WQ0012690_Monitoring - 08-2021_20210928

ORM:
NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page of
Permit No.: Q00.•0
Facility Name: Mount Mitchell State Park
County: Yancey
Month: August
Year: 2021

NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page j92_ of T
Sampling Person(s) 11 Certified Laboratories
Name: Robert Kramer 11 Name: KACE Environmental, Inc.
Name: 11 Name: Environmental Testing Solutions, Inc.
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 0 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: Robert J. Kramer III
Permittee: Mt. Mitchell State Park
Certification No.: 1005910
Signing Official: Rachael Kramer for KACE Environmental, Inc.
Grade: III Phone Number: [phone]
Signing official's Title: Authorized Representative
Has the ORC changed since the previous NDMR? ❑ Yes El No
Phone Number: [phone] Permit Expiration:
9/28/2021(�Z
9/28/2021
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
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.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

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PPFRP1M*PNDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page ty ofC
Did the application rates exceed the limits in Attachment B of your permit?
r❑ Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent'ponding in or runoff from the sites?
ElCompliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
❑� Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
FA Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
it 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 necessarv.
Operator in Responsible Charge (ORC) Certification
i ORC: Ken Deaver
Certification No.: 922372
Grade: SI Phone Number:' [phone]
Has the ORC changed since the previous NDAR-1? ❑ Yes 0 No
1
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:
Mt. Mitchell State Park
Signing Official: Rachael Kramer for KACE Environmental, Inc.
Signing Officials Title: Authorized Representative
Phone Neer: [phone] Permit Exp.:
JAQJIJA 9/28/21
Signature Date
I certify, under penalty of la , that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to ;sure 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 fine"; 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