WQ0009098_Monitoring - 02-2020_20200401

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR)
Permit No.:U1 Facility Name: '� County: (I t
PPi: X I Flow Measurina Point: n Influent n Effluent FyNo flow generated Parameter Monitoring Point:
I Month:l
Influent n Effluent n Grou
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Parameter Code - P
60060
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19
20
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22
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23
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25
26
27
28
29
30
31

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) 11 Certified Laboratories
Name: 11 Name:
Name: II Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ Compliant ❑ Non -Cc
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 cot
action(s) taken. Attach additional sheets if necessary.
�o Loa!�&OCL�'ec
'%S6,��c�ea Sv+o
UJ uO'TF S�s+enn
Operator in Responsible Charge (ORC) Certification
AV, M11 lem
Certification No.:' LA (� !.J 3
Grade: 1 Phone Number: •- b . 15CH
Has the ORC-1chhanged since the previous NDMR? ❑ Yes VNo 1
Signature f
By this signature, I certify that this report is accurrate and complete to the best of my knowledge
Permittee Certification
Permittee: �d�� �w1li� ,hCTarl'It1
Signing Official:- �ktlll'1CS`i��llj!",
Signing Official's Title: •�` �` _ i��
Phone Number: �lq Permit Expiration:
J_+L'Z� 5
Signature �*Da
certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitti
my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the in
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violat
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page � of SQL
County:�
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Area (acres)::"",
Area (acres):
Area (acres):
Area (acres)-:
at this facility?
Cover Crop:
L Cover Crop: I
El YES Tj •
Hourly Rate (in):'
Hourly Rate (in):;
Hourly Rate (in)::
Hourly Rate (in):
Annual Rate (in):
Annual Rate (in):
L Annual Rate (in):
:
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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? ❑ Compliant ❑ Non-Compli
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑ Compliant ❑ Non-Compli
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑ Compliant ❑ Non-Compli
Were all setbacks listed in your permit maintained for every application to each permitted site? ❑ Compliant ❑ Non-Compli
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ Compliant ❑ Non-Compli
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 cor
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
ORCrP,C,Lj_ me, 0A
Certification No.: i i� 0?)
Grade: 5-1— Phone Number: %q _,ram 5�q
Has the ORC changed since the previous NDAR-1? `�_11❑] Yes l Vo
I Signature 1
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:
Signing Official:
w 2 xmes _J&MAla,,
Signing Official's Title:ZA
PA tV sirc4or
Phone Number:( 7 Perrttit Ex .:
Signature
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. E
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the inform
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violation
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617