WQ0033804_Monitoring - 04-2020_20200529

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0033804
Facility Name: Laurel Mountain Retreat
County: Buncombe
Month: April
Year: 2020
Did irrigation
Field Name:
1A
Field Name:
1B
Field Name:
2
Field Name:
3
occur
Area (acres):
0.2
Area (acres):
0.19
Area (acres):
0.34
Area (acres):
0.45
at this facility?
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
M YES ❑ No
Hourly Rate (in):
0.2
Hourly Rate (in):
0.2
Hourly Rate (in):
0.2
Hourly Rate (in):
0.2
Annual Rate (in):
23.53
Annual Rate (in):
23.53
Annual Rate (in):
23.53
Annual Rate (in):
23.53
Weather
Freeboard
Field Irrigated?
❑ YES O NO
Field Irrigated?
❑ YES F11 No
Field Irrigated?
❑ YES O No
Field Irrigated?
❑ YES F11 NO
i
o
a
O
V
O
L
a�i
7
f6
O'
E
N
H
0
M
w
Q
.�
y
�
a
N
O
to
w
••
N M
u
T Q
tC M
Q
£ 2
a
O O.
9 Q
N
d r
E
H •i
i
T C
G p
J
7 -` C
L
E 3
•M 2 0
J
N
E.
3 a
O O'
% Q
Y
ET
~ "i
i
?` C
(a
O
J
7 �` C
L
E o
txC 2
J
E 2
a
O CL
% a
N
Y
E
~ "�
i
?' C
o
G C
J
7 �` C
L
E 3 0
.R 2 C
J
C� N
E.
_3 a
O Q
% Q
E
H •�
i
T
p p
J
L
� 2 0
J
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
CL
48
0.06
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
2
PC
60
0
7.5
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
3
C
75
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
5
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
6
1 PC
1 80
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
7
CL
77
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
8
CL
69
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
9
CL
65
0.06
7.5
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
10
PC
64
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
11
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
121
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
13
CL
67
3.75
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
14
C
70
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
15
C
58
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
16
C
60
0
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
17
C
70
0
1 0
0
0.00
0.00
0
1 0
0.00
1 0.00
0
1 0
0.00
0.00
0
0
0.00
0.00
181
1
1
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
19
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
20
PC
63
1
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
21
CL
64
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
22
C
64
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
23
CL
58
0.5
7.5
0
0
0.00
0.00
0
1 0
0.00
1 0.00
0
1 0
0.00
0.00 1
0
0
0.00
0.00
241
CL
65
0.25
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
25
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
26
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
27
C
70
0.13
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
28
PC
70
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
29
PC
70
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
301
CL
1 65
2.06
4.5
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
311
1
1
1
1
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
Monthly Loading:
0
0.00
0
0.00
1 1 1
0
` `
0.00
` '
0
0.00
` `
12 Month Floating Total (in):
` . `
` ".
0.00
` `
0.00
` `
` ` `
0.00
. ` `
0.00
` ` `

