WQ0005150_Final Permit_20150105

WDENR
North Carolina Department of Environment and Natural Resources
Pat McCrary
Governor
January 5, 2015
Danny Holloman — Superintendent
Person County Board of Education
304 S. Morgan St., #25
Roxboro, NC 27573
Dear Mr. Holloman:
Donald vacs der Vaart
Secretary
Subject: Permit No. WQ0005150
North End Elementary
Wastewater Irrigation System
Person County
In accordance with your permit renewal request received October 15, 2014, we are forwarding
herewith Permit No. WQ0005150 dated January 5, 2015, to Person County Board of Education for the
continued operation of the subject wastewater treatment and irrigation facilities. Please note that this
renewed permit shall become effective on June 1, 2015 (i.e. the day after the expiration date of the
existing permit), which differs from the date of this letter.
This permit shall be effective from June 1, 2015 until May 31, 2020, shall void Permit No.
WQ0005150 issued February 11, 2011, and shall be subject to the conditions and limitations as specified
therein. Please pay particular attention to the monitoring requirements listed in Attachments A, B and C
for they may differ from the previous permit issuance. Failure to establish an adequate system for
collecting and maintaining the required operational information shall result in future compliance
problems.
For your convenience, customized electronic copies of your facility's NDMR and NDAR-1
reporting forms are available for download at: h_ttp://porLai.nedenr.orm/web/wq;gps/fauireportine.
Please note the following permit conditions are new since the last permit issuance:
1. Condition II.3: Maintenance of wastewater irrigation sewer lines.
2. Condition II.10: How to handle sale of part of property that impacts wastewater irrigation
and maintaining permit.
3. Condition 111.16: Chlorination tablets to be used. The language is more specific than in
2011 permit while not requiring pre -approval of chlorine tablets used.
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail
Service Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding.
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phore: 919-807-64641 Intemet: ht1D:HRortal.ncdenr.oM/webtwg
An Equal Opyorrtinity 1 Affirmative Action Employer - Made in part with recycled paper

Mr. Danny Holloman
January 5, 2015
Page 2 of 2
If you need additional information concerning this permit, please contact Troy Doby at (919)
807-6336 or [e-mail].
Sincerely,
/6�omisA. Reeder, Director
Division of Water Resources
cc: Person County Health Department (EIectronic Copy)
Raleigh Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Central Files
Digital Permit Archive (Electronic Copy)

I.
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMIVIISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER IRRIGATION SYSTEM PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules and Regulations
PERMISSION IS FIEREBY GRANTED TO
Person County Board of Education
Person County
FOR THE
continued operation of a 5,430 gallon per day (GPD) wastewater treatment and wastewater irrigation
facility consisting of:
a 9,800-gallon septic tank, a dosing tank with dual siphons rated at 110 gallons per inch draw down, a
1,000 square foot surface sand filter, a table chlorinator in an open grate vault, a 100 gallon per minute
(GPM) pump station with dual submersible pumps and high water alarms, approximately 841 linear feet
of 4-inch force main, a 119,000-gallon lined storage lagoon with high water alarms, a pad -mounted spray
field suction pump rated at 67 GPM, a 1.10-acre spray field (Area 1) and a 1.76-acre spray field (Area 2),
all associated valves, piping, and appurtenances
to serve the North End EIementary School, with no discharge of wastes to surface waters, pursuant to the
application received October 15, 2015, and in conformity with the project plans, specifications, and other
supporting data subsequently filed and approved by the Department of Environment and Natural
Resources and considered a part of this permit.
This permit shall be effective from June 1, 2015, until May 31, 2020, shall void Permit No. WQ0005150
issued February 11, 2011 and shall be subject to the following specified conditions and limitations:
1. No later than six months prior to the expiration of this permit, the Permittee shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal
application.
WQ0005150 Version 4.0 Shell Version 140707 Page 1 of 8

