons who mare the "dam, orttme Willem dlroctty rorporNtbir for pr 0ft the Information, the
iMamvftn submUted Is, to fne best of my Ivwwtselns and brie{, *W, accurate, and complete. I am aware that !hare are signiticant
penalties for subrnitikq false i 4brrrnion, indWNV its porsibiity of fifes aM imprjmn for loiowing violations.
it
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center