WQ0002857_Monitoring - 08-2016_20160929 (2)

Page 2 of 3
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDIDTIONAL PAGES AS NEEDED
PERMIT NUMBER: W00002857 MONTH: August YEAR: 2016
FACILITY NAME: Piedmont Custom Meats WWTF COUNTY: Caswell
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feettgallon) x 12 (Inches/foot)] / [Area Sprayed (acres) x 43,560 (square feettacre) or
= [Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch).
Maximum Hourly Loading (inches) = Daily Loading (inches) I [rime irrigated (minutes)160 (minutes/hour)] Monthly Loading (inches) =Sum of Daily Loading (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (inches) = [Monthly Loading (inches/month) / Number of days in the month (days/month )] x 7 (days/week)
iDid Irrigation Occur Al This Facility:
Did Irrigation Occur On This Field:
Did Irrigation Occur On This Field:
Yes: ❑ No: ❑
Yes: ® No: ❑
Yes: ❑ No:
Field Number: 11
Field Number: 12
Area Sprayed (acres): 1
Area Sprayed (acres): I 1
Cover Crop: Fescue
Cover Crop: Fescue
Permitted Hourly Rate (inches):
0.2
Permitted Hourly Rale (Inches):
0.2
WEATHER CONDITIONS
Permitted Yearly Rale (Inches):
52
Permitted Yearly Rate (Inches):
52
D
A
Weather Temperature
Storage
Maximum
Maximum
T
Coda° at Precipita-
Lagoon
Volume Time Daily
Hourly
vol.... Time Daily
Hourly
application lion
Free -hoard
Applied Irrigated Loading
Loading
Applied Irrigated Loading
Loading
(°r) inches
f t
gallons minutes inchesinches
gallons minutes inches
inches
All
c 0`OR.?
"Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Steven Yarbrough Phone: [phone]
ORC Certification Number: 986612 Check Box iLQRC Has Changed: ❑
Mail ORIGINAL and Two COPIES to:
ATTN: Non -Discharge Compliance Unit X
DENR (SIGNATU OPERATOR I ESPONSIBLE CHARGE)
Division of Water Quality By thi gnature, I certify that this report is accurate and
1617 Mail Service Center complete to the best of my knowledge.
RALEIGH, NC 27699-1617
DENR Form NDAR-1 (5/2003)
12 Month Floating Total (inches)
Accrug, Weekly Loading (inches)
a^
"Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Steven Yarbrough Phone: [phone]
ORC Certification Number: 986612 Check Box iLQRC Has Changed: ❑
Mail ORIGINAL and Two COPIES to:
ATTN: Non -Discharge Compliance Unit X
DENR (SIGNATU OPERATOR I ESPONSIBLE CHARGE)
Division of Water Quality By thi gnature, I certify that this report is accurate and
1617 Mail Service Center complete to the best of my knowledge.
RALEIGH, NC 27699-1617
DENR Form NDAR-1 (5/2003)

FACILITY STATUS:
Please indicate( by inserting Y(es) or N (o) in the appropriate box) whether the facility has been compliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.)
Compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
4. All buffer zones as specified in the permit were maintained during each application.
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the
Er
limit(s) specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 a qualified personnel properly gather and evaluate 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
inforrpatiop submitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant
pena ties f+ submitting qqs )qormation, including the possibility of fines and imprisonment for knowing violations."
PA
of
(Permittee -Please print or type)
9683 Kerr's Chapel Road
Gibsonville. NC
(Permittee Address)
James M. Cheshire
(Name of Signing Official -Please print or type)
President R & A Laboratories
(Position or Title)
336-582-8247
(Phone Number)
03/31/21
(Permit Exp. Date)
* If signed by other than the Permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b) (2) (D).
DENR Form NDAR-1 (5/2003)

