WQ0012690_Monitoring - 09-2021_20211029

FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR) Z(I
Page / of
Permit No.:
WQ001
2690Mitchell_
Park
County: Yancey
Month: September
Flow Measuring Point: El Influent
13
13
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FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page 13 of tf-)-
Name: Robert Kramer
Name:
Sampling Person(s) II Certified Laboratories
Name: KACE Environmental, Inc.
Name: Environmemntal Testing Solutions, Inc.
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑J 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 G. 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 ❑� No
Phone Number: [phone] Permit Expiration:
alzj�rj &V.4 11
Zilt
10/29/2021
1P K I 2_4 0 if I � 4. 10/29/2021
Si ature 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, tha 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

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Page of
PPPFORM:.NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?. 2 compliant ❑ Non -compliant .
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? p compliant ❑ Non-compiiant
Was a suitable vegetative cover