WQ0009098_Monitoring - 04-2020_20200603

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR)
Permit No. Facility Name: County:
PPI: A I Flow Measuring Point: ❑ influent ❑ Effluent o flow generated Parameter Monitoring Point
Month:
❑ Influent ❑ Effluent
Page A, of z
Groundwater Lowerinq [, Surf
Parameter Code 0
50050
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24-hr
hrs
GPD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
911
20
21
22
23
24
25
26
27
28
29
30
31

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) II Certified Laboratories
Name: 11 Name:
Name: 11 Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ Compliant ❑ Non -Co
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 coi
action(s) taken. Attach additional sheets if necessary.
�lc�
�isc��
Operator in Responsible Charge (ORC) Certification
ORC: —4?.OLAo UkIvI1 lICLV\
Certification No.: , gOL03
Grade: C Phone Number: �� —(0 �� aq
Has the ORC changed since the previous NDMR? ` ❑ Yes` U/No
I Signature 1 Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge
Permittee Certification
Permittee:
Signing Official: o.,�i,e-5-,A mea-wip—Mi 16v)
Signing Official's Title: W (At A ts4i-tt%
Phone Number: CAL q _33a- a.;R(*
Signature
Per it Eation:
'ration:
*Da
I 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 submilt-
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
00
40
Facility Name:
County:
Did irrigation
Area (acres
Area (acres):
Area (acres):
at this facility?
Cover Crop:!
YES V/NO
Hourly -.
-.
-.Hourly
-.
Annual Rate (in):
Annual Rate (in):
Annual Rate (in):
L Field Irrigated?:
:.
MMI
rE
■rimR
®___-_-

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? U/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? V Compliant ❑ Non-Compli
Were all setbacks listed in your permit maintained for every application to each permitted site? V Compliant ❑ Non-Compli
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? Compliant ❑ Nan-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.
Flo
Operator in Responsible Charge (ORC) Certification
Rav\1�DY111"N
Certification No.: t 4 6102)
Grade: S: Phone Number:
�..�
Has the ORC changed since the previous NDAR-1? ❑ Yes ED/N.
V Signature
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: ",5,uW\e,4) fcx* (`y
Signing Official:
Signing Official's Title:Y • 1 1J ��G`�4t"
Phone Number:gL _,3%a_9a[Yv Permit 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