H. PERFORMANCE STANDARDS
1. The subject non -discharge facilities shall be effectively maintained and operated at all times so there
is no discharge to surface waters, nor any contravention of groundwater or surface water standards.
In the event the facilities fail to perform satisfactorily, including the creation of nuisance conditions
due to improper operation and maintenance, or failure of the irrigation areas to adequately assimilate
the effluent, the Permittee shall take immediate corrective actions including Division required actions,
such as the construction of additional or replacement wastewater treatment or irrigation facilities.
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or
surface water resulting from the operation of this facility.
The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities in accordance with 15A NCAC 02T .0400. If an
individual permit is not required, the following performance criteria shall be met as provided in 15A
NCAC 02T .0403.
a. The sewer system shall be effectively maintained and operated at all times to prevent discharge to
land or surface waters, and any contravention of groundwater or surface water standards.
b. A map of the sewer system shall be developed and actively maintained.
c. An operation and maintenance plan shall be developed, implemented and maintained.
d. Pump stations not connected to a telemetry system shall be inspected every day (i.e., 365 days per
year). Pump stations connected to a telemetry system shall be inspected at least once per week.
e. High -priority sewers shall be inspected at least once every six months.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Overflows and bypasses shall be reported to the Raleigh Regional Office in accordance with 15A
NCAC 02B .0506(a), and public notice shall be provided as required per North Carolina General
Statute § 143-215.1 C.
h. A grease control program shall be developed, implemented and maintained.
i. Right-of-ways and easements shall be maintained.
j. Inspection and maintenance records for Conditions II.3.a. through II.31 shall be maintained for a
period of at least three years, except for Conditions I1.3.b. and 11.3.c., which shall be maintained
for the life of the system.
4. Effluent quality shall not exceed the limitations specified in Attachment A.
Application rates, whether hydraulic, nutrient or other pollutant, shall not exceed those specified in
Attachment B.
6. The compliance boundary for the disposal system shall be specified in accordance with 15A NCAC
02L .01.07(b). This disposal system was individually permitted on or after December 30, 1983;
therefore, the compliance boundary is established at either 250 feet from the effluent disposal area, or
50 feet within the property boundary, whichever is closest to the effluent disposal area. An
exceedance of groundwater standards at or beyond the compliance boundary is subject to remediation
action according to 15A NCAC 02L .0106(d)(2) as well as enforcement actions in accordance with
North Carolina General Statute 143-215.6A through 143-215.6C.
7. In accordance with 15A NCAC 02L .0108, the review boundary is established midway between the
compliance boundary and the effluent disposal area. Any exceedance of groundwater standards at the
review boundary shal l require action in accordance with 15A NCAC 02L .0106.
WQ0005150 Version 4.0 Shell Version 140707 Page 2 of 8

