WQ0000819_Monitoring - 01-2021_20210315

Cr'%DIA- MMAR In-i3 NnN_rnscHARGE MONITORING REPORT (NDMR) Page of
Permit No.: li 11 I 1 : 19.Facility
Name: Plantation HarborCounty:
Craven.Month:
January
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NON DISCHARGE WASTEWATER MONITORING REPORT
Facility Status:
Page ___ of
Please answer the following question:
1. Does all monitoring data and sampling frequencies meet permit requirements?
Compliant ,N)
Y.
if tbe.faciiity is non -compliant, please explain in the space below the reason(s) the fpcility was not in compliance
with its permit. Provide in your explanation the date(s) of the non-compliance 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 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. 1 am aware that there are significant penalties for submitting
false information, including the possibility of fines and imprisonment for knowing violations."
Pe 1* Dabs (Name of Signing Official -Please print or type)
GtCrrd Director of PHPOA
(Permittee-Please print or type) (Position or Title)
PHPAA ..202 .Sumter Court. __ [phone] 1 -
(Phonle Number) (Permit Exp. Date)
Havelock, NC 28532 _
(Permittee Address)
Parameter Codes:
Parameter Code assistance maybe obtained by calling the Water Quality Compilance/Enforcement Unit at (919) T33-5083 ext. 529.
The monthly average for Fecal Col)form Is to be reported as a GEOMETRIC mean. on__"iyhe uni _desgingglkd in the reportanQ
facili s� permit for reporting data.
If signed by other than the permifteee, do"i ation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(2)(D).
DENR FORM NDMR-1 (512003)

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page of
Facility Name: Plantation Harbor
County: C raven
Month: January
Field Name::
Field Name::
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NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Page i of ^,
Facility Status:
Please indicate (by inserting Y(es) or N(o) in the appropriate box) whether the facility has been comiinlianL
with the following permit requirements: (Note: if a requirement does riot apply to your facility put (NAB in the
compliant box. )
1. The application rate(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 sita(s) in accordance with the permit.
4. Ail buffer zones as specified in the permit were maintained during each application.
The freeboard to the treatment and/or storage lagoon(s) was not less than the limit(s)
specified In the permit
com an — --IN)
Y
K==
L�J
CY �1
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 non-compliance 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 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."
(Permittse-Please print or type)
PHPOA 202 Sumter court
Havelock NC 28532
(Pennittee Address)
Kevin MuMneaux
(Name of Signing Officla Wlease print or type)
ORC
(Position or Title)
(252) 463-W7 /01 _ a A
(Pbons Number) (Permit Exp. Date)
If signed by other than the Permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).
DENR FORM NDARA (5l2003)