WQ0002829_Monitoring - 07-2020_20200824

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0002829
Name of Facility:* KDHWWTP
Month:* July
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Year:* 2020
Upload Document*
WQ0002829 KDHWWTP-
July.pdf.pdf
PDF Only
Please upload only one combined pdf document. Upload GW-59 individually.
Confirmation Email Address:* [e-mail]
Name of Submitter:*
Signature:*
Date of submittal:
Initial Review
JAMES BLIVEN
l p
Reviewer: Williams, Kendall
Is the project number correct? * WQ0002829
8/24/2020
This will be filled in automatically
1.09MB

Is the monitoring report 6' Yes C NO
accepted?*
Regional Office* Washington
Accepted Date: 8/24/2020

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0002829
Facility Name: KDHWWTP
County. Dare
Month: July
Year: 2020
Did irrigation occur
Field Name:
IRR-1
Field Name:
IRR-2
Field Name:
IRR-3
Field Name:
IRR-4
Area (acres):
4.6
Area (acres):
6.47
Area (acres):
3.27
Area (acres):
5.62
at this facility?
Cover Crop:Cover
Crop:
p�
Cover Crop:
p�
Cover Crop:
p:
❑YES El NO
Hourly Rate (in):
1
Hourly Rate (in):
1
Hourly Rate (in):
1
Hourly Rate (in):
1
Annual Rate (in):
118
Annual Rate (in):
118
Annual Rate (in):
118
Annual Rate (in):
118
Weather
Freeboard
Field Irrigated?
❑YES ❑NO
Field Irrigated?
❑YES El NO
Field Irrigated?
❑YES ❑NO
Field Irrigated?
❑YES El NO
T
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R O R
R 0 0
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
CL
81
1.9
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
2
C
75
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
3
C
80
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
4
C
86
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
5
C
80
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
6
1 C
82
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
7
C
84
0
3
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
8
C
84
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
9
CL
80
0.2
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
10
CL
80
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
11
CL
82
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
121
C
85
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
13
C
80
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
14
CL
80
0
3.2
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
15
C
80
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
16
C
82
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
17
PC
82
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
181
C
84
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
19
C
82
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
20
C
84
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
21
C
84
0
3.2
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
22
C
84
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
23
C
84
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
241
CL
82
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
25
PC
80
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
26
C
84
0.1
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
27
C
83
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
28
C
84
0
3.25
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
29
CL
80
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
30
C
82
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
311
CL
1 83
0
24,000
216
0.19
0.05
12,000
180
0.07
0.02
36,000
324
0.41
0.08
40,000
360
0.26
0.04
Monthly
Loading:
744,000
1=5.96
1=1
372,000
1=
2.12
1,116,000
12.57
1,240,000
8.13
12 Month Floating Total (in):

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0002829
Facility Name: KDHWWTP
County. Dare
Month: July
Year: 2020
Did irrigation occur
Field Name:
IRR-5
Field Name:
IRR-6
Field Name:
IRR-7
Field Name:
Area (acres):
0.94
Area (acres):
1.65
Area (acres):
2
Area (acres):
at this facility?
Cover Crop:Cover
Crop:
p�
Cover Crop:
p�
Cover Crop:
p:
❑YES El NO
Hourly Rate (in):
1
Hourly Rate (in):
1
Hourly Rate (in):
1
Hourly Rate (in):
Annual Rate (in):
118
Annual Rate (in):
118
Annual Rate (in):
118
Annual Rate (in):
Weather
Freeboard
Field Irrigated?
❑YES ❑NO
Field Irrigated?
❑YES El NO
Field Irrigated?
❑YES ❑NO
Field Irrigated?
DYES El NO
T
0
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R O R
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°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
CL
81
1.9
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
2
C
75
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
3
C
80
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
4
C
86
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
5
C
80
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
6
1 C
82
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
7
C
84
0
3
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
8
C
84
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
9
CL
80
0.2
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
10
CL
80
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
11
CL
82
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
121
C
85
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
13
C
80
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
14
CL
80
0
3.2
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
15
C
80
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
16
C
82
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
17
PC
82
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
181
C
84
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
19
C
82
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
20
C
84
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
21
C
84
0
3.2
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
22
C
84
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
23
C
84
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
241
CL
82
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
25
PC
80
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
26
C
84
0.1
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
27
C
83
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
28
C
84
0
3.25
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
29
CL
80
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
30
C
82
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
311
CL
1 83
0
16,000
120
0.63
0.31
12,000
120
0.27
0.13
0
0
0.00
0.00
Monthly
Loading:
496,000
EM
19.43
372,000
j=
8.30
0=1
0
0.00
0
0.00
12 Month Floating Total (in):

