Non-Discharge Application Report (NDAR-2) Form 131014 (1)

Permit No.:
Did infiltration occur at this facility?
Day
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
Monthly Loading (GPD/ft2):
Year to Date Loading (GPD/ft2):
Weather
Weather Code
Temperature
ºF
Precipitation
in
Freeboard
Storage (if applicable)
ft
5-Day Upset (if applicable)
ft
Facility Name:
Site Name:
Area (acres):
Rate (GPD/ft2):
Site Infiltrated?
Volume Applied
gal
Time Infiltrated
min
Daily Loading
GPD/ft2

Freeboard (Basins Only)
ft
Site Name:
Area (acres):
Rate (GPD/ft2):
Site Infiltrated?
Volume Applied
gal
Time Infiltrated
min
Daily Loading
GPD/ft2

Freeboard (Basins Only)
ft
County:
Site Name:
Area (acres):
Rate (GPD/ft2):
Site Infiltrated?
Volume Applied
gal
Time Infiltrated
min
Daily Loading
GPD/ft2

Month:
Freeboard (Basins Only)
ft
Site Name:
Area (acres):
Rate (GPD/ft2):
Site Infiltrated?
Volume Applied
gal
Time Infiltrated
min
Year:
Daily Loading
GPD/ft2

Freeboard (Basins Only)
ft

Did the application rates exceed the limits in Attachment B of your permit?
If not a basin, were the sites kept free of vegetation and raked?
If not a basin, were there any instances of effluent ponding in or runoff from the sites?
If a basin, were there any instances of breakout from the berms?
Was the onsite automatically activated standby power source tested and operational?
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
ORC:
Certification No.:
Grade:
Has the ORC changed since the previous NDAR-2?
Signature
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Phone Number:
Date
Permittee Certification
Permittee:
Signing Official:
Signing Official's Title:
Phone Number:
Signature
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.
Permit Exp.:
Date

Formulas
Weather Codes
Clear
Cloudy
Partly Cloudy
Rain
Sleet
Snow
C
CL
PC
R
SL
SN