8. The Permittee shall apply for a permit modification to establish a new compliance boundary prior to
any sale or transfer of property affecting a compliance boundary.
9. In accordance with 15A NCAC 02L 0107(d), no wells, excluding Division approved monitoring
wells, shall be constructed within the compliance boundary except as provided for in 15A NCAC 02L
.0107(g).
10. Except as provided for in 15A NCAC 02L .0107(g), the Permittee shall ensure any landowner who is
not the Permittee and owns land within the compliance boundary shall execute and file with the
Person County Register of Deeds an easement running with the land containing the following items:
a. A notice of the permit and number or other description as allowed in 15A NCAC 02L .0107(f)(1);
b. Prohibits construction and operation of water supply wells within the compliance boundary; and
c. Reserves the right of the Permittee or the State to enter the property within the compliance
boundary for purposes related to the permit.
The Director may terminate the easement when its purpose has been fulfilled or is no longer needed.
11. The facilities permitted herein shall maintain the following setbacks:
a. The setbacks for irrigation sites (permitted prior to September 1, 2006) shall be as follows (all
distances in feet):
i.
Any habitable residence or place of public assembly under separate ownership:
400
ii.
Surface waters:
100
iii.
Any well with exception of monitoring wells:
100
iv.
Any property line;
150
v.
Public right of way:
50
b. The setbacks for storage and treatment units (permitted prior to September 1, 2006) shall be as
follows (all distances in feet):
i. Any well with exception of monitoring wells: 100
ii. Any property line: 50
III. OPERATION AND MAINTENANCE REQUIREMENTS
1. The facilities shall be properly maintained and operated at all times. The facilities shall be effectively
maintained and operated as a non -discharge system to prevent the discharge of any wastewater
resulting from the operation of this facility. The Permittee shall maintain an Operation and
Maintenance Plan pursuant to 15A NCAC 02T .0507, which at a minimum shall include operational
functions, maintenance schedules, safety measures and a spill response plan.
2. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the subject non -discharge facilities, in accordance with 15A NCAC 08G .0200 the
Permittee shall designate and employ a certified operator in responsible charge (ORC) and one or
more certified operator(s) as back-up ORC(s). The ORC or their back-up shall visit the facilities in
accordance with 15A NCAC 08G .0200, and shall comply with all other conditions specified in the
previously cited rules.
3. A suitable year round vegetative cover shall be maintained at all times, such that crop health is
optimized, allows for even distribution of effluent and allows inspection of the irrigation system.
4. Adequate measures shall be taken to prevent effluent ponding in or runoff from the irrigation sites
listed in Attachment B.
WQ0005150 Version 4.0 Shell Version 140707 Page 3 of 8

5. Irrigation shall not be performed during inclement weather or when the ground is in a condition that
will cause ponding or runoff.
6. All irrigation equipment shall be tested and calibrated at least once per permit cycle. Calibration
records shall be maintained at the facility for a period of no less than five years, and shall be made
available to the Division upon request.
7. Only effluent from North End Elementary School shall be irrigated on the sites listed in Attachment
B.
8. No automobiles or machinery shall be allowed on the irrigation sites except during equipment
installation or while maintenance is being performed.
9. Public access to the irrigation sites and wastewater treatment facilities shall be prohibited.
10. The residuals generated from the wastewater treatment facilities shall be disposed or utilized in
accordance with 15A NCAC 02T .1100. The Permittee shall maintain a residual management plan
pursuant to ISA NCAC 02T .0508.
11. Diversion or bypassing of untreated or partially treated wastewater from the treatment facilities is
prohibited.
12. freeboard in the storage pond shall not be less than two feet at any time.
13. A gauge to monitor waste levels in the storage lagoon shall be provided. This gauge shall have
readily visible permanent markings indicating the following elevations: maximum liquid level at the
top of the temporary liquid storage volume; minimum liquid level at the bottom of the temporary
liquid storage volume; and the lowest point on top of the dam.
14. A protective vegetative cover shall be established and maintained on all earthen embankments (i.e.,
outside toe of embankment to maximum allowable temporary storage elevation on the inside of the
embankment), berms, pipe runs, erosion control areas, and surface water diversions. Trees, shrubs,
and other woody vegetation shall not be allowed to grow on the earthen dikes or embankments.
Earthen embankment areas shall be kept mowed or otherwise controlled and accessible.
15. The tablet chlorinator shall be checked weekly. Wastewater grade chlorine tablets (calcium
hypochlorite) shall be added as needed to provide proper chlorination. Pool chlorine tablets shall not
be used.
IV. MONITORING AND REPORTING REQUIREWNTS
1. Any Division required monitoring (including groundwater, plant tissue, soil and surface water
analyses) necessary to ensure groundwater and surface water protection shall be established, and an
acceptable sampling reporting schedule shall be followed.
2. Per 15A NCAC 02H .0800, a Division certified laboratory shall conduct all laboratory analyses for
the required effluent, groundwater or surface water parameters.
3. Flow through the treatment facility shall be continuously monitored, and daily average flow values
shall be reported on Form NDMR. Flow may be estimated from water use records, provided the
Permittee's water use is metered. Daily average flow values shall be calculated by dividing the
monthly metered water usage by the number of days in the month.
4. The Permittee shall monitor the effluent from the subject facilities at the frequencies and locations for
the parameters specified in Attachment A.
WQ0005150 Version 4.0 Shell Version 140707 Page 4 of 8

