HomeMy WebLinkAboutWQ0000488_Monitoring - 10-2016_20161207 (2)FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: •111•:88
Facility Name:
SILK HOPE ELEMENTARY SCHOOLOctober
1
• irrigation occur
this •
at
Field Name.i
Cover Crop:
K
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FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
QCompliant
F1Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
F±1Compliant
FiNon-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?
QCompliant
0Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
QCompliant
0Non-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.
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Permittee:
Certification No.:
Signing Official:
Grade: Phone Number:
Signing Official's Title: Operator
Has the ORC changed since the previous NDAR-1? E]Yes Q No
11/30/16
Phone Number: Permit Exp.:
�11/30/16
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 tines 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