Page 3 of 3
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDIDTIONAL PAGES AS NEEDED
PERMIT NUMBER:_ W00002857 MONTH: August YEAR: 2016
FACILITY NAME: Piedmont Custom Meats WWTF COUNTY: Caswell
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/fool)] /[Area Sprayed (acres) x 43,560 (square feet/acre) or
= [Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch).
Maximum Hourly Loading (inches) = Daily Loading (inches) / [rime Irrigated (minutes) / 60 (minutes/hour)] Monthly Loading (Inches) =Sum of Daily Loading (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (inches) = [Monthly Loading (inches/month) / Number of days In the month (days/month )] x 7 (days/week)
Did Irrigation Occur At This Facility:
Did Irrigation Occur On This Field:
Did Irrigation Occur On This Field:
Yes: ❑ No:
❑
Yes: ❑ No: ®
Yes: ❑
No: ❑
Field Number: 13
Field Number:
14
Area Sprayed (acres): 1
Area Sprayed (acres):
1
Cover Crop: Fescue
Cover Crop:
Fescue
Permitted Hourly Rate (inches): 0.2
Permitted Hourly Rale (inche
WEATHER CONDITIONS
Permitted Yearly Rate (Inches): 52
Permitted Yearly Rate (inches
D
A
Weather Temperature
Storage
Maximum
T
Code' at Precipila-
Lagoon
Volume Time Daily Hourly
Volume Time
Daily
r.
application
lion
Rr I acrd
Applied Irrlgmed Loading Loading
Applied Inigared
Lunch,
ff)
inches
feet
gallons minor. inches inches
gallons minutes
inches
1
C 77
a0�'
2.3 `;
12960` 3600.48
z
s_lc
52
Maximum
Hourly
Loading
inches
0.08
*Wcutlmr Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Steven Yarbrough Phone: [phone]
ORC Certification Number: 986612 Check Box ' RC Has Changed: ❑
Mail ORIGINAL and Two COPIES to:
ATTN: Non -Discharge Compliance Unit X
DENR (SIGNAT OF PERATOR IN RESPONSIBLE CHARGE)
Division of Water Quality By t ' signature, I certify that this report is accurate and
1617 Mail Service Center complete to the best of my knowledge.
RALEIGH, NC 27699-1617
DENR Form NDAR-1 (5/2003)
12Mouth Floating Total (lnchc�)
Z. w
fie,` t a .� qrx
'.."' � .1��
a •
,y ^ ,p
*Wcutlmr Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Steven Yarbrough Phone: [phone]
ORC Certification Number: 986612 Check Box ' RC Has Changed: ❑
Mail ORIGINAL and Two COPIES to:
ATTN: Non -Discharge Compliance Unit X
DENR (SIGNAT OF PERATOR IN RESPONSIBLE CHARGE)
Division of Water Quality By t ' signature, I certify that this report is accurate and
1617 Mail Service Center complete to the best of my knowledge.
RALEIGH, NC 27699-1617
DENR Form NDAR-1 (5/2003)

FACILITY STATUS:
Please indicate( by inserting Y(es) or N (o) in the appropriate box) whether the facility has been compliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.)
Compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit.
EF
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
T
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
EY,
4. All buffer zones as specified in the permit were maintained during each application.
Elp
S. The freeboard in the treatment and/or storage lagoon(s) was not less than the
E
limit(s) specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 a qualified personnel properly gather and evaluate 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
penaltie or s bmitting fal i f ation, including the possibility of fines and imprisonment for knowing violations."
James M. Cheshire
(Si atu of Permite * D to (Name of Signing Official -Please print or type)
JWes M. Cheshire (Authorized Agent) President R & A Laboratories
(Permittee -Please print or type) (Position or Title)
9683 Kerr's Chapel Road 336-582-8247 03/31/21
Gibsonville, NC (Phone Number) (Permit Exp. Date)
(Permittee Address)
* If signed by other than the Permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b) (2) (D).
DENR Form NDAR-1 (5/2003)