WQ0009098_Monitoring - 09-2020_20201104

• FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page -t— of
Permit No . Facility Name: County:U3aVe_Month:G'
PPI: Flow Measuring Point: ❑ Influent []"Effluent No flow generated Parameter Monitoring Point: ❑ Influent [—] Effluent ❑ Groundwater Lowering Surf
Parameter Code 10
50050
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3
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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
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) 11 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 -cc
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 col
action(s) taken. Attach additional sheets if necessary.
(gyp I,l)a<,-� t6c4e r
-As&arged �.lio
I,OT �F
Operator in Responsible Charge (ORC) Certification
Nit '� tjo
Certification No.: % ,
Grade: Phone Number: [q `�' __ ,L59
Has the ORC changed since the previous NDMR? [ J Yes `r �o t t
C- C
Signature
By this signature, I certify that this report is accurrate and complete to the best of my knowledge
Permittee Certification
Permittee: -TbuvtC-,s�,j i -( vv i+eA Cl.tr+t-\ers. k t
Signing Official:Fa/ 4�b� • \� � 't 46V)
Signing Official's Title::C041/\1v1 sth-64or
Phone Number:(AR9_)/")% Permit Expiration:
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Signature Da
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 submitt,
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 _Q_of_a,
irrigation
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Did occur
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Area (acres):
at this facility?
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Cover Crop:
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YES V/N0
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Hourly Rate (in):
Annual Rate (in)
Annual Rate (in):
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FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
Page of
IV/Compliant [] Non-Compli
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? U/Compliant ❑ Non-Compli
Was a suitable vegetative cover maintained on all sites as specified in your permit? Compliant ❑ Non-Compli
Were all setbacks listed in your permit maintained for every application to each permitted site? h/c/ompliant ❑ Non-Compli
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? Compliant ❑ Non-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.
L
Certification No.
Operator in Responsible Charge (ORC) Certification
M
Grade: 5T Phone Number: tlq_( )Claj^q"ll'
Has the ORC changed since the previous NDAR-1? `k' ❑ Yes _N.`1
' Signature I Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: vv1AM-Par-+ne_ 4)%P7Vav'CGS I
Signing Official: ILL�Ne Tame-5 McM
1aiti
Signing Official's Title: U}'� `�'��� r
Phone Number:(, C1 _� �1 0 ".' F�
Signature
Permit Exp.:
Da
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