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
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?
OCompliant ❑Non -Compliant
OCompliant ❑Non -Compliant
OCompliant ❑Non -Compliant
OCompliant ❑Non -Compliant
OCompliant ❑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: Jimmy Bliven
Permittee:
George E Goodrich
Certification No.: 28243
Signing Official: Tina Gee by Authority
Grade: SI Phone Number: 2522022435
Signing Official's Title: Area Manager Envirolink
Has the ORC changed since the previous NDAR-1? ❑yes ElNo
Phone Number: 2524915277 Permit Exp.: 6/30/22
08/24/2020
08/24/2020
L
Signature Date
Signature Date
Bythis 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
Raleigh, North Carolina 27699-1617

FORM: NDAR-2 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page of
Permit No.: WQ0002829
Facility Name: KDHWWTP
County. Dare
Month: July
Year: 2020
Did infiltration occur at
Site Name:
1-A
Site Name:
1-B
Site Name:
3
Site Name:
4
this facility?
Area (acres):
0.28
Area (acres):
0.28
Area (acres):
0.06
Area (acres):
0.12
❑YES ❑No
Rate (GPDIft):
10
Rate (GPDIft):
10
Rate (GPDIft2):
10
Rate (GPDIft):
10
Weather
Freeboard
Site Infiltrated?
❑YES ❑No
Site Infiltrated?
❑YES El NO
Site Infiltrated?
❑YES ❑No
Site Infiltrated?
❑YES El NO
0
w
0
0
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LL m
°F
in
ft
ft
j gal
min
GpDjft2
ft
gal
min
GPDIft2
ft
gal
min
GpDjft2
ft
gal
min
GPDIft2
ft
1
CL
81
1.9
0
0
0.00
0
0
0.00
10,080
90
3.86
19,404
126
3.71
2
C
75
0
0
0
0.00
0
0
0.00
9,408
84
3.60
20,328
132
3.89
3
C
80
0
0
0
0.00
0
0
0.00
10,080
90
3.86
20,328
132
3.89
4
C
86
0
0
0
0.00
0
0
0.00
10,080
90
3.86
19,404
126
3.71
5
C
80
1 0
1
0
0
0.00
0
0
0.00
8,064
72
3.09
16,632
108
3.18
6
C
82
0
0
0
0.00
0
0
0.00
8,064
72
3.09
16,632
108
3.18
7
C
84
0
0
0
0.00
0
0
0.00
8,736
78
3.34
17,556
114
3.36
8
CL
84
0
0
0
0.00
0
0
0.00
9,408
84
3.60
18,480
120
3.54
9
CL
80
0.2
0
0
0.00
0
0
0.00
9,408
84
3.60
19,404
126
3.71
10
CL
80
0
0
0
0.00
0
0
0.00
10,080
90
3.86
20,328
132
3.89
11
C
82
0
0
0
0.00
0
0
0.00
10,752
96
4.11
23,100
150
4.42
12
C
85
0
0
0
0.00
0
0
0.00
10,752
96
4.11
21,252
138
4.07
13
CL
80
0
0
0
0.00
0
0
0.00
7,392
66
2.83
14,748
96
2.82
14
C
80
0
0
0
0.00
0
0
0.00
10,080
90
3.86
20,328
132
3.89
15
C
80
0
0
0
0.00
0
0
0.00
10,752
96
4.11
21,252
138
4.07
16
C
82
0
0
0
0.00
0
0
0.00
7,392
66
2.83
15,708
102
3.01
17
PC
82
0
0
0
0.00
0
0
0.00
8,064
72
3.09
15,708
102
3.01
18
C
84
0
0
0
0.00
0
0
0.00
7,392
66
2.83
15,708
102
3.01
19
C
82
0
0
0
0.00
0
0
0.00
6,720
60
2.57
12,936
84
2.47
20
C
84
0
0
0
0.00
0
0
0.00
7,392
66
2.83
15,708
102
3.01
21
C
84
0
0
0
0.00
0
0
0.00
7,392
66
2.83
15,708
102
3.01
22
C
84
0
0
0
0.00
0
0
0.00
7,392
66
2.83
15,708
102
3.01
23
C
84
0
0
0
0.00
0
0
0.00
8,064
72
3.09
16,632
108
3.18
24
CL
82
0
0
0
0.00
0
0
0.00
10,080
90
3.86
19,404
126
3.71
25
PC
80
0
0
0
0.00
0
0
0.00
10,752
96
4.11
21,252
138
4.07
26
C
84
0.1
0
0
0.00
0
0
0.00
8,736
78
3.34
18,480
120
3.54
27
C
83
0
0
0
0.00
0
0
0.00
6,048
54
2.31
12,012
78
2.30
28
C
84
0
0
0
0.00
0
0
0.00
8,064
72
3.09
16,632
108
3.18
29
CL
80
0
0
0
0.00
0
0
0.00
8,064
72
3.09
16,632
108
3.18
30
C
82
0
0
0
0.00
0
0
0.00
7,392
66
2.83
12, 936
84
2.47
311
CL
83
1 0
0.00
0
0
0.00
6,720
60
2.57
12,936
84
2.47
Monthly Loading (GPDIft ):
Year to Date LoadingGPDIft2
kiiii
0.00
0.00
3.32
3.35

