HomeMy WebLinkAboutWQ0034817_Monitoring - 02-2020_20201222FORM: NDAR-3 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-3) Page � of I
Permit No.: !11 4S17
Facility Name: St Thomas More• •
g-
February1
1
• conjunctive utilization
this facility?
®®
■®
occur at
YES Fil N 0
ea (acres):
Area (acres)l
Area (acres):
Area (acres):
Field Irrigated?
Field Irrigated?
Field Irrigated?
� rIIllIllIllIllIllIllI
FORM: NDAR-3 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-3) Page i 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? 0 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? ❑J Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? Q 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: Les Mazur
Permittee:
Certification No.:
Signing Official:
Grade: Phone Number: 919-942-6259
Signing Official's Title:
Has the ORC changed since he previo s NDAR-3? ❑ Yes Ej No
Phone Number: Permit Exp.:
3/8/20
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617