WQ0028693_Monitoring - 05-2020_20200824

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0028693
Name of Facility:*
Month:* May
Report Information
Mountain Top Golf & Lake Club
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Year:* 2020
Upload Document*
WQ0028693.pdf
FDF Only
Please upload only one combined pdf document. Upload GW-59 individually.
Confirmation Email Address:* [e-mail]
Name of Submitter:* Kimber Reese
Signature:*
Date of submittal: 8/24/2020
This will be filled in &Aorratically
Initial Review
Reviewer: Williams, Kendall
Is the project number correct?* WQ0028693
8.17MB

Is the monitoring report r Yes r No
accepted?*
Regional Office* Asheville
Accepted Date: 8/24/2020

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page 1
of I'
Permit No.:
WQ0028693
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson Month:
May
Year:
2020
Did irrigation occur
q
d,.i 3 1.�iYtl I f' �M��� L b �,�. � �
��
Field Name:
02
�
®®
Field Name:
04
Area (acres);
4.35
Area (acres):
4.26
at this facility?
Cover Crop:
Bluegrass/Bentgras
Cover Crop:
Bluegrass/Bentgrass
El YES
❑ NO
'
Hourly Rate (in):
0.15
���
Hourly Rate (in):
0.15
Annual Rate (in):
18.2
Annual Rate (in):
18.2
Weather
Freeboard
Field Irrigated?
[j YES
❑ No
J
Field Irrigated?
YES
No
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I of t
Did the application rates exceed the limits in Attachment B of your permit?
❑ Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Q Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
❑ Compliant
❑ Non -Compliant
Were all setbacks listed in. your permit maintained for every application to each permitted site?
Q Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
Q 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
Permittee Certification
ORC: Michael Beck
Permittee.-
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ Yes R] No
Phone Number: [phone] Permit Exp.: 8/31/19
T�AoA b-Zi-1,el,
-
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-11)
Page �'�' -
of Po
Permit No.:
W00028693
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Month:
May
Year:
2020
Did irrigation occur�''
Field Name:
06
-
Field Name:
08
:jAal 6,7
� �'���""
Area (ac res):
3.95
�az„'a'z
Area {acres):
2.31
at this
facility?
'�� e'� �'� `���
�_ '�
Cover Crop:
Bluegrass/Bentgras
Cover Crop:
Bluegrass/Bentgrass
�
0 YES
NO
Hourly Rate (in):
0.15
_ �
Hourly Rate (in):
0.15
Annual Rate (in):
18.2�
Annual Rate (in):
18.2
Weather
freeboard
Field Irrigated?
Q YES
Q NO
Field Irrigated?
fl YES
El NO
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page- of la
Did the application rates exceed the limits in Attachment B of your permit? ❑ compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ED compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? [D compliant ❑ 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? Q 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
Permittee Certification
ORC: , Michael Beck
Permittee: Mountaintop Golf &Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ Yes R1 No
Phone Number: (828) 251.-1900 Permit Exp.: 8/31/19
n-A
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page -7,
of Ga
Permit No.:
WQ0028693
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Month:
May
Year:
2020
Did Irrigation occur��,
Field Name:
10
as
Field Name:
12
e
_�� ��;
Area (acres):
2.22
Area (acres):
3.88
at this facility?
Cover Crop:
Bluegrass/Bentgras
Cover Crop: Bluegrass/Bentgras:
Yes
❑ NO
w
Hourly Rate (in):
0.15
�s
k
Hourly Rate (m) :
0.15
Annual Rate (in):
18.2
Annual Rate (in):
18.2
Weather
Freeboard
"
Field Irrigated?
[j YES
N0
Field Irrigated?
❑ Yes
NO
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12 Month Floating Total (in):
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0.00
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 3 oflci,
Did the application rates exceed the limits in Attachment B of your permit?
Q Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
0 Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
0 Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
P1 Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
[21 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
acuonts) taKen. Anacn additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
PermMee: -
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official:. Robert Barr
Grade: SI WWIV Phone Number: [phone] �.
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ Yes 0 No
Phone Number: [phone] Permit Exp.: 8/31/19
(�
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-'I)
Page 4- ofh
Permit No.:
WQ0028693
Facility Name:
Mountaintop Golf & Lake Club WWTF
County: Jackson
Month:
May
Year:
2020
Did irrigation occur
Field Name:
-
14
Field Name:
16
�'
Area (acres):
2.81
a
Area (acres):
1.76
at this. facility?
� '�'�'��'
'1�`%
Cover Crop:
Bluegrass/Bentgras
Cover Crop:
Bluegrass/Bentgrass
dYES
NO
-.,.� r
Hourly Rate
0.15
Hourly Rate (in):
0.15
- � Annual Rate (in):
18.2
Annual Rate (in):
18.2
Weather
Freeboard
Field Irrigated?
❑ YES
Q NO
Field Irrigated?
[] YES
0 NO
s
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Monthly Loading:
0
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0
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12 Month Floating Total (in):
0.00
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page ofl a
Did the application rates exceed the limits in Attachment B of your permit?
["";I compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
21 Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
M Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
P Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
R] 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
Permittee Certification
ORC: Michael Beck `
Permittee:
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ Yes 0 No
Phone Number: [phone] Permit Exp.: 8/31/19
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Permit No.:
WQ0028693
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Field Name:
18�
Did irrigation occur
.:.Y;Gl��;
4 4
�' Area (acres):
3.26
at this
facility?�
Cover Crop:
Bluegrass/Bentgras
Q YES
❑ NO
Hourly Rate (in):
0.15
a�
Annual Rate (in):
18.2P
?,
Weather
Freeboard
M Field Irrigated?
YES
NO
s
•y
y
~
�JS
s
l4 Q.
i Q
J
k 1
D
L
a
a
°F
in
ft
ft
gal
min
in
in
1
C
37
0
6
24
0
0
0.00
0.00
;.
2
0
0
0.00
0.00
3
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0
0.00
0.00
4
CL
1 68
0
6
24
0
0
0.00
0.00
5
C
65
0.5
5
24
0
0
0.00
0.00�
6
C
39
0.4
8
24
mmm. 0
0
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.
7
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34
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8
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37
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11
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301
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311
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0
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Monthly Loading:
0
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12 Month Floating Total (in):
0111111111111111
1
0.00
F
Month:
. NANOCover
Crop:
I
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NOMINEE@

