WQ0033804_Monitoring - 02-2021_20210331

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0033804
Name of Facility:*
Month:* February
Report Information
Laurel Mountain Retreat
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
WQ0033804. pdf 13.54 MB
FDF only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
[e-mail]
Kimber Reese
Reviewer: Williams, Kendall
3/31 /2021
This will be filled in automatically

Is the project number correct? * WQ0033804
Is the monitoring report r Yes r No
accepted?*
Regional Office * Asheville
Accepted Date: 3/31/2021

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? V'Compliant 0 Non -compliant
Were adequate measures tak en to prevent effluent ponding in or runoff from the sites? 0 /Compliant El Non -Compliant
Was a suitable vegetative cover maintained on all it as specified in your permit? Compliant [I Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 21 /Compliant 0 Non -compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 2(cumpliant El 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: Robert Barr Pernniftee: Laurel Mountain Retreat
Certification No.: 24262 Signing Official: Robert Barr
Grade: SI Phone Number: 828-251-1900 Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1 ? El Yes El No Phone Number: 828-251-1900 Permit Exp.: 1/31/22
A a
WWA, -202 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
I
Division of Water Resources
Information Processing Ujnit
1617 Mail Service Center
Zzleiy,]1, Vortj�

FORM: NDMR 5-16 NON -DISCHARGE MONITORINGT (IJ ) Page L of
Samplin Personmsl Certified Laboratories
Name: Robert Barr arse: Pace Analytical, Inc.
Dame: Kevin Bryan Name:
Does all monitoring data and samplingfrequencies meet the requirements in Attachmentpermit? ompiant ❑ 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 ( RC) Certification Perrnittee Certification
RC: Robert Barr Permittee: Laurel Mountain Retreat
Certification No.: 24262 Signing Official: Robert Barr
Grade: SI Phone Number: 323-251-1900 Signing Official's Title: Signatory
Has the ®RC changed since the previous NDMR? El Yes ❑ No Phone Number: 323-251-1900 Permit Expiration: 1/31/2022
�)
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.
Mall Original and Two Copies to:
Division of Water Resources
Information Processing unit
1617 Mall Service Center
Raleigh, North Carolina 769 -1617