No preview available
HomeMy WebLinkAboutWQ0008489_Monitoring - 08-2020_20200930rORM: NDMR D3-12 NON -DISCHARGE MONITORING REPORT (NDMR) Nage 1 OT �_ 11►Mck )n L � r'n�� FS Permit No.: Q110:4:9 •-Correctional • WWTF •- ' r • . Surface water •. ■ ■ ParametE Code • ® r' - • r r -®-® m to r �+ -�-®-=_-_-_®__-_-_-_- .�• Daily Maximum: Daily Minimum: Sampling ..---- FORM: NUMB 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page --I— of Sampling Person(s) Certified Laboratories Name: BOBBY C"04 Name: EAM RON M L ►vT �-- I NC-' Name: TC6Ef H F, SAbILE12 Name: Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ 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: Tosepo F. S A D I—E k' Permittee: (2OuN Ty (0 F H \i 0 Certification No.: Signing Official: J-oSEP i+ , 5 A b �� Q Grade: = Phone Number: \`�5� ct Z 6 ^ ZZZLf Signing Official's Title: iM h N I'-ir6 E K () (Zc Has the ORC changed since the previous NDMR? ❑ yes �ANo Phone Number: C.1 Sa) CfZtp — ZZ.Z 4 Permit Expiration: (D R— 01" "tO�Z 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 t-VKIVI: INIUHM- I I U- 1 1) NUN-U13CHARGE AVVLI(;Al IUN. KLVUK I (NUAK-1) j:rj, r-"c ' — !q-- Permlt No.: WQ0008489 Facility Name: Hyde Correctional Institution WWTF County: Hyde Month: ALIGALST Year: Q0A0 Fie Field Name: 2 Field Name: 4 Did irrigation occur -A Area (acres): 9.5 Area (acres): 9.7 at this facility? -4 S:S0315Kr1 CoverCrop: ovroeri .P.c . . . . . . . . . Cover Crop: Hourly Rate (in): 0.25 Hourly Rate (in): 0.25 YES C3 NO Annual Rate n): .56 Annual R ate (In): 14.56 Weather Freeboard y VERB 01W Field Irrigated? YES Ej NO a a rrig 'a w M 0, 1� i =htr�-15= wo, . . . . .•. . . . . . -brA 204 ;ffM E D •- W=2 0 E Z. C 0 CD CL E M CL M 0 >, CL M in M - I , 62 .1- ;tJ;-"Iffi j-E N 12 9 Mal E .2 CL > < E 0 -i a E 0 a: 0 _j CU_ B., tta aI : - w - 1.5 F� sffi Cis", 110 -, E .2 CL 0 B - .E -0 . 0 _j - ra _j (D 'S I — V-4 ISM, 10 I "S M, .1, . . . . . . . . . . RM 1 ......... ... M WRINAA ow W71 wwo-ri-ag ma `fix. ti-s'n"na-mg -4 ON, 11 * OR - IVE-1 8-0 NAMED, F in ft ft I gal I min i n I n 11,1401-M-10,11 ,,.11 IRNRN, I MOTOR 121 WE,, MMNT," MEMO4 gal min in in 2 3 VEME X0155 am103 100-EOW 011111111001t�lt 590, ORION 11N� 61 mamx it a'a"momy, - = "IN -r mow S� 6 1 7 Is 0 IJL WIN! 14MR,410 MMOt'110; 9 -,no J60 0.150 0.376 •:jR. q1tow 11SO S ax- Iry 0 - WE Offly, 81 9 1 NOUN 10011,31,01, ffil. .12411� 101 11 M . . . . . �4R29 r1rw1 -1110 =,124-M11010 - 1a,11 r 1-21 131 . "fJ . . . . . . . . . . . "M AIX 141 RENRIP-301-1 00005 , F M OR, wiizi 0. 151 1 's Umv WIN, 0 1 11 -- BIT 161. 17j . . . . . . . . . . . . . . . . 4, NO MAN IT • sm " r- E-11,11.11,17 91, VIBVTK� 1-3014 MIN-6 INVNWN % MEIER IE 19 OOZE 20 21..S -12. Q R-10,11 IAMB ANIMEW.. -r.l%"t j, MUNN.-tVIN 100 ME' 10000. 15ZO) 0.165 b.-39-9 221 11R,11111095 WMNIMI E -1 NE -231 ?R00151y 011,11,11, 0 'IS MOORE 10,10 PEN, a 241M C> 12AD �a % w a 93M 9 NNE, 25 26 27 28 29. 301 311 10 1ALgj I _S Monthly Loading: 0. VIA ct (Dun 12 Month Floating Total (in): &.Arm�� �po FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page_ I of-L.