5. The Permittee shall maintain adequate records tracking the amount of effluent irrigated. At a
minimum, these records shall include the following information for each irrigation site listed in
Attachment B:
a. Date of irrigation;
b. Volume of effluent irrigated;
c. Site irrigated;
d. Length of time site is irrigated;
e. Continuous weekly, monthly, and year-to-date hydraulic (inches/acre) loadings;
f. Weather conditions; and
g. Maintenance of cover crops.
6. Freeboard (i.e., waste level to the lowest embankment elevation) in the storage pond shall be recorded
weekly. Weekly freeboard records shall be maintained at the facility for a period of no less than five
years, and shall be made available to the Division upon request.
7. Three copies of all monitoring data (as specified in Conditions IV.3. and IVA.) on Form NDMR for
each PPI and three copies of all operation and disposal records (as specified in Conditions IV.S. on
Form NDAR-1 for every site in Attachment B shall be submitted on or before the last day of the
following month. If no activities occurred during the monitoring month, monitoring reports are still
required documenting the absence of the activity. All information shall be submitted to the following
address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
8. A record shall be maintained of all residuals removed from this facility. This record shall be
maintained at the facility for a period of no less than five years, and shall be made available to the
Division upon request. At a minimum, this record shall include:
a. Name of the residuals hauler;
b. Non -Discharge permit number authorizing the residuals disposal, or a letter from a municipality
agreeing to accept the residuals;
c. Date the residuals were hauled; and
d. Volume of residuals removed.
9. A maintenance log shall be maintained at this facility. This log shall be maintained at the facility for
a period of no less than five years, and shall be made available to the Division upon request. At a
minimum, this log shall include:
a. Date of calibration of flow measurement device;
b. Visual observations of the plant and plant site; and
c. Record of preventative maintenance (e.g., changing of equipment, adjustments, testing,
inspections and cleanings, etc.).
WQ0005150 Version 4.0 Shell Version 140707 Page 5 of 9

10. An annual representative soils analysis (i.e., Standard Soil Fertility Analysis) shall be conducted on
each irrigation site listed in Attachment B. These results shall be maintained at the facility for a
period of no less than five years, and shall be made available to the Division upon request. At a
minimum, the Standard Soil Fertility Analysis shall include the following parameters:
Acidity
Exchangeable Sodium Percentage
Phosphorus
Base Saturation (by calculation)
Magnesium
Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Humic Matter
Zinc
Copper
pH
11. Noncompliance Notification:
The Permittee shall report by telephone to the Raleigh Regional Office, telephone number (919) 791-
4200, as soon -as possible, but in no case more than 24 hours, or on the next working day following
the occurrence or first knowledge of the occurrence of any of the following:
a. Any occurrence at the facility resulting in the treatment of significant amounts of wastes that is
abnormal in quantity or characteristic, including the known passage of a hazardous substance.
b. Any process unit failure (e.g., mechanical, electrical, etc.), due to known or unknown reasons,
rendering the facility incapable of adequate wastewater treatment.
c. Any facility failure resulting in a by-pass directly to receiving surface waters.
d. Any time self -monitoring indicates the facility has gone out of compliance with its permit
limitations.
e. Ponding in or runoff from the irrigation sites_
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone].
Persons reporting such occurrences by telephone shall also file a written report in letter form within
five days following first knowledge of the occurrence. This report shall outline the actions taken or
proposed to be taken to ensure the problem does not recur.
V. INSPECTIONS
1. The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
wastewater treatment and irrigation facilities.
2. The Permittee or their designee shall inspect the wastewater treatment and irrigation facilities to
prevent malfunctions, facility deterioration and operator errors resulting in discharges, which may
cause the release of wastes to the environment, a threat to human health or a public nuisance. The
Permittee shall maintain an inspection log that includes, at a minimum, the date and time of
inspection, observations made, and any maintenance, repairs, or corrective actions taken. The
Permittee shall maintain this inspection log for a period of five years from the date of the inspection,
and this log shall be made available to the Division upon request.
3. Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premises or place on or related to the wastewater treatment and irrigation facilities
permitted herein at any reasonable time for the purpose of determining compliance with this permit;
may inspect or copy any records required to be maintained under the terms and conditions of this
permit, and may collect groundwater, surface water or leachate samples.
WQ0005150 Version 4.0 Shell Version 140707 Page 6 of 8

