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Home My WebLink AboutWQ0024577_Monitoring - 03-2020_20200506Facility Name: Sutton's Rest Home county: Wayne ::j PPI: 001 OEM p , . r ,, IZIX0 ©�swh" a WAM-Iwzgm o��MMM n �rr-MM Fj �� m A i Mrs POME EIVI A a'L.L /I slr�{�r' A EEI m WZANr.7 m��M m��M ® ro f►". - r s FORM: NDMR 07-13 Sampling Person(s) Name: Name: NON -DISCHARGE MONITORING REPORT (NDMR) Name: /U'l�pi- c,'/ iL'ir.' i Name: Certified Laboratories 624.,C? Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Page _L of I— ❑ 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 inResponsibleCharge (ORC) Certification Permittee Certification ORC:�+� �!�.� :J Permittee: If �rg, 1 �u,,Z Certification No.: �*qD :3 Signing Official: Grade: r} , Phone Number: +�C " 7,56' Signing Official's Title: Has the ORC changed since the previous NDMR? ❑ Yes 0No Phone Number: %CQ7� l` Permit Expiration: 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, 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 _NON DISCHARGE APPUCATION REPORT Page of SPRAY IRRIGATION SITE(S) PERMtT NUMBER: S�4"7 TOTAL NUMBER OF FIELDS: _ _ MONTH: FACILITY NAME YEAR: A Ile CLASS: -C�COUNTY: Formulas ` Daily taadinz (inches) _ (Volume Applied (gallons) x 0.1336 (cubic feetfgatlonl x 12 (inchesdoot)j I (Arm Sprayed (acrrsl x 43S6D (sr(oart fect/acre)] Ma"imnm iioudy t,md$4 (Inches) - Daily Loading (itches) I rr=C irrigated (minutes) 160 (mmumsibouril 32 Month Floating Taal (inches) =Sum of this rnootWs Momh1 Loading Monthly Caadint {itu hes) = Sum of Daily Loadings (inches) f g (inches) and prc• Taus t i awaWs Jtomhly Loadings (incbrs) Awe Wecict� LO'�L (inches) _ [xtomhly (daring (i�es/awn b) I Number of days in the aAn& (dasshnomLu: ] tda—A—t-, - --- - _ '_. -- ,..,.....�. --,—V. nndnr, Z9:-6it044, J4-Slti9t OPERATOR IN RESPONSIBLE CHARGE (ORC) l Z7 d GRADE L /� y.�, CHECK BOX IF ORC HAS CHANGED ❑ � PIi0NE7 443', I MMatl ORIGINAL and TWO COPIES to: ATTN- COMPLIANCE GROUP DIV. OF ENVIRONMENTAL MGT. I liEtityR (P.O. BOX 29535 1 RAI )=)fU4 NC- 97f,?fi-535 X OPERATOR IN RESPONSIBLE CI�ARG� -- I ATTIRE, I CERTIFY THAT THIS REPORT- IS ACCURA t rrr AND COMPLETE TO THE BEST OF MY KNOWLEDGE. M_ y Please indicate (by checking the appropriate box) whether the facility has been compliant or non -comp -Han with the following permit requirements: (Note_ If a requirement does not apply to your facility put (NA) in the compliant box) non- compliant complia L The application rate(s) did not exceed the limit(s) specified in the permit_ Q, ❑ 2. Adequate measures were taken to prevent wastewater runoff from the site(s). Lin ❑ 3. A suitable vegetative cover was maintained on the site(s) in accordance with Q� ❑ the permit. 4. All buffer zones as specified in the permit were maintained during each application. S. The freeboard in the treatment and/or storage lagoon(s) was not less than the [✓Y ❑ limit(s) specified in the permit. If the facility is non -compliant. please explain in the space below thereason(s) the facility was not in compliance wit] permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attz additional sheets if necessary_ 'I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervisi accordance with a system designed to assure that qualified personnel properly gathered and evaluated the info ma lIhMITIP4 I3a.5ed on Inv inn-airy of the vurson or perSO11S who manage the svaem, or Lhose Der -Sons directly .,..-.,1l1..l7tii �tG .:111:c e..Gi1:..._ .a:. ... '.1:....2L•S_ �l: L'._-.. �'! _il. tL _! _ °'•___•�_=�LY�__i�� iL•a! J�:i�G. _._-. _�_�i ___ ... /1 (... �t.�..._ _ ��. L' �•.2':..............: L. ...._....'..=_...=1..Cii .-_•j{ISS��Z SL_ J�2:Gi�ti=_ �:L-�S�i_�3_!S l�.. _ _�______^ il! Jf::'_l._____.. .._ If sg-.aed by Other. Lh.--- the peermifttee' dee ador.a be 1'11e With the State S- rP- 1CIi� ^ Cv FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) p 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? Page y of I ,�/ pliant ElNon-Compliant CJ Compliant ❑ Non -Compliant Was a suitable vegetative cover maintained on all sites as specified in your permit? OSmpliant ❑ Non -Compliant Were all setbacks listed in your permit maintained for every application to each permitted site? Compliant ❑ Non -Compliant Were all freeboards maintained in accordance with the specified freeboard heights in 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 action(s) taken. Attach additional sheets if necessary. Operator in Responsible Charge (ORC) Certification ORC: l Certification No.: �ti �4 � Grade: F _ . Phone Number: Has the ORC changed since the previous NDAR-1? If%G` ❑, 21C �aG , e)4 1:7— v4r Signature Date By this signature, I certify that this report is accw rate and complete to the hest of my knowledge. Permittee Certification Signing Official: C '" Signing Official's Title: Phone Number: (qtq 7 ' y`a `Permit Ex _,�;�-; 6) � p.: 46 - )070 V Signature Date 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. 1 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 /r��'