WQ0018146_Monitoring - 10-2016_20161207 (3)

I
NON -DISCHARGE APPLICATION REPORT Page d of
SPRAY IRRIGATION SITE(S)
'THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: °' MONTH: �����' YEAR:
FACILITY NAME:-. ur_- Pf'��Wi✓ X7 �'n taAjJ WW -r_- COUNTY:
Formulas: — —
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / [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 Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loadina linchesl = IM—thw i n rlinn Anrh, m,nnrh\ r d ­In rho month /dmrdmnnfh\1 v 7 Mmm -kI
Did Irrigation OrAt This Facility:
Yes: No: ❑
Did Irrigation Or On This Field:
Yes- No: ❑
Did Irrigation Occyr On This Field:
Yes: I No: ❑
..
FIELD NUMBER: 1 Ar
AREA SPRAYED acres : • Jr
COVER CROP: I e
PERMITTED HOURLY RATE (inches):
5�
¢i . i
FIELD NUMBER:
AREA SPRAYED (acres):
COVER CROP: 6604 U�
PERMITTED HOURLY RATE (inches): f7, /
D
A
T
E
WEATHER CONDITIONS
Temper-ature Storage
weather Code* at Precipita- Lagoon
application tion Free -board
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated Loading
f q io�
Maximum
Hourly
Loading
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated Loading
/11,5
Maximum
Hourly
Loading
('F) inches feet
gallons minutes
inches
inches
gallons minutes
inches
inches
1
4
2
3
• Z. 0
! a
5
bio a
o=�r?PJCJ � .4 `J
o �J
6
V7 V
.31 _bR� q0
2
so 675 460
A�a
7
s
s
10
11
13
PC, 41 0
s d1
14
f> it
15
C,
16
17
G�
a ' °9J�rJ i
,T
r �✓�
18
PC, 5q-
19
PC, Ej 0
20
FC, 51 0
, 7 2 f,7f, 0
, :� .._.
2 —
'' S e 5? � �
tl .
, 35
21
--- ---
22
23
24
GV,
25
Ui n 0
2e
27
28
29
30
31
Total GLoading (inches)
�
::::allons/Monthly
p ::::::::::::::::::::::::
,
12 Month Floating Total (inches) :;:::'::;:::::
:::::.: : : : : : :: : :::
�` (�
1'
Average Weekly Loading (inches)[:
::;:;•::•:::•;•;•::
e 1:5
�•....-. .... •. c.�. +-...c , v-Fmuy ­uy, \-Wvuuy, R-Idlrr, an-w1uw, al-SIeel '
Spray Irrigation Operator in Responsible Charge (ORC): r` iMl444 FC—'r�S Phone: ail ` °3-V5- 2Z
ORC Certification Number: g Check Box if ORCH Chan ed: El
Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality � TT 7�
ATTN: Information Processing Unit (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
RALEIGH, NC 27699-1617 COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (11/2005)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
rTyHERE
� a,
-ARE
r�TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: 00 6 914b MONTH: 0 om.7>e —
Page 2- of 3
YEAR: _
FACILITYNAME: ,2i� PR56-,v6 Ar -JbF1h>1%,1J 1-61f'" COUNTY: ctl4Me4l
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] /[Area Sprayed (acres) x 43,560 (square feeVacre)) OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / [Time Irrigated (minutes) / 60 (minutes/hour)) Monthly Loading (inches) =Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
A—no W-0. I —lino nnrhnel
Did Irrigation Occ At This Facility:
Yes' [7 No: ❑
Did Irrigation Occ On This Field:
Yes: No:
❑
Did Irrigation Occjd On This Field:
Yes: No: ❑
...
............
FIELD NUMBER: a
AREA SPRAYED acres : i4
COVER CROP:I G
PERMITTED HOURLY RATE (inches): 0A1
FIELD NUMBER:
AREA SPRAYED acres
COVER CROP:1 Ory 136 -1 .4
PERMITTED HOURLY RATE (inches): 0, •
D
A
T
E
TTED YEARLY RATE (inches): l
Temperature Storage Maximum
WEATHER CONDITIONS fAd
Weather at Precipita• Lagoon Time Daily Hourly
Code
application tion Free -board Irrigated LoadingLoadingApplied
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Irrigated Loadin
Maximum
Hourly
Loading
CF) inches feet
gallons
minutes
Inches
inches
gallons minutes
Inches
inches
1
nr
2
3
•�
a �� (�.(�
17-0
vJ
rv`�
c r?�J `r•e �t1`U
�'3
eU
4
Q
`' Z & Ct7
t Z-0
.07>
` f -ml &C, 6 2,q 0
0:3
' el -,
5
R
"•Q 2
6
lel:
6 E)
&%
12-,0
u 3
eV 6-
77
7
8
9
10
11
13
C-
14
t7 C,
S '.
,. 2-6tv
1 zo
.0`3
ve g'
15
C✓
51 C
v 42-400
12-0
U7
.uiS
16
17
*2-60&
2-C,
;dJ3
4LiS
18
19
:t 0C
—1
12-0
z65
> L1
sr'7�
20
PC,
5-1
-
21
22
23
24
L
[)
V2-", C)
120
. Q3
s r3e J�
25
Crrr
Lto
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
ljb(_ 6130
2J?�
OC7
12 Month Floating Total (inches) :::::::::::
::::::::::::;:;:::;:;:;
$I
Average Weekly Loading (]nches)
III/e��4,.,. r•...�..... r ..r-...- n
• -
3•+
d ri
Spray Irrigation Operator in Responsible Charge (ORC): ?tFt VV J Pi: I
ORC Certification Number: 76 % `a 02 -
Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1617
Phone: m- 545-2za1
Check Box if ORC Has Changed: ❑
%I*T
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (11/2005)

NON -DISCHARGE APPLICATION REPORT Page of
SPRAY IRRIGATION SITE(S)
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. )
'
1. The application rate(s) did not exceed the limit(s) specified in the permit. CompliantY,N)
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_ (1
5_ The freeboard in the treatment and/or storage lagoon(s) was not less than the 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 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 fal information, including the possibility of fines
and imprisonment for knowing violations."
ZA
Signatu mittee)* Date (Name of Signing Official -Please print or type)
"0,V �+ arra -o -,"JA
(Permittee -Please print or type)
,2,02- : A AC-i1-G,JA-1—A C-1-1
cA F-1 tJ e- 2_1 6 11
(Permittee Address)
(Position or Title)
(Phone Number)
(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)(1)).
DENR FORM NDAR 1 0 1/20051