WQ0028693_Monitoring - 03-2020_20200430

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page
I of (0
Permit No.:
WQ0028693
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: March
Year:
2020
Did irrigation occur
'; t i' „i rt) '��
Field Name:
02
Field Name:
04
le_
Area (acres):
4.35
Area (acres):
4.26
at this facility?
Cover Crop:
Bluegrass/Bentgras
Cover Crop:
Bluegrass/Bentgras:
0 YES
❑ NO
Hourly Rate (in):
0.15
Hourly Rate (in):
0.15
Annual Rate (in):
18.2
Annual Rate (in):
18.2
Weather
Freeboard
1
Field Irrigated?
0 YES
❑ NO
Field Irrigated?
El YES
E NO
m
O
m
0
m
C
�` C
T
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44
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8
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0
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0.00
0
0
0.00
0.00
Monthly
Loading:
64,800
0.55
0
0.00
12 Month Floating Total (in):
6.69
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page —L of 10
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?
El Compliant ❑ Non -Compliant
Q+ Compliant ❑ Non -Compliant
0 Compliant ❑ Non -Compliant
21 Compliant ❑ Non -Compliant
O 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
rancu. rumen euwuunai sneers If necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
Permittee:
Mountaintop Golf 8r Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ yes El No
Phone Number: [phone] Permit Exp.: 8/31/19
r(A� 4 a
vvk^
Signature Date
Signature Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
certify, under penally 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 qualifted 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 fines and imprisonment for knovdng violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page 2 of 1,0
Permit No.:
W00028693
Facility Name:
Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: March
Year:
2020
Field Name:
06
Field Name:
08
Did irrigation occur
Area (acres):
3.95
Area (acres):
2.31
at this facility?
Cover Crop:
Bluegrass/Bentgras
Cover Crop:
Bluegrass/Bentgras:
0 YES
❑ NO
', t „
)' ci 'ug �{� _
Hourly Rate (in):
0.15
Hourly Rate (in):
0.15
Annual Rate (in):
18.2
Annual Rate (in):
18.2
Weather
Freeboard
�
a Md,
�"t, + +,; I �
Field Irrigated?
❑ YES
O NO
Field Irrigated?
DYES
p NO
N
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44
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Monthly
Loading:
0
0.00
0
0.00
12 Month Floating Total (in):
0.00
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page 2, of Is
Did the application rates exceed the limits in Attachment B of your permit?
0 Compliant ❑ Nan -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
71 Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
O Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
0 Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
O Compliant ❑ Nan -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: Michael Beck
Permittee:
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? 11 yes 21 No
Phone Number: [phone] Permit Exp.: 8131/19
-�- -asr-Z
G-
Signature Date
Signature Date
By this signature, I certify that this report is accurrale and complete to the best of my knowledge.
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 passibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page 3
ofto
Permit No.:
WQ0028693
Facility Name:
Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: March
Year:
2020
Field Name:
10
Field Name:
12
Did irrigation occurIs
Area (acres):
2.22
Area (acres):
3.88
at this facility?
Cover Crop:
Biuegrass/Bentgras
Cover Crop:
Bluegrass/Bentgras:
O YES
LINO
Hourly Rate (in):
0.15
Hourly Rate (in):
0.15
Annual Rate (in):
18.2
Annual Rate (in):
18.2
Weather
FreeboardField
Irrigated?
❑ YES
ONO
Field Irrigated?
❑ YES
ONO
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8
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0
0
0.00
0.00
0
0
0.00
0.00
Monthly
Loading:
0
0.00
0
0.00
12 Month Floating Total (in):
0.00
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 3 of 1 -0
Did the application rates exceed the limits in Attachment B of your permit? o Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? lol Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? o Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? o Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? O 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
Luvutay mnen. nuaun auumunai sneers Ir necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
Permittee:
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? yes 0 No
Phone Number: [phone] Permit Exp.: 8131/19
4 -;?S -ate
P/Z&�
#zp/,
Signature Date
Signature Date
By this signature, I certify, that this report is accumme 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 fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 276994617