-L— 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? EX Compliant ❑ Non -Compliant Compliant ❑ Non -Compliant ® Compliant ❑ Non -Compliant ® Compliant ❑ Non -Compliant (� 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 explangtion 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: wog E P H F S P Q L L l2 Permittee: C Olt N V y OF E-1 4 6 E Certification No.: (sj^(� Signing Official: J-081Ep14 P. SADLER Grade: Iz- Phone Number: Ca.sal i-(P— Z 7-24 Signing Official's Title: O RC I/yl j�jJ%} G DER Has the ORC changed since the previous NDAR`-1? ❑ Yes [!� No Phone Number: C�s2, q u* 2, Permit Exp.: `��LuA_a ZbZD 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 Resources Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) " Permit No.: • WQ0008489 Facility Name Hyde Correctional Institution ty County'. Hyde H Month. j4UGUSIT ear: OZa Name: 6 Fteld Name 7 ` Field Name: 8 . Did11'Plgat1011 OCCUC Field Name 5 Field Area (acres): 9.2 Area (acres) 9,3� Area (acres): 7.67 Area acres} 9 3 at this facility? Crop: CgverCrap' Cover Crop: Cover Crop Cover , rHourly Rate (in)� 0 25'> Hourly Rate (in): 0.25 HoujJY Rate`(in) 0 25 Hourly Rate (in): 0.25 +/ o /1 [}.YES ❑ NO 6 14.56 " Rafe (fir)) + ; t '4`56 st 1 1 Annual Rate (in): 4 5 ArinuaUR`ate (tn) i i 14+5s i , Annual Rate (in): ?tiAnnual i 1 aQ ❑YES ❑ No `Yh` Fiel'd]lrrigafed? ❑YES „ d'tJo' . Field Irrigated? ❑YES ❑ NO Weather Freeboard Field�I�Cl9atec(7 7s -, 5 , e 7 ❑sYESr �xi x Flo Field Irrigated? 1 /s r Jtti ` C , i ,, s ' 4.iE' 'D E y ' J t ' "O h} i c �t \ E LA. d •O >+ -O 7 ° y M .O i a' N 'O?t ? x S ('� t -, f, s < e i !T F>++ " 6s a O) O T C N 4-° ll My i� , y y , 1 Gl RC C i >, �t = !+ G E D N C1 T C L ° `3 O) O. tv rt y.y a Y E r.O� y tiT C4 7 G E d d ,.�+ ?' C -9 i E° 'v , , 'EttY_ E t m i s v, t` L o, ° a E s6 ° >, ° V L° ° .. .E I ,3i,c 1 rEffm,, :�Jyv� 'oEf,a a'' a m Ern v ° ;i X O Co .t ,to aly , otf s�i Ix i4o 4f4' ° t s o a m F- o o x o A x o p L m a ° >. a, �< r§r r ° �c �/O x o to , o a 1- p ° o i i o r nl w t F-r v b.t�T v o� t i mi S t° i Q _ J J d Q U r0-G. F-f .. 1 t`RS!`SJs 1 0.. 'F Q i J tC S J �r l S� lQY t r ty,ts, iJ c {�. J... r E ...r fC d llI ;�" > '. I t 1 ti ,' min in in gal min in in g al °F in ft 1 �{ 'f: 4'✓!F/. rr(� y��' 4 2 ZR// f 1. (Il l�rrl,��� xf /.��! 1 �{T Ztt:: f3/1 r 1( S f 2 t7 ZI `�.b�,�45 ttj/t% i Fvs�'-, n r 1. ltw` 3 t iPtyt. titari,yr/ 4J e> °i i� yk )r, a.�Ku'b !' 3, ti ; a t r yN F K,t i tif3 • 4 6 efi`tir"'E, ,l i '� r F .ass ns iv . K, r !� �, rrt s r'•/ ,rXtAr. 1v, 1.. ih t �. ,k t 7 �, ` iz°.rr['�^ t. .. d 22 Lr,� �'rti Y7.1 �rf r4 r 1 s f/rt t^` tu.l,, •x fi- `�s.i , e a JS is a.A R`1 Ki ! Sws - { ). �� 0 0.16 9 ,53l Zl i {r. i ra� J t`x i t t I ! r t� j 9 ts5 FA d Lff n t 7 FM S' r i V 0. 0. 4C 1 G{ it 4tY l 7' �U .1 10 S 6 t� la �r n �•, ar k I Ai-«1n1't! a ;'Il £�ti >vr a f" � '�` J4 i:' 4f. _ x is a, i .i r �, lls /!/+I � i i >i rr^�t / .b �„ � . 12 13 r i F s 1�'t t )v ifr t y F r 15 r 16 t 4i1 3j i 18 r 1/ r +J -.\ {f• e i S fd� 2 r 4+ { Y i`�' f t. f cif ;_ \ f nx t•v s s .. tfJ t-i _ i, f 19 .