WQ0020881_Monitoring - 04-2024_20240523

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month: * April
WQ0020881
LAKE NORMAN STATE PARK
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2024
Upload Document*
04-2024 LNSP NDMR-AR.pdf 1.47MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Madelyn Mills
Reviewer: Wanda.Gerald
5/23/2024
This will be filled in automatically

Is the project number correct?* W00020881
Is the monitoring report accepted?* Yes NO
Regional Office* Mooresville
Reviewer: _anonymous
Review Date: 6/18/2024

FORM NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 of 2
Permit No.: Q10 I::
of •rman SP)
County: Iredell••
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FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 2
Sampling Person(s) Certified Laboratories
Name: Operators Name: Statesville Analytical, Inc.
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? a 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
Perm ittee Certification
ORC: Todd Robinson
Permittee: Div. Of Parks & Rec (Lake Norman SP)
Certification No.: 1006252
Signing Official: Nathan Greene
Grade: S1 Phone Number: 252-235-8809
Signing Officials Title: State Ranger
Has the ORC changed since the previous NDMR? 11 Yes m No
Phone Number: [phone] Permit Expiration: 6/30/2026
Digitally signed by Todd Robinson
Todd DN: CN = Todd Robinson email =
[e-mail] C = US
5/23/2024
O = ENVIROLINK. INC. OU = ORC
z3 l
Robinson
.�
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: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Pagel of 2
Permit No.: •11 1"
Of Parks & Rec- Norman SP)-
••
1 I
• irrigation occur
Area (acres�.
at this facility?
.... .
. ..
.... .
Le YES NO
1
1•Hourly
Rate (in):
1
1Annual
Rate (in):
Field Irrigated?
M.Urw���
om====
WMINMEMME
0=10=10=10M
WMAMMEMME
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MMINMIMMME

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 2 of 2
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?
m Compliant ❑ Non -Compliant
m Compliant ❑ Non -Compliant
m Compliant ❑ Non -Compliant
m Compliant ❑ Non -Compliant
m 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: Todd Robinson
Permittee:
Div. Of Parks & Rec (Lake Norman SP)
Certification No.: 1006252
Signing Official: Nathan Greene
Grade: S1 Phone Number: 252-235-8809
Signing Official's Title: State Ranger
Has the ORC changed since the previous NDAR-1? ❑ Yes [a No
Phone Number: [phone] Permit Exp.: 6/30/26
Todd Digitally signed by Todd Robinson
DN. CN = Todd Robinson email =
[e-mail] C = US
Robnsnn0 = ENVIROLINK. INC. OU = ORC 5/23/2024
r>3te �n�n ns �� 1,�F sz _na na
(�y
S Z3 L
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 lawthat this document and all attachments were prepared under my direction or supernsion 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. trueaccurateand 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