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I oflT
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?
2tompliant ❑ Non -Compliant
J'Compliant ❑ Non -Compliant
.Compliant
❑ Non -Compliant
Ld Compliant
❑ Non -Compliant
)1 Compliant
11 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 sheet% if nprv%%ary
Operator in Responsible Charge (ORC) Certification
- Permittee Certification
ORC: Robert Barr
Permittee:
Laurel Mountain Retreat
Certification No.: 24262 -
Sighing Official: Robert Barr
Grade: Sl Phone Number: 828-251-1900
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ yes ❑ No
Phone Number: 828-251-1900 Permit Exp.: 1/31/22
llpo_� -21-?A
5-2(-2v
Signature Date
Signature Date
By this signature, I certify that this report is aavrrate 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0033804
Facility Name: Laurel Mountain Retreat
County: Buncombe
Month: April
Year: 2020
Did irrigation
Field Name:
4
Field Name:
5
Field Name:
6
Field Name:
7
occur
Area (acres):
0.31
Area (acres):
0.33
Area (acres):
0.42
Area (acres):
0.38
at this facility?
Cover Crop:Cover
Crop:
p�
Cover Crop:
p�
Cover Crop:
p:
M YES ❑ NO
Hourly Rate (in):
0.2
Hourly Rate (in):
0.2
Hourly Rate (in):
0.2
Hourly Rate (in):
0.2
Annual Rate (in):
23.53
Annual Rate (in):
23.53
Annual Rate (in):
23.53
Annual Rate (in):
23.53
Weather
Freeboard
Field Irrigated?
❑ YES O NO
Field Irrigated?
❑ YES F11 NO
Field Irrigated?
F] YES ❑ No
Field Irrigated?
❑ YES El NO
i
o
a
O
V
O
M
a�i
7
f6
CL
E
N
H
0
M
w
Q
.�
y
a
N
O
to
w
••
N M
u
T Q
tC u
Q
£ N
a
O O.
9 Q
N
d r
E
H •i
i
T C
G p
J
7 -` C
L
E 3
•R 2 0
J
N
E.
3 a
O O'
% Q
Y
ET
H "i
i
?` C
(a
O
J
7 �` C
L
E o
txC 2
J
E d
a
O O'
9 Q
N
Y
E
P "�
i
?' C
o
G C
J
7 �` C
L
E 3 0
.R 2 C
J
E. N
_3 a
O Q
% Q
E
H •�
i
C
T
a
p p
J
L
E_ a
� 2 0
J
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
CL
48
0.06
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
2
PC
60
0
7.5
0
0
0.00
0.00
0
0
0.00
0.00
1,070
65.644
0.09
0.09
0
0
0.00
0.00
3
C
75
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
4
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
5
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
6
1 PC
1 80
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
7
CL
77
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
8
CL
69
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
9
CL
65
0.06
7.5
0
0
0.00
0.00
0
0
0.00
0.00
1,150
70.552
0.10
0.09
0
0
0.00
0.00
10
PC
64
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
11
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
121
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
13
CL
67
3.75
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
14
C
70
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
15
C
58
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
16
C
60
0
4
0
0
0.00
0.00
0
0
0.00
0.00
1,990
122.09
0.17
0.09
0
0
0.00
0.00
17
C
70
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
181
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
19
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
20
PC
63
1
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
21
CL
64
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
22
C
64
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
23
CL
58
0.5
7.5
0
0
0.00
0.00
0
0
0.00
0.00
1,900
116.56
0.17
0.09
0
0
0.00
0.00
241
CL
65
0.25
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
25
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
26
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
27
C
70
0.13
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
28
PC
70
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
29
PC
70
0
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
301
CL
65
2.06
7.5
0
0
0.00
0.00
0
0
0.00
0.00
1,390
85.276
0.12
0.09
0
0
0.00
0.00
311
1
1
1
1
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
0
0
0.00
0.00
Monthly Loading:
0
0.00
0
0.00
7,500
' ` `
0.66
' ` '
0
0.00
` `
12 Month Floating Total (in):
` , `
` ".
0.00
` `
` `
0.00
` `
` ` `
13.21
` ` `
0.00
` ` `

FORM: NDAR-1 05-16
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page -2, of C_
Did the application rates exceed the limits in Attachment B of your permit?
❑2ompliant ❑Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
17.compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
❑mpliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
J?6mpliant
❑ Compliant
❑ Non -Compliant
lithe facility is non -compliant, please explain in the space below the reason(s) the facilitywas not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
acuontar mneu. Aiiduh auuuionai sheets If necessary.
Operator in Responsible Charge ORC) Certification
-Permittee.Certification
ORC: Robert Barr - . - - ..
Permittee:
Laurel Mountain Retreat
Certification No.: 24262 -
Signing Official: Robert Barr
Grade: SI Phone. Number: 828-251-1900
Signing Official's Title: Signatory -
Has the ORC changed since the previous NDAR-1? ❑ yes ❑ No
Phone Number: 828-251-1900 - Permit Exp.: 1/31/22
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 acmrdance
with a system designed to assure that all qualified personnel properly gathered and evaluated the immrnation 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0033804
Facility Name: Laurel Mountain Retreat
County: Buncombe
Month: April
Year: 2020
Did irrigation
Field Name:
8
Field Name:
Field Name:
Field Name:
occur
Area (acres):
0.44
Area (acres):
Area (acres):
Area (acres):
at this facility?
Cover Crop:Cover
Crop:
p�
Cover Crop:
p�
Cover Crop:
p:
[,d YES ❑ NO
Hourly Rate (in):
0.2
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Annual Rate (in):
23.53
Annual Rate (in):
Annual Rate (in):
Annual Rate (in):
Weather
Freeboard
Field Irrigated?
❑ YES O NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YES ❑ NO
-Wa
O
m
W
0
d
°
r
L
a
m
O
i
v
m °7
a
Q
O .
>
0
Q��__j
E
7
K O
E d
�
_fl
>
E
_
7 C
�E
KO
�
E N
O
>
6
��__j
E
7
K p 6
E d
>a
EU
_
7 TLw
aa
E7�
�E
X p rn0Q
_�
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
CL
48
0.06
0
0
0.00
0.00
2
PC
60
0
7.5
0
0
0.00
0.00
3
C
75
0
0
0
0.00
0.00
4
0
0
0.00
0.00
5
0
0
0.00
0.00
6
1 PC
1 80
0
0
0
0.00
0.00
7
CL
77
0
0
0
0.00
0.00
8
CL
69
0
0
0
0.00
0.00
9
CL
65
0.06
7.5
0
0
0.00
0.00
10
PC
64
0
0
0
0.00
0.00
11
0
0
0.00
0.00
121
0
0
0.00
0.00
13
CL
67
3.75
0
0
0.00
0.00
14
C
70
0
0
0
0.00
0.00
15
C
58
0
0
0
0.00
0.00
16
C
60
0
4
0
0
0.00
0.00
17
C
70
0
0
0
0.00
0.00
181
0
0
0.00
0.00
19
0
0
0.00
0.00
20
PC
63
1
0
0
0.00
0.00
21
CL
64
0
0
0
0.00
1 0.00
22
C
64
0
0
0
0.00
0.00
23
CL
58
0.5
7.5
0
0
0.00
0.00
241
CL
65
0.25
0
0
0.00
0.00
25
0
0
0.00
0.00
26
0
1 0
0.00
0.00
27
C
70
0.13
0
0
0.00
0.00
28
PC
70
0
0
0
0.00
0.00
29
PC
70
0
0
0
0.00
0.00
301
CL
65
2.06
4.5
0
0
0.00
0.00
311
1
1
1
1
0
0
0.00
0.00
Monthly Loading:
0
0.00
0
0.00
0
0.00
0
0.00
12 Month Floating Total (in):
0.00

