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HomeMy WebLinkAboutNon-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