WQ0018857_Monitoring - 04-2020_20200609

Permit
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Did irrigation occur
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Field Name -
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Are a J[acr�j
Area (acres):
Area (acre s):'
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Crop:..
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El YES! NO
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Annual Rate (in):,
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Irrigated?
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NUN -DISCHARGE APPLICATION REPORT (NDAR-1)
1_-id the application rates exceed the limits in Attachment B of your permit?
Page _L of C
Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
❑ Compliant ❑Non{ompliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
❑ Compliant ❑Non{ompGant
Were all setbacks listed in your permit maintained for every application to each permitted site?
❑ Compliant ❑ NorrCompfiant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
❑ Compliant ❑Non{ompliant
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
L
ORC: '
Permittee:
Certification No.:
Signing Official:
Grade: d ` Phone Number.�,1' ��-�Z�
Signing Official's Title:
Has the ORC changed since the previous NDAR-1? ❑ yg lid''No Phone Number:
%" Permit Exp.:
Signature Date
Signature Date
By this signature. 1 certify that this report is accurate and complete to the best of my knowledge.
I certify, under penalty of law that this document and all attachments were prepared wider my direction or supervision in accordance
with a system designed to assure that al qualified 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 responskile for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that Uwe are significant
penalties for submitting false information, mduding the possitAity of fines and imprisonment for knowkg violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1647