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 3 of T
Did the application rates exceed the limits in Attachment B of your permit?
B 'Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
mpliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
rrc mpliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
fl c Iiant 0 Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
/0 cy npliant ❑ 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
Pennittee Certification
ORC: Robert Barr
Perri
-
Laurel Mountain Retreat
Certification h1m: 24262
Signing Official: Robert Barr
Grade: SI Phone Number: 828-251-1900
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ yes 0 No
Phone Number: 828-251-1900 Permit Exp.: 1/31/22
y^ U_�D —
V�t� t_2�z
Signature Date
Signature Date
By this signature, I certify that this report is accurnme 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
penal ies for submitting false information, including the possibility of fines 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

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: WQ0033804
Facility Name: Laurel Mountain Retreat
County: Buncombe
Month: April
Year: 2020
PPI: 001
Flow Measuring Point: ❑ Influent El Effluent El No flow generated
Parameter Monitoring Point: El Influent EZ Effluent ❑Groundwater Lowering El Surface Water
Parameter Code 0
50050
00310
31616
00610
00625
00620
00600
00400
00665
00530
00076
'C y
U
O
O
H N
O
°
ui
E
i
L
U
R
C
L
-a
41
Y0
o
ate+
Z
N
Z
a
y
p
o0
t
aN
M U)
rm N
H
24-hr
hrs
GPD
mg/L
#/100 mL
mg/L
mg/L
mg/L
mg/L
su
mg/L
mg/L
NTU
1
282
1.3
2
11:45
0.25
282
7.6
1.4
3
153
1.4
4
153
1.5
5
153
1.4
6
153
1.4
7
153
1.3
8
153
1.4
9
13:20
0.42
153
7.5
1.3
10
284
1.3
11
284
1.3
12
284
1.4
131
284
1.3
14
284
1.3
15
284
1.4
16
13:55
0.42
284
7.3
1.4
17
271
1.3
18
271
1.3
191
271
1.5
20
271
1.5
21
271
1.4
22
271
1.8
23
12:10
0.42
271
7.4
2.1
24
199
2
251
199
2
26
199
2
27
199
1.8
28
199
1.7
29
199
1.6
30
13:00
0.42
199
7
1.2
31
Average:
230
1.50
Daily Maximum:
284
7.60
2.10
Daily Minimum:
153
7.00
1.20
Sampling Type:
Calculated
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Recorder
Monthly Limit:
See Permit
10
14
4
5
Daily Limit:
15
25
6
6-9
10
10
Sample Frequency:
Monthly
4 X Year
4 X Year
4 X Year
4 X Year
4 X Year
4 X Year
Weekly
4 X Year
4 X Year
Continuous

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page _,�- of
Sampling Person(s) 11 � Certified Laboratories
Name: Robert Barr Name: Pace Analytical, Inc.
Name:. Kevin Bryan Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 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
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Robert Barr
Permittee: Laurel Mountain Retreat
Certification No.: 24262 _
Signing Official: Robert Barr
Grade: SI Phone Number: 828-251-1900
Signing Official's Title: Signatory
Has the ORC changed since the previous NDMR?. ❑ yes ❑ No
Phone Number: 828-251-1900 Permit Expiration: 1/31/2022
Signature Date
Signature Date
By this signature, I certify that this report is accurrale and complete to the best of my knowledge.
I 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 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617