FORM: NDAR-2 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page of
Did the application rates exceed the limits in Attachment B of your permit? OCompliant ❑Non -Compliant
If not a basin, were the sites kept free of vegetation and raked? OCompliant ❑Non -Compliant
If not a basin, were there any instances of effluent ponding in or runoff from the sites? OCompliant ❑Non -Compliant
If a basin, were there any instances of breakout from the berms? OCompliant ❑Non -Compliant
Was the onsite automatically activated standby power source tested and operational? OCompliant ❑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: Jimmy Bliven
Permittee:
George E Goodrich
Certification No.: 28243
Signing Official: Tina Gee by Authority
Grade: SI Phone Number: 2522022435
Signing Official's Title: Area Manager Envirolink
Has the ORC changed since the previous NDAR-2? ❑ves ElNo
Phone Number: 2524915277 Permit Exp.: 6/30/22
r
08/24/2020
08/24/2020
Signature Date
Signature Date
Bythis 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
Raleigh, North Carolina 27699-1617

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: Qlll •
• Dare
•
1 1
11Flow
Measuring •• ElInfluent ■ Effluent E]No flow generated
Parameter Monitoring •• ■ E]Effluent OGroundwater Lowering E]Surface Water
Parameter Code
Daily Maximum:
Daily Minimum:
Sampling Type:
Monthly Limit:
Daily Limit:
Sample Frequency:

