WQ0033804_Monitoring - 11-2021_20211230

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * November
Report Information
WQ0033804
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 1000.18KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Robert Barr
Reviewer: Zhong, Vivien
12/30/2021
This will be filled in automatically

Is the project number correct?*
Is the monitoring report accepted?* Yes No
Regional Office*
Accepted Date:
1 /31 /2022

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 1 of 6

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 2 of 6
Permit No.: W00033804
Facility Name: Laurel Mountain Retreat
County:' Buncombe
Month: November
Year: 2021
Did irrigation occur
Field Name:!
5
Fj ... KIN
Field Name:
7
this facility?
Area (acres)::
0.33
woc
YE,
-E�,4
Area (acres):
0-38
at
Cover Crop:
PM r", Ctp
Cover Crop:
❑ El NO YES
b
Hourly Rate (in):
0.2
-.7,
Hourly Rate (in):
0.2
Annual Rate (I n):
23.53
i
nnua
Annual Rate in):
23.53
Weather
Freeboard
Field'rrib
Field Irrigated?
El YES [Z No
FS
Field Irrigated?
El YES 121 NO
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Monthly Loading:
0
MAW
0.00
AT
12 Month Floating

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 3 of 6

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 4 of 6
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
0 Compliant D Non -Compliant
2 Compliant LI Non -Compliant
El Compliant ❑ Non -Compliant
2 Compliant ❑ Non -Compliant
171 Compliant ❑ 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: Kevin Bryan
Permittee:
Laurel Mountain Retreat
Certification No.: 1010633
Signing Official: Robert Barr
Grade: Sl Phone Number: 828-251-1900
Signing Official's Title: Signatory
Has the ORC changed since the previous NDARA? ❑ yes p No
Phone Number: 828-251-1900 Permit Exp.: 3131/27
L7\_2 Fr2 t
Z-3 " zl
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 qualit[ed 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:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page 5 of 6
Permit No.: WQ0033804
Facility Name-, Laurel Mountain Retreat
county: Buncombe 7Month:
November
Year: 2021
PPI: 001
Flow Measuring Point: ❑ Influent El Effluent E] No flow generated
Parameter Monitoring Point: El Influent E Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) rage 6 of 6
Sampling Person(s) Certified Laboratories
Name: Kevin Bryan Name: Pace Analytical, Inc.
Name: Robert Barr Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? o compliant: ❑ 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_ Atfach additional sheets if necessary_
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Kevin Bryan
Permittee: Laurel Mountain Retreat
Certification No.: 1010633
Signing Official: Robert Barr
Grade: Si Phone Number: 828-251-1900
Signing Official's Title: Signatory
Has the ORC changed since the previous NDMR? ❑ Yes p No
Phone Number: 828-251-1900 Permit Expiration: 3/21/2027
L F
S" nature 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:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617