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page ¢ of dc>
Permit No.:
WQ0028693
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: March
Year:
2020
(
Field Name:
14
Field Name:
16
Did irrigation occur
p
Area (acres):
2.81
Area (acres):
1.76
at this facility?'
t
Cover Crop:
BluegrasslBentgras
Cover Crop:
Bluegrass/Bentgras!
R YES
❑ NO
Hourly Rate (in):
0.15
Hourly Rate (in):
0.15
Annual Rate (in):
18.2
Annual Rate (in):
18.2
Weather
Freeboard
Field Irrigated?
F1 YES
0 NO
Field Irrigated?
❑ YES
0 NO
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Monthly Loading:
0
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12 Month Floating Total (in):
0.00
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page ¢ of)-0
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?
O Compliant ❑ Non -Compliant
0 Compliant ❑ Non -Compliant
0 Compliant ❑ Non -Compliant
0 Compliant ❑ Non -Compliant
0 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
aCrUU11ka) mnorr. muaui aumnunar sneezes n necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
Permittee:
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
signing Official . Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ yes 0 No
Phone Number: [phone] Permit Exp.: 8/31/19
-
¢ 2p^?j
Signature Date
Signature Date
By this signature, I certify that this report is ac ximate 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11
Permit No.: W00028693
Did irrigation occur
at this facility?
0 YES ❑ NO
Weather
freeboard
m
0
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t
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PC 1 48 1 0 1 5 1 21
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Facility Name: Mountaintop Golf & Lake Club WWTF I County: Jackson
a
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100
Page
5'of 10
Month: March
Year: 2020
Field Name:
20
Area (acres):
3.96
Cover Crop:
Bluegrass/Bentgras:
Hourly Rate (in):
0.15
Annual Rate (in):
18.2
Field Irrigated?
0 YES p NO
E N
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page -(;7 of
Did the application rates exceed the limits in Attachment B of your permit?
21 Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Q Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
21 Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
O Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
21 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
action(s) taken. Attach additional sheets if ner•.essary
the non-compliance and
describe the corrective
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
Permittee:
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
signing Official: Robert Barr
Grade: Si WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? p yes 0 No
Phone Number: [phone] Permit Exp.: 8/31119
Signature Date
Signature Date
By this signature, I certify that this report is accumate and complete to the best of my knowledge.
1 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 fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

b
rb
FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION
REPORT (NDAR-11)
Page
of
Permit No.: W00028693
FacilityName:
Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: March
Year:
2020
Field Name:
22
Field Name:
24
Did irrigation occ1,rd
Area (acres):
5.49
Area (acres):
3.81
at this facility?
:over Crop:
Bluegrass/Bentgras
Cover Crop: Bluegrass/Bentgras:
21 YES ❑ No
Hourly Rate (in):
0.15
Hourly Rate (in):
0.15
Annual Rate (in):
18.2
Annual Rate (in):
18.2
Weather
Freeb
Field Irrigated?
El YES
17 No
Field Irrigated?
❑ YES
O No
y
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page V of 0
Did the application rates exceed the limits in Attachment B of your permit?
21 Compliant ❑ NowCompliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
o Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
M Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
I7 Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
O 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: Michael Beck -
Permittee:
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade:. SI WWIV Phone Number: ,[phone] _
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ Yes 0 No
Phone Number: [phone] Permit Exp.: 8/31/19
r %�•eSiS•a�A
1 "t
Signature Date
Signature Date
By this signature, I certify that this report is accuirate 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 fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