VL GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to
an enforcement action by the Division in accordance with North Carolina General Statutes 143-
215.6A to 143-215.6C.
2. This permit shall become voidable if the permitted facilities are not constructed in accordance with
the conditions of this permit, the Division approved plans and specifications, and other supporting
documentation.
3. This permit is effective only with respect to the nature and volume of wastes described in the permit
application, Division approved plans and specifications, and other supporting documentation. No
variances 'to applicable rules governing the construction or operation of the permitted facilities are
granted, unless specifically requested and approved in this permit pursuant to 15A NCAC 02T
,0105(n).
4. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., local, state, and federal). Of particular concern to the Division are applicable river buffer rules
in 15A NCAC 02B .0200; erosion and sedimentation control requirements in 15A NCAC Chapter 4
and under General Permit NCG010000; any requirements pertaining to wetlands under 15A NCAC
02B .0200 and 02H .0500; and documentation of compliance with Article 21 Part 6 of Chapter 143 of
the General Statutes.
5. In the event the permitted facilities change ownership or the Permittee changes their name, a formal
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate property ownership documentation and other supporting
documentation as necessary. The Permittee of record shall remain fully responsible for maintaining
and operating the facilities permitted herein until a permit is issued to the new owner.
6. The Permittee shall retain a set of Division approved plans and specifications for the life of the
facilities permitted herein.
7. The Permittee shall maintain this permit until all permitted facilities herein are properly closed or
permitted under another permit issued by the appropriate permitting authority pursuant to 15A NCAC
02T .01050).
8. This permit is subject to revocation or unilateral modification upon 60 days notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T .0110.
9. Unless the Division Director grants a variance, expansion of the permitted facilities contained herein
shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC 02T .0120(b).
10. The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to
pay the annual fee accordingly shall be cause for the Division to revoke this permit pursuant to 15A
NCAC 02T .0105(e)(3).
WQ0005150 Version 4.0 Shell Version 140707 Page 7 of 8

Permit issued this the 5`h day of January, 2015
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
01
�—d,
mas . Reeder, Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0005150
WQ0005150 Version 4.0 ShelI Version 140707 Page 8 of 8

ATTACHMENT A — LIMITATIONS AND MONITORING REQUIREMENTS
PPI 001— WWTF Effluent
Permit Number: WQ0005150 Version: 4.0
EFFLUENT CHARACTERISTICS
EFFLUENT LIMITS
MONITORING REQUIREMENTS
PCs
Code
Parameter Description
Units of
Measure
Monthly
Average
Monthly
Geometric Mean
Daily Minimum
Daily Maximum
Measurement
Frequency
Sample
Type
50050
Flow, in conduit or through treatment plant'
GPD
5,430
Monthly
Estimate
00310
BOD, 5-Day (20°C)
3 x Year'
Grab
00530
Solids, Total Suspended
3 x Year'
Grab
31616
Coliform, Fecal MF, M-FC Broth_44.5°C
3 x Year
Grab
00610
Nitrogen, Ammonia Total (as N)
3 x Year2
Grab
00620
Nitrogen, Nitrate Total (as N)
3 x Year-2
Grab
00625
Nitrogen, Kjeldahl, Total (as N)
3 x Year'
Grab
00665
Phosphorus, Total (as P)
3 x Year
Grab
00400
pH
3 x Year
Grab
. Measured at influent point.
2. 3 x Year sampling shall be conducted in March, July, and September.
WQ0005150 Version 4.0 Attachment A Page 1 of 1

