WQ0034817_Monitoring - 09-2019_20201222

FORM: NDAR-3 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-3) Page of
Permit No.: •11 4S17
Facility Name: St Thomas More• •
Orange
Month: September1
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Did conjunctive utilization
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Field Name:
YES NO
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FORM: NDAR-3 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-3)
Page t. of
Did the application rates exceed the limits in Attachment B of your permit?
Q 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?
Q 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
acuonts) taKen. Hnacn aaamonal sneets It necessary.
Operator in Responsible Charge (ORC) Certification
I ORC: Les Mazur
I Certification No.:
Grade: Phone Number: 919-942-6259
Has the ORC changed since the previous NDAR-3? ❑ Yes [2] No
Signature
By this signature. I certify that this report is accurrate and complete to the best of my knowledge.
Permittee:
Signing Official:
Signing Official's Title:
Phone Number:
10/12/19
Perrnittee Certification
Permit Exp.:
Date 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617