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: WQ0002829
Facility Name: KDHWWTP
County: Dare
Month: July
Year: 2020
PPI: 002
Flow Measuring Point: ❑influent El Effluent ❑No flow generated
Parameter Monitoring Point: ❑influent []Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code
60060
00310
00940
31616
00610
00626
00620
00600
00400
00666
70300
00630
0
'ai
U
O
�
a
O O
LL
La
m
L
U
ri O
U
C
O
E
a
H O .'
Y Z
Z
N
H=
Z
Q
LL
H O
a
R'a
~ y N
d
V!
M C a
~ H N
M
N
24-hr
hrs
GPD
mg/L
mg/L
#/100 mL
mg/L
mg/L
mg/L
mg/L
su
mg/L
mg/L
mg/L
1
10:20
2
220,490
6.75
2
08:10
2
224,130
7.02
3
08:15
2
233,960
7.07
4
00:00
0
211,940
5
00:00
0
181,370
6
1 08:30
2
188,480
<2
1
6.1
4.4
1.01
5.6
7.04
4.23
1 <2.5
7
08:30
3
187,100
6.94
8
08:35
2
204,270
6.96
9
08:35
3
204,810
6.88
10
08:20
2
199,030
6.75
11
00:00
0
215,450
121
00:00
0
204,360
13
08:45
2
142,720
<2
1
4.2
2.4
15.3
17.8
6.93
5.67
<2.5
14
08:20
3
224,820
6.95
15
08:30
3
223,030
6.95
16
08:15
2
169,470
6.87
17
08:10
2
141,630
6.81
181
00:00
0
175,990
19
00:00
0
145,740
20
07:45
3
173,320
<2
<1
0.2
<0.5
19.1
19.1
6.79
5.35
<2.5
21
08:10
2
197,570
6.88
22
08:30
2
160,830
6.88
23
08:30
3
185,940
6.96
241
08:40
2
220,850
6.94
25
07:00
2
244,820
26
08:00
2
200,580
27
08:15
2
133,740
5
<1
4.2
3.3
17.5
20.9
7.05
5.26
3.2
28
08:30
3
193,320
6.95
29
09:00
3
180,430
6.95
301
08:30
2
148,310
6.97
311
08:20
3
175,470
6.96
Average:
190,773
1.25
1.00
3.68
2.53
13.23
15.85
5.13
0.80
Daily Maximum:
244,820
5.00
1.00
6.10
4.40
19.10
20.90
7.07
5.67
3.20
Daily Minimum:
133,740
2.00
1 1.00
0.20
0.50
1.01
5.60
6.75
4.23
2.50
Sampling Type:
Recorder
Composite
Composite
Grab
Composite
Composite
Composite
Composite
Grab
Composite
Composite
Composite
Monthly Limit:
327,735
10
14
4
7
3
20
Daily Limit:
43
6-9
Sample Frequency:
Continuous
See Permit
3 X Year
See Permit
See Permit
See Permit
See Permit
See Permit
5 X Week
See Permit
3 X Year
See Permit

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: Qlll •
• Dare
•
1 1
11Flow
Measuring •• ElInfluent ■ Effluent E]No flow generated
Parameter Monitoring •• ■ []Effluent OGroundwater Lowering E]Surface Water
Parameter Code
•
•
Daily Maximum:
Daily Minimum:
Sampling Type:
Monthly
��0-©-----------
Daily
®®0���----------

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: Qlll •
• Dare
•
1 1
11Flow
Measuring •• ElInfluent ■ Effluent E]No flow generated
Parameter Monitoring •• ■ E]Effluent OGroundwater Lowering E]Surface Water
Parameter Code
Daily Maximum:
D.
0---------------

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: Qlll •
• Dare
•
1 1
11Flow
Measuring •• ElInfluent ■ Effluent E]No flow generated
Parameter Monitoring •• ■ E]Effluent OGroundwater Lowering E]Surface Water
Parameter Code
Daily Maximum:
Daily Minimum:
Sampling Type:
Monthly Limit:
Daily Limit:
Sample Frequency:

701VLTA Oki IQLTA IMIMN11
NON -DISCHARGE MONITORING REPORT (NDMR)
Page of
Sampling Person(s) Certified Laboratories
Name: Jimmy Bliven Name: Envirochem
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? OCompliant ❑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: Jimmy Bliven
Permittee: George E Goodrich
Certification No.: 991879
Signing Official: Tina Gee by Authority
Grade: 4 Phone Number: 2522022435
Signing Official's Title: Area Manager Envirolink
Has the ORC changed since the previous NDMR? ❑Yes 21No
Phone Number: 2524915277 Permit Expiration:
2s� 08/24/2020
L 08/24/2020
2,ti,_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
Raleigh, North Carolina 27699-1617