THIS PAGE BLANK

ATTACHMENT B - APPROVED LAND APPLICATION SITES AND MUTATIONS
Person County Board of Education — North End Elementary School
Permit Number: WQ0005150 Version: 4.0
IRRIGATION AREA INFORMATION
APPLICATION LIMITATIONS
Field
Owner
County
Latitude
Longitude
Net Acreage
Dominant
Soil Series
Parameter
Hourly
hate
Yearly
Max
Units
1
North End Elementary School
Person
36026'I8"
78054'26"
1.10
01284 — Non -Discharge Application hate
0.15
26
inches
2
North End Elementary School
Person
36026'18"
78054'29"
1.76
01284 —Non-Discharge Application Rate
0.30
18.2
inches
Totals
F_
T
I
2.76
i
WQ0005150 Version 4.0 Attachment B Page 1 of i

THIS PAGE BLANK

*' 1101 a N RIM so
Permit rio.:/
Person
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-_-
----
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 3
Sampling Person(s) I Certifiers Laboratories
Name: II Name:
Name: II Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit- com-.4,ant i--.ven{omp5ant
If the facility is non-comr4lant please explain in the space below the reason(s) the facility was not in compliance Provide ut your explanation the date(s) of the non-comrlianc4 and describe the corrective
action(s) taken Attach additional sheets if necessary
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Permittee:
Certification No_:
Signing Official:
Grade: Phone Number
Signing Official's Title:
Has the ORC changed since the Previous NDMR? f 'res r, No
Phone Number: Permit Expiration:
Signature Cate
Signature Oale
By this s�;oature t _ert. N, :rat Ihns report is accurrate and compete to the best of my 6nowledge
i certify. ucder penally of Wei. that this document and all attachments were rferare�, urdeY my delction or superrsion
M accordance wRh a system designed to assure that ail qualirted perscnnet prLpv k, ;an ar ed and evaluated the
v fc-matron submitted Based on my inquiry of the person or persons whc manage t"e s;: alem, of ti :se persons directly
respansiVe for gathering the inforntatxn, the information submitted is. to the tes: a' ^ t ev kdye and tehef, true
accurate. and complete. 1 am aware that there are significant peralt es. for Sumpter; faA-e to f: ma13r. mch,d vg the
poss:a»1y of Gres and trrgnsonment rcr knot: u:y
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

