WQ0009098_Monitoring - 11-2020_20210108

FDRM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page J_ of
Permit No.: Facility Name: 1. County: Month: o9•
PPI_ Flow Measuring Point: ❑ Influent ❑ Effluent 4 No flow generated I Parameter Monitoring Point: ❑ Influent ❑ Effluent ❑ Groundwater Lowering [ ] Surf
Parameter Code —0
50050
a
M
Q 1
U ~
0
O
c
O
Y
U (
O
3
C
LL
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) II Certified Laboratories
Name: II Name:
Name: Il Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? V 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 coi
action(s) taken. Attach additional sheets if necessary.
UkSC 6kF fA �n
Operator in Responsible Charge (ORC) Certification
Certification No.: l \ 0 3
Grade: Phone Number:
Has the ORC changed since the previous NDMR? n yes tV/No
Signature '
By this signature, I certify that this report is accurrate and complete to the best of my knowledge
Permittee Certification
Permittee: +
.Janney `t-ni �i I� L,�,M;.-}�-Pariwrsky
Signing Official:Qxinn�,l
Signing Official's Title: tYi t��-� -C
Phone Number: 1Q —,''1 `1 �� Permit Expiration:
:Y,,ZAL�4 ANAAA
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 submitl-
ny 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

FARM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page -a— of
Facility Name: I
Field Name:
D • irrigation occur
Area (acres):!
Area (acres)-
Area (acres):
at this facility?
Cover Crop:
■ 1�1 •
YES....
-.
-.
�. -.
-.
M..,
..
■ •
.. •.
■ .Field
Irrigated?

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit? �VC-0-pliant
pliant ❑ Non-Compli
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑ Non-Compli
Was a suitable vegetative cover maintained on all sites as specified in your permit? C mpliant ❑ Non-Compli
i
Were all setbacks listed in your permit maintained for every application to each permitted site? Compliant ❑ Non-Compli
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? �ompliant ❑ 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.
Operator in Responsible Charge (ORC) Certification
ORC_-_PA y joj ph Me -
Certification No.: I
Grade: J J— Phone Number: c�V-A
Has the ORC changed since the previous NDAR-1? ❑ Yes M/No
Signature ' Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: tea; ,� AA I y �.- i Mi-7�cQ fir-- ,�r4N
Signing Official:�JG�'
t
Signing Official's Title:
Phone Number: C '(�1 2'1_ Per it Exp,:
,.-I A „ i ► .,1 I
Signature
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