WQ0009098_Monitoring - 03-2020_20200511

grORK NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _t-- of
Permit No. Facility Name: County: Month:
PPI_ A I Flow Measurina Point: Influent n Effluent No Flow generated Parameter Monitoring Point: ❑ Influent Effluent ❑ Groundwater Lowering Surf
Parameter Code
50050
M
m
Q E
U~
O
c
O
E (D
1
V c
O
3
_O
LL
24-hr
hrs
GPD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
181-
19
20
2
21
22
23
24
25
26
27
29
30
L3128

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of '
Sampling Person(s) Certified Laboratories
Name: 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 col
action(s) taken. Attach additional sheets if necessary.
NA uIL,36,4er
asc, r 6 T_nrkv
t,AJlt?'CS�s-jeM
Operator in Responsible Charge (ORC) Certification
l
ORC
� f. /I 1 M(.1t"1{ l{ Lv 1
Certification No.: ( �.1 A O3
Grade: S Phone Number: 1 `q --�& —�5Q q
Has the ORC changed since the previous NDMR? ` ❑ yes `
V Signature
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: c J� t5 �f✓�l-��l�
Signing Official:,F�W`Il`e, G11�1QS-111�C����Ciyl
Signing Official's Title:�rj/�
Phone Number:q t((_Permit Ex iration:
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 submitb
ny 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

F-ORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
• irrigation occur,--
at this facility?
■YES V•
Field Name:
. -
Area (acres):,
Area (acres):
Area (acres).
..Cover
Crop:'Crop:
Hourly '.
'.
'.
Rate (in):
Annual Rate (in):
Field Irrigated?
Monthly Loading:Annual
�-
Month Floating Total (in):�j
Field Name:
Area (acres):
Cover Crop:
Hourly Rate (in):
Annual Rate (in):
Field Irrigated? ❑ YES
N
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a
Q
O
E @
P p
0
min I in

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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?
Page
of
V/compliant
[] Non-Compli
Compliant
Non-Compli
U/Compliant
n Non-Compli
Compliant [] Non-Compli
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
ORC M' m i 611a• 1
Certification No.: 1 C., Ylo�)
Grade: �51 '_T_ Phone Number: � 1q —(Ogrn
Has the ORC changed since the previous NDAR--1? El YIN.
Signature
By this signature, I certify that this report is accurrate and complete to the best of my knowledge
Permittee Certification
Permittee: J Cv► •0.w�� `mil W,6TcE.�('` ii'lrJ1 �l
Signing Official:
Signing Official's Title: �i
Phone Number: Qlt(���2"1,�"'1Li( )f„ Permit Exp.:
s 12>1 O-D_
M&M6 aqW
Signature D2
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