User Friendly Name
Officaal Parameter Name
DWQAccepted Units
00010
Temperature
Temperature, water Deg. Centigrade
�C
O 76
Turbidity
Turbidity, HCHTurbidimeter
NTU
00092
Flmv - Maximum
Flow, Maximum Flow Range
GPD
00094
Conductivity
Conductivity
1;Q
00125
Dichtorobenzene
DicH(orobeezene ilsomers) MiP lm Water uglt
pg7L
00300
Dissolved Oxygen
00, Oxygen, Dissolved
rng/L
00310
BOO,
BOD, S-0ay (ZG Veg. C)
melt.
00340
COD
COD, Oxygen Demand, Chem. (High Level)
mg/L
00400
pH
PH
su
00480
Satm:ty
Sa�lmty
rag/L
00515
Total Filterable Residue
Residue, Tot FUrble (aced at 105C)
mg/L
00530
TotalSu5pended Soiids
Scuds, Total Suspended
mg/L.
00545
Settleable St(ie5
Solids, Settleable
mLIL
00556
Oil 8 Grease
OA rx Grease
Mg/L.
00600
Total Nitrogen
Nitrogen, Tota; (as N)
mg/L.
00610
Ammonia
ttitragen, Ammonia Total (as N)
mg/L
J0615
nitrite
Nitrogen, tlAnteTotal :as N)
mgiL
J0620
Nitrate
Itltrogen, Nitrate-otal las N)
mgiL
00625
Total Kjeldaht Nitrogen
Nitrogen, Kjeldaht, Total (as N)
mgiL
00630
Nitrite+ Nitrate
nitrite plus Nitrate Total I DET. (as 11)
m9JL
00660
Ortho Phosphate
Phosphate, Ortho(as PO4)
mg/L
00665
Total Phosphorus
Phosphorus, Total fas P)
mg/L
00670
Organic Phosphorus
Phosphorous, Total Organic (as Py
mg/L
W680
Total Organic Carton
Carbon, Tat Orgar.,_ (TOC)
mg/L
W681
Dissolved Organic Carton
Carbon, Dissdved Organic (As C)
mg/L
(50916
Calcium
Calcium, Total (as Cal
mg1L
00927
Magnesium
Magnesium, Total (as Mg)
r.g/L
00929
Sodium
Sodium, Total (as Na)
nig/L
00931
Sodium Adsorption Ratio
Sodium Adsorption Ratio
Ratio
0 937
Potassium
Potassium. Total (as K)
mg, L
O"O40
Chloride
Chloride as Cl,
rig; L
0t,945
Sulfate
Sul(ate, Total Las SO-11
n,g1s.
01002
Arsenic
Arsenic, Total (as As)
mg/L
01E0
Barium
Banum, Totalfas8a)
rlgiL
01022
Boron
Boron,TotaL;as B)
mgiL
01027
Cadmium
Cadmium,Total (as Cdy
mgiL
01034
Chromium
Chromium, Tot& (as Cr1
mgiL
01042
Copper
Copper, Total as Cu)
mgiL
01045
Iron
Iron, Total (as Fe,
mgiL
01051
Lead
Lead, Total (as Pb,
mg/L
01055
h%anganese
Manganese, -oWl (as Mny
mg/L
01067
NiCkee.
!hekei, Totai fay Nil
mg/L
01 777
Slver
Silver, Total (as Ag1
m.g/L
01092
2:nt
Zmc, Total fas Zni
mg/L.
Ot ^.47
Selenium
Seieniurn, Total (as Se)
mg/L
01284
Y.D Application Pate
Non Discharge Application Rate
inlyr
31504
Totai Cofiform
Conform, Total MF, immed,LES Endo Agar
al1DO mL
31505
Total Cdiform
Conform, To, MPH, Completed, (100 mL)
1APH1100 mL
31613
Fecal Loliforrn
Cdiform, Fecal MF, M•FC Agar,44.5C,24hr
4 1100 mL
31616
Fecal£obform
Cdiform, Fecal MF, M•FC Broth,44.5C
a 100 mL
32106
Chloroform
Chloroform
mgiL
32730
Phenatfcs - Re:overatge
Phenolics. Totai Recoverable
mg/L
32730
Phenols
mgiL
34469
Pyrene
Pyrene
pg/L
346,94
Phenol - Single
Phenol, S=ngie Compound
mgiL
38260
5urfactants
Surfactants (h56ASi
mg/L
50050
Flow
Flow, in conduit or thru treatment plant
GPD
50 660
Total Resioual chiorme
Chlorine, Total Residual
mgiL
7OZ95
Total Cissdveo Solids
Solids, Total Dissolved
mgiL
70300
Total Dissolved SW6
Sd!ds, Total Dissolved- 180 Deg,C
mg/L
70318
: 50.ds
Solids, Total, Percent
71880
Formaldehyde
Formaldehyde
mg/L
719DG
Mercury
Mercury, Total ras Hg)
mg1L
78732
VolaWeCompounds
%IotaUeCompaurids,(GUNIS)
Yes/No
60082
Carbonaceous BCD
SOD, Carbonaceous 05 Day, 20C
mglL
a1639
Total Kjeldah( Nitrogen
Nitrogen Kjetda-1, Total (TKNI
lbs/a:
81688
Ethylene Glycot
Ethyleneglycot
y91L
62385
Nitrogen 0x,.des
Nitrogen Oyu des (as N)
n=g/L
82546
Water Level
Water Level, dstance from measuring point
ft
C0310
GODS - Conc.
BOO, 5-Dal 120 Deg. C) - Concentration
mgiL
C0530
TSS - Conc.
Solds. Total Suspended - Concentration
mg/L
C0600
Total Nitrogen - Conc.
Nitrogen, Total 'as hi - Concentration
mg1L
C0610
Ammonia - Conc.
tktrogen, Ammonia Total (as N, - Concentration
mgi L
C0665
Total Phosphorus � Conc.
Phosphorus, Total (as Pt -Concentration
mg/L
WQ39C
Plant AvavaUe Nitrogen
Part AvaJatie Nitrogen- Concentration
mg/L

