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Home My WebLink AboutWQ0012696_Monitoring - 10-2020_20201204FORM: I AW 03-12 NON -DISCHARGE NG REPORT (NDMR) Page ,_ IJ Sampling Person(s) Name: Name: Name: Name: Certified Laboratories Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ® Compllant ❑ 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: GgR_Y Mrgst7N Permittee: AX00 Porn 1r 'Ca 4r r i%t r- 1-er-r Certification No.: Signing Official: S A Fr r /`f ��o u' e Grade: I Phone Number: 2 sz' 7 GT,4S Z 1 Signing Official's Title: �/�?/(JJ� Q e ice' Has the ORC changed since the previous NDMR? ❑ yes M No Phone Number: �Z - 96 �/J� �tS Z / Permit Expiration: Ll- 30- gD Zt • D 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 ,FORM: NDAR-1 08-11 NON -DISCHARGE APP&ATION REPORT (NDAR-1) Page -,gW of Perrnithw WQ0012696 FacilityName: NCDOT Pamlico River Month:ounty:eaufort - + r Did irrigation occur Field Name: Field Na --Field Name -.- at this facility? Area (acres): Area (acres):, Area (acres): . : ..Bermuda Cover CoverCrop: Hourly Rate (in):' Hou :.... :..... Annual Rate (I :. . o . . Ron ammmwaMM ►,rn . �■�� r��■�■�■� ME ®C:.... :..®®..�...�... �5...... ....� ®..�....�. ®®®.....ISM ®®...�C. m....�.......®®■...�........ �...®......�.... ®...�..........®®®......�� .............�..... m�. ......®..®........�.....�......®.........� m -�....�......® r.........��.... MM MM..��..� ®...®�.....�...1....It....�...�.�..� m........�.... .........�..M.......®®�.�......�. mmmmmm ®ess�— �■�� sw�■a®�� mmmmmm■ ��a�s� ��■■� �®®� �■�� mm ISM �®®®��■� mmmmo■� mmr. mm.: ®�� ■�■�■� �■■i��■■��®r�� ■■�_r� ISM mmmmmm ®��■■��s�■■��ME mmmmmm ®�■■�®r �� ®�r ��■� mmmmmm �_�� ■ �■�®� �� mmmmmm ®�� ■�� ®�o �■��■� FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) `°yC Did the application rates exceed the limits in Attachment B of your permit? kXCompliant ❑ Non -Compliant Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 46mphant ❑ Non -Compliant Was a suitable vegetative cover maintained on all sites as specified in your permit? ompliant ❑ Non -Compliant Were all setbacks listed in your permit maintained for every application to each permitted site? a6mpliant ❑ 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 .....r.... % •.,r.. Aff—k—4,14fi—I chn fe if nnrnecary Operator in Responsible Charge (ORC) Certification ORC: G y /4f+50At Certification No.: Grade: t Phone Number: 2-5— _7 — � I T —"l �z Has the ORC changed since the previous NDAR-1? ❑ yes C5 CWIALw Permittee Certification Permittee: Ne Pc)- 119h1 JI CO i JV e, r-7i'ir y Signing Official: 54t re y cil�OvJC'1I Signing Official's Title: M PJA,1,4y e -- Phone Number: z5Z _96 Lf -4 Z) Permit Exp.: Signature Date Signature Date By this signature, I certify that this report is aceurrale and complete to the best of my knowledge. I certify, under penalty of law, that this document and all attachments were prep.' nder my direction or supervision in accordance with a system designed to assure that all qualified personnel properly gathered and eva d 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 e