7
FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION
REPORT (NDAR-1)
Page
ofia
Permit No.:
WQ0028693
Facility Name:
Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: March
Year:
2020
Field Name:
26
Field Name:
28
Did irrigation occur
Area {acres):.
4.05
Area (acres):
2.28
at this facility?
Cover Crop:
Bluegrass/Bentgras
Cover Crop:
Bluegrass/Bentgras
Hourly Rate (in):
0.15
Hourly Rate (in):
0.15
0 YES
❑ No
Annual Rate (in):
18.2
Annual Rate (in):
18.2
Weather
Freeboard
Field Irrigated?
L] YES
p No
Field Irrigated?
0 YES
O No
°
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0.00
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0
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PC
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0
0
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0.00
0
0
0.00
0.00
CL
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0
7
18
0
0
0.00
0.00
0
0
0.00
0.00
CL
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0.1
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0
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2 C
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0
7
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0
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0.00
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3 - R
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s
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0
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0.00
0.00
3 CL
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0.1
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0
0
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0
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0.00
0.00
r CL
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0.9
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0
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- _,
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0
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PC
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0
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0
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3 R
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0
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0.00
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0.00
0.00
t CL
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0.1
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21.5
0
0
0.00
0.00
0
0
0.00
0.00
5 C
48
1.1
6
21.5
0
0
0.00
0.00
0
0
0.00
0.00
5 PC
46
0
6
21.5
0
0
0.00
0.00
0
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0.00
0.00
7 C
54
0
5
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0
0
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0.00
0
0
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0.00
3
0
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0.00
0.00
0
0
0.00
0.00
9
0
0
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0
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D PC
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0
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-
0
0
0.00
0.00
0
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0.00
0.00
t CL
42
0
8
21
-
0
0
0.00
0.00
0
0
0.00
0.00
Monthly
Loading:
0
0.00
0
0.00
12 Month Floating Total (in):
0.00
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page 7 of I -o
Did the application rates exceed the limits in Attachment B of your permit?
M Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
o Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
o Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
O Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
o 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: Michael Beck
Permittee:
Mountaintop Golf &Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? p yes El No
Phone Number: [phone] Permit Exp.: 8/31/19
'AS-'�
0A)vli,,
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 pmpedy 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

a
Co
FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION
REPORT (NDAR-1)
Page
of
Permit No.: W00028693
FacilityName:
Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: March
Year:
2020
Field Name:
30
Field Name:
32
Did irrigation OCCUR
Area (acres):
5.34
Area (acres):
4.8
at this facility?
Cover Crop:
Bluegrass/Bentgras
Cover Crop:
Bluegrass/Bentgras.O
YES ❑NO
Hourly Rate (in):
0.15
Hourly Rate (in):
0.15
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-t) Page D ofPa
Did the application rates exceed the limits in Attachment B of your permit?
0 Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
o Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
O Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
o Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
O 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: Michael Beck
Permlttee:
Mountaintop Golf & Lake Club _
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr'
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed the previous NDAR-1? ❑ Yes 21 No
Phone Number: [phone]. Permit Exp.: 8/31/19
/since
Signature_ Date
Signature Date
By this signature, I certify that this report is accurate 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 knowedge 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page f of to

FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR)
Page! of f-D
Sampling Persons) Certified Laboratories
Name: Michael Beck Name: Environmental Testing Solutions, Inc
Name: Name: Prisim Laboratories, Inc
wes an monitoring aria and sampling frequencies meet the requirements in Attachment A of your permit? ._ :ompliant 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
aouurgs) raven. rlaacn additional sneers if necessary.
On 3-17 the daily TSS limit was exceeded by 2 mg/l. The plant was resampled.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
Permittee: Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changedsince the previous NDMR? ❑ yes O No
Phone Number: [phone] Permit Expiration: 8/31/201^'9
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, hue, 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NOMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page L of J

FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page L of / z
Sampling Person(s) II Certified Laboratories
Name: Michael Beck I Name: Environmental Testing Solutions, Inc
Name: Name: Prisim Laboratories, Inc
WWVV 411 Illvmborrng taaza ano sampling Trequencies meet the requirements in Attachment A of your permit? ❑ 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
3-17 the
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
Permittee: Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV: Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDMR? _ ❑ Yes O No.
Phone Number: [phone] Permit Expiration: 8/31/2019
' r.P 4. -aa-ate
4=2k-2__.)
Signature Date
Signature Date
By this signature, I certify that this report is accumate and complete to the best of my knowledge.
I cer fhy, 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 imormation, 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617