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page 5—of is
Did the application rates exceed the limits in Attachment B of your permit?
21 compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
2 compliant
❑ Non -compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
❑s compliant
❑ Non -compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
7 compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
I] 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
Permittee Certification
ORC: Michael Beck
Permittee:
_ Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ yes El No
Phone Number: [phone] - Permit Exp.: 8131/19
Jz
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page 4 of / a
Permit No.:
W00028693
Facility Name:
Mountaintop Golf & Lake Club WWTF
County:
Jackson
Month:
May
Year:
2020
Did irrigation occure�
ro
b
Field Name:
22
ago
Field Name:
24
at this facility?
s A
Area (acres):
5.490
Area (acres):
3.81
Cover Crop:
Bluegrass/Bentgras
Cover Crop:
Bluegrass/Bentgrass
0 YES
NO
Hourly Rate (in):
0.15
Hourly Rate (in):
0.15
Annual Rate (in):
18.2
Annual Rate jin):
18.2
Weather
Freeboard
Field Irrigated?
❑ YES
fl No
Field Irrigated?
❑ YES
El No
C
Y
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mow, mm
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31
0
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0.00
0
0
0.00
0.00
Monthly Loading
0
0.00
0
0.00
12 Month Floating' (in}:
0.00
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page t0 of to
Did the application rates exceed the limits in Attachment B of your permit?
El Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Q Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
El Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
0 Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
C] 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
Permittee Certification
ORC: Michael Beck
Permittee:
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grades SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ yes El No
Phone Number: [phone] Permit Exp.: 8/31/19
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page 7
of
Permit No.:
W00028693
Facility Name:
Mountaintop Golf & Lake Club WWTF
County: Jackson Month:
May
Year:
2020
Did
irrigation occur-
Field Name:
26
Field Name:
28
at
this
facility?
°�
�
Area (acres):
4.05
Area (acres):
2.28
Cover Crop:*Blue
rasslBent ras
9 9
�'
Cover Crop:
BluegrasslBentgrass
YES
El NO
Hourly Rate (in):
0.15
`
Hourly Rate (in):�
0.15
n
Annual Rate (in):
18.2
Annual Rate (in):
18.2
Weather
Freeboard
Field Irrigated?
F-1 YES
Q NO
�,• .e �� s-ate x ��, . �� i
Field Irrigated?
YES
NO
0
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v
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m
T
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fli
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p
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37
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FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page 7 of /-0
Did the application rates exceed the limits in Attachment B of your permit?
[A Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Q Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
0 Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
El Compliant
❑ Non -Compliant
Were all freeboards maintained .in accordance with the specified freeboard heights in your permit?
F-11 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
Permittee Certification
ORC: Michael Beck
Permittee:
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ Yes I] No
Phone Number: [phone] Permit Exp.: 8/31/19
b-2f_22)
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11
Permit No.: WQ0028693
Did irrigation occur
at this facility?
F/I YES ❑ NO
Weather
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NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page of �a
Did the application rates exceed the limits in Attachment IS of your permit?
0 Compliant:
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
P] Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
F Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
0 Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
E 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
Permittee Certification
ORC: Michael Beck
Permittee: Mountaintop Golf &Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ yes El No
Phone Number: [phone] Permit Exp.: 8131119
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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1�1 of /0

FORM: NDMR 08-11
NON -DISCHARGE MONITORING REPORT (NDMR)
Page ! o} o
Sampling Person(s) Certified Laboratories
Name: Michael Beck Name: Environmental Testing Solutions, Inc
Name: Name: Prisim Laboratories, Inc
11
noes all monitoring aata and sampling frequencies meet the requirements in Attachment A of your permit? 0 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
actionW taken Attach arlrlitinnal chaates if na-p-
- --- -----.-.._-
.... �.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
Permittee: Mountaintop Golf&Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDMR? ❑ Yes FZI No
Phone Number: [phone] Permit Expiration: 8/31/2019
1,7
(� L
Signature Date
Signature Date
By this signature, I 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 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR_03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page lOof h

FORM: NDMR 08-11
NON -DISCHARGE MONITORING REPORT (NDMR)
Page j Dof 1-0
Sampling Person(s) Certified Laboratories
Name: Michael Beck Name: Environmental Testing Solutions, Inc
Name: Name: Prisim Laboratories, Inc
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Q 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 necPssary
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
Permittee: Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: Si WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDMR? ❑ Yes El No— "}
Phone Number: [phone] Permit Expiration: 8/31/2019
Signature - Date
Signature Date
By this signature, 1 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 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617