�GI ,, 4✓JJti 20 Yf Y S y J4 S Jti S C 21 Z 1 14�tZ ti 22 t 23 t t k 25 26 t y i J 27 28 'I 0 3.06 `15t ` zs 30 Monthly Loading O. O.$i:• 12 Month Floating Total (in): 'V-" NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page .2— of 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? [� Compliant ❑ Non -Compliant Was a suitable vegetative cover maintained on all sites as specified in your permit? 97 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? ® 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: S'OSE p H S INp LCR Permittee: COutNTI or- WOE Certification No.: Signing Official: J'OSL=PH I-, SAOLez Grade: Phone Number: `D,5,A) Q�(p—ZZZi-} Signing Official's Title: 0AIL — I'�f4Ni4GE2 Has the ORC changed since the previous NDAR--1? El yes ElNo Phone Number: Ca"" 4 2(6— 222 Permit Exp.: ^ b (^ D-O 22 0-i Z02i7 f) 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 'dye �' NON DISCHARGE APPLICATION REPOR I 40aiL F-D 60PIE5 SPRAY IRRIGATION SITE(S) PERMIT NUMBER: W6 (BOO 2q$ TOTAL NUMBER OF, FIELDS: 12— MONTH: Jq(jC :UST YEAR o[v�S� FACILITY NAME: P1El W wQs U%ullpCLASS: _ COUNTY: — Formulas Daily Loading (inches) = (Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / (Area.Sprayed (acres) x 43,560 (squarejeet/acre)] Maximum Hourly Loading (inches) =Daily Loading (inches) / [runt Irrigated (minutes)160 (minutes/hour)] Monthly Loadiog (inches) = Sum of Daily Loadings (inches) 12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous I I month's Monthly Loadings (inches) Averave Weekly Loading (inches) = I'Monthly Loading (inches/month) / Number of days in the month (days/month)] x 7 (days/week) FIELD NUMBER FIELD NUMBER: C. AREA SPRAYED (acres): q 1.61 AREA SPRAYED (acres): COVER CROP: COVER CROP: Permitted HOURLY Rate (inches): 2.5 Permitted HOURLY Rate (inches): Q . WEATHER CONDITIONS Permitted WEEKLY Rate tnehes : . Z7 Permitted WEEKLY Rate inches Weather• Tcmp. at Precipi- Volume Time Maximum Hourly Daily Volume Tune Maximum Hourly Daily D A Storage Lagoon T E Code, a plicatioo tation Freeboard Applied Irrigated Loading Loading Ap lied Irrigated Loading Leading CD -r%"l.-�c -.> inches � < rr^�ti. feel �'><^G�`:= :.✓.mr>., gallons a. `%<'�ITa,YY"'wa minutes oa<a' i roa'_r..,', inches •c<%:�, .:nK.�.'c{ � "..�.L, ::ram"...:,+-; inches `.'_.r"^_h',�„'�'t.�:,.ti4y`�%�r.? '�•C. �'%'C »t- gallons ._£':. x'� s'<J t minutes 3"-.c� L't�-+tYer w�� <..r". inches r oS9.IIYsy."—_'`--, .q<=.a:w �,�,. inches < r•'-''-,� _ •s".? .i' w �c _ . .. -,,,fin....-..._>F. :.awS,,.nf mac �.C^'p, ;� .,w i-"-� •.a M �' h Y '.'u%%. ^� WWII `n? v �<, 4 rs v s:: ' <' ;-':rrr,�x>,� -ai. <zs:<;:.;.*;:,,.�'•`�c�".;`"�z::. ;;?;r '4`x'3 �'�r`L;Y'`,_•„!^,=,,"%"`a's H'N ..T....�,:�' ,»'ti.'::F'`_>'..>-';. r.- .:.;;ray:.=x<��w`k,: ��� a- ;GJ �; S,>> N-.ntroi+�j'.ri,.a`+...twr..^..<�"., b `,�SA:�,',,.�+;,.h•'GK> » r'�.� ^�xe.R�a$Yu=^%.iI1-Z-t'�.. (]^:nc:w 7,.wS=ai3H'•fiir? : - ,e':.•>'' w= —"i':r».y%us.% �r✓` a°teens_' Z J " c'-,','S7-, ^'c of a.Y�x._- NON 7.�c.�,; ' .,:r<�., ^ •t''�' .wu�i.:rr� r ' ���Y'«�a �-. B S 5sa'+-^�.��w••-��'' <Y:r.�. '�1� . .,.,.-,.-- .F.. 1y^..'