WQ0018857_Monitoring - 02-2020_20200406

FORM: NDAR-1 10-13
NON -DISCHARGE APPUCA 1 ioN REPORT (NDAR-i
Page of /
Permit No.LU
Facility Name: e�
County:
Month. z/
Year: 7n i
O�Y
Did irrigation occur
Field Name:
"
Field Name:
Field me.
Field Name:
this facility?
Area (acres):
Area (acres):
Area (acres).,
Area (acres):
at
Cover Erop ,
Cover Crop:
Cover Crop
Cover Crop:
❑ YES NO
Hourly Rate (m)a
HourlyRate(in):Hou
Rate to `
Hourly Rate m
Y ( )-
Annual Rate (in)
_
Annual Rate (in):
Anrivaftafex(�nj
' `�
Annual Rate (in):
Weather Freeboard
Field Irngated�
,❑ YES ❑ N�
Field Irrigated?
E]YES E]NO
Fie ng 3ec?
❑ rE5—
Field Irrigated?
❑YES ❑ No
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NUN -DISCHARGE APPLICATION REPORT (NDAR-1)
�_rld the application rates exceed the limits in Attachment B of your permit?
Page I of C
Compliant ij Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑ Compliant ❑ Non -compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Compliant E] Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? p Compliant ❑ Nw,-compria,t
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ compliant ❑ Non[.ompfiant
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: L
Permittee:
Certification No.: Signing Official:
Grade: J ( Phone Number a f l ` �� - �z� Signing Official's Title:
Has the ORC changed since the previous NDAR-1? Elyes f5�'No Phone Number: Permit Ex 1" p.:
r / i
Signature Date
Signature Date
By this signature, 1 certify that this report is accurrate and complete to the best of my knowledge. 1 certify, under penally of law, that this document and all attachments were prepared under my daection or supervision in accordance
with a system designed to assure that an quaGried 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617