-County.
Person
Did irrigation occur
at this facility?
a ■
Area (acres):
Area (acresh
Cove r C
Cover Crop,
..
Hourly Rate 7�in)�:
Hourly Rate (ill):
Hourly Rate (ill)::
Annual Rate
AnnLlal Rate (in)-
Annual Rate (in):
Field Irrigated?
■
■ ■
Field Irrigated?mmirm.mmml

FORM NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT AR -I Page 2 of 3
Did the application rates exceed the limits in Attachment B of your permit? i- comp-xant r Non•Cotrspk.ant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? r comyiant r fson-comg"n.,
Was a suitable vegetative cover maintained on all sites as specified in your permit? r- c0,70hant 1— rJon-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? F coftokant r tion-coma-,t
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? I--- comyant r- No-%-CDm,!ant
:F '"le is non -compliant, please explain in the space ceiove the reasorisi the facility •rjas not in compliance Provide in your eypianattcn t:s- dateis; ofthe non-compliance and describe the corrective
acticn(s; taken Attach addrtiona! sheets rf necessary
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Permittee:
Certification rfo.:
Signing Official:
Grade. Phone flumber:
Signing Official's Title:
Has the ORC changed since the previous 11DAR.1? r .es F ;to
Phone Number: Permit Exp.:
Signature Date
Signature Date
EY this signature. t ce-city that ihes report m wmur-ate an! c-n-Ct_te t::ht List =C my
i certify under penary of tow. that Mrs document ar-.0 all .sere prepared under my direGion or suer: isee il,
acco-dance v: rh a syste'f Ies gned', assure t`.ai of nuairoe: peessnne: prsperfy gathered and evacuated the Yiiornue,—
subrrged. Based un my rr.oury cf tts pttscn :r psrscn s inc ma :age the system. Of those persons directly responsible
for gathering it-e nfor.^ia: en. tht m%rmat.r. suer—c-e: s.:c ...e tes! of my 0owledge and beref. t-ue. accarate. a•:d
_o=,ete.: amaerare that !here are vynd an; perams fnr sut>mr:rg false mforination, i Ciudrng the possit"y sl fines a-=
r-�res�a-rrrt Y .a:rug^ :riafr ns.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

f FORM NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 3 of 3
Formulas
Volume Applied (gal ions)
Dail�•Loadrrzg (.irFches) = ,
z►ea;acres) x'7,152 gallons
acre inch
If Time Irrigated is < 60 minutes:
.'.tag:rr;umHo-Nr •Loading(inches)= Dali Loadbzrg(inches)
If Time Irrigated is 2 60 minutes:
DailyLoadin finches) minutes
iaxmium Hourly Loadfng (,inches) = 4 b0 l
TimeIrrigated kmr nuresr izotir- I
MorztizlS• Loading (iric?zes) = Szi»t of Dai2v Loading (inches)
12 ::IorztJz Floating Iota? (inches) = Szirrz of this 771011tlt's Atar:tlzi} Loadirytg +inches} and previous 11 rnonth's Xfozzthl ;•Loading (inches)
Weather Codes
Clear
Cloudy
C L
Partly Cloudy
PC
Rain
R
Sleet
SL
Snow
Sri