-`� fd.= -% -' ism: i>'L?'_' a -..,' �........:_. �: -3-y^«c.Hy.�.Hr�<>. �by'F'-»''i :•�`.,�"" �;-':;,.�;».�.:y .^� w ">.c.- �. �.:.;�s�" x i%',�;-_:? �..'6'�.�e<Y:O_"s�v`�z:t` ;,.. •�'r�"". a,�..•� r:.�� �"',''?•3�"'':•�s � �..:..i�.,.:... x :. a;�'� u,=• �.a...>.<r.. prX^ , /tY'-vr�.-�'='-.-%mac- .: yycr. -�i ': T ..ter �. ,.•,.-.r _ K-?' .....E-r. v .ZX:napsC: : ' '�.<�-..r o 1 0 z. V."^t". ::?i.•-%'^` 3�,-..(rem-.YTS-• acri-.,'-. ^�'-v i�>, w. �:e� LiGra�..Cl-S�'.'w,"v'�.R� �''=i :^_x-ur'•>4 ^^i`J_. Lai' r£✓�'..,..z�`:u "�'.^.':-`.»C'.�..wrs...._v.•: >. .� b: 25!8 ,„yes• =�r,.' h .>h�M'�Oq _. AQT'�"q"'.d "�A00:� MINN. ^0�.."-4.^= .- 'Y.YL' :, s1'c �'.'<;i.Y.'Y,-"' `rl.S`���..z�`F.^',t� .f_r=sR-•rD, 'TO�F .+<1. NGD. ja yG -., :S��% a,hzL. 0..... 02l6 , 14 VetK--k:,, er 2 .•:a b 5c "i.Y?_,�-..c[d. u ,.......te ._..`-«` 1 6Ig ��L ' : y G i4 ^T"•ea : ,a�V .yr �'`�-rr.. 5 t3 —a`if J'�a.=ati��^"Y: P7�g� )7?: L T'✓Jl'nv: '�!� xo�F..,.»v 18 6G'�fJ• r`� �- .v..y. � - �a ?..+ .3- � �� �T �'^2�� '�-^ 1� �r'�%R.. a i`i?.': s.=� u^l >�� r� �.Wt, ^*�Z33....-� h ��`F'fk:FM'�-e'�SiS�R�''_'�Y -a4 y r 20 s rra�y- :'y.'>...�✓=.1w ' `c <""� :b `= r.^a+>S'S:Chia'ly" :..-.wN.i'i%�ie"-- Z2 N `L.y.`. '} ^ 's M� xca- r f �` xTa <r �-.>-`Y "�'..r..eM ' >xevi-'.. „+¢?<$--i �%'""t •a�i�'Gi'' '--' ./G( ..... v Y[..: �<E-5, "i4` Y:si i. ....'",.:... 1a.ritt G r<"' r c .G'a:�ao>� c S ,:• z? •. ,cy-7 f V �sr=�.,-:N;;.N �a:i �.� �"" �� �',>e�-ra.�;�:y:..>"-a'a.'^` i'a:.5.., �.._., l•:J >:....: - =,-._<,, .av.:_:r'_"::`3` .�"wU."-'r'r-�.:,.`C<-.�M'w �a'Y';E<3`- ca +ram..Oy"`v,,,;,N<� 3rr--my`,-.'�,F�;z:^�_..firW%.� <Hu>✓ccr:✓w�=+'%.:.s>.g,'."r.'4 s2r4 -eu.;'^"�,"✓z L^.'. r., 'V:-2'i 'e':-� rvy<-'•%„°'w�„.�.� �,s ���'Z:ac. <t-=��„'� �"«iE'.i`.t>_5.:� YJ'�'.Y ��r, "S++ T'��.�,yd _ �,y'�'.�`.� Sa�.'w resi �,_.,c• U+..C'=E`a�,� 5� yYt `Z1„�Cw '.Lev 26 �.. > �d�"�'a...- yR�"'o-<� ,r..<„v,�.-�. 5,<«<, ,.r ''. sPa;, r`"f.. 1:.=`a'sse u r�= Fm-,1.&",c i"a'`z' T'- � s,..r✓.'r»..._' ' 28 F^'Yt'�c;^c•� T .rs_r:�..` "�.-`�� ,,. _ ,.._ E`r"Y^ qc.. 3��ki�6+as-''•,`v!`>"".�,-.�� �> +, �`'"E'._Y' a"•�cf=T Fic�C�".cLMR... ..�-�'sl:�:tir-". �z'.wSu�z:s...= -' ,� �:=ts .;=� '�- �'lo�-� tZ_'�- '.<.�' Monthly Loading (inches) p 1(ab 1 o'1 &0 12 Month Floating Total (inches) Loading (inches) Average Weekly Weather Codes: S-sunny, PC partly cloudy. CI -cloudy, H-rain, an-suvvv, � A GRADE PHONE 222 OPERATOR IN RESPONSIBLE CHARGE (ORC) /J14 F. IL CHECK BOX IF ORC HAS CHANGED D Mail ORIGINAL and TWO COPIES to: ATTN: COMPLIANCE GROUP DIV_ OF ENVIRONMENTAL MGT. DEHNR P.O- BOX 29535 RALEIGH, NC 27626-535 X (SI ATU E OF OPERATOR IN RESPONSIBLE CHARGE) BY IS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. FACILITY STATUS: Please indicate (by checking the appropriate box) whether the .facility has been conrt� t or in the pliant with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) compliant box) non- compliant compliant I. The application rate(s) did not exceed the limit(s) specified in the permit El 2. Adequate measures were taken to prevent wastewater runoff"fxom the site(s). Q 3. A suitable vegetative cover was maintained on the site(s) in accordance with ® Q the permit 4. All buffer zones as specified in the permit were maintained during each application. S. The freeboard in the treatment and/or storage lagoon(s) was not less than the El lb-Dit(s) specified in the permit If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its permit Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach additional sheets if necessary. "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 qualified personnel properly gathered and evaluated the information. submitted_ Based on my inquiry of the person -or persons who manage the system, oz 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." Address) (Permittee- 'lease or type) a5j-q2-6_g«6 _ as 01--�1ozZ . (Phone Number) (Perr%it Flop. Date) •" If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A. NCA.0 2B-0506 (b) (2) (D). //�/u" v �— NON DISCHARGE APPLICATION REPORT Page of SPRAY IRRIGATION SITE(S) PERMIT NUMBER: IAA TOTAL NUMBER OF•FIELDS: --�- MONTH: YEAR:QD20— _,,, FACILITY NAME: ���F U)DO �1A)-rp CLASS: _1 ____ COUNTY: �E Formulas r Daily Loading (inches) = (Volume Applied (gallons) x 0.1336 (cubic feet/gailon) x 12 (inches/foot)) / (Area Sprayed (acres) x 43,560 (square.feetlaae)) Maximum Hourly Loading (inches) =Daily Loading Cinches)/ CI-une Irrigated (minutes) / 60 (mioutes/bour)) Monthly Loading Cinches) = Sum of Daily Loadings (inches).' 12 Mouth Floating Total (iuches) = Sum of this months Monthly Loading (inches) and previous I I months Monthly Loadings (inches) Weather Codes: S-sunny, PC -partly cloudy. CI-eloudy, K-ram, an-snuw, or-w-, PHONE z6 �' SAIY EQ OPERATOR IN RESPONSIBLE CHARGE (ORC) �DSEPI�t G� GRADE CHECK BOX IF ORC HAS CHANGED ❑ Mail ORIGINAL and TWO COPIES to: ATTN: COMPLIANCE GROUP DIV. OF ENVIRONMENTAL MGT. DEHNR P.O. BOX 29535 RALEIGH, NC 27626-535 (SI ATU E OF OPERATOR IN RESPONSIBLE CHARGE) BY IS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. FACILITY STATUS: Please indicate (by checking the appropriate box) whether the facility has been compliant or non -compliant with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the compliant box.) non- compliant compliant 1. The applicatiokrate(s) did not exceed the limit(s) specified in the permit. © ❑ 2. Adequate measures were taken to prevent wastewater runoff from the site(s). ❑ 3. A suitable vegetative cover was maintained on the site(s) in accordance with ® ❑ the permit. 4. All buffer zones as specified in the permit were maintained during each ❑ application. 5. The freeboard in the treatment and/or storage lagoon(s) was not less than -the ® ❑ lirnit(s) specified in the permit. If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach additional sheets if necessary. "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 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." (Permittee t= (Permittee- Please print or type) 42 SF 7 s.,� -� z6 - � tQ6 d 8-01- ao 22- - (]Phone Number) (Perrhit FJxp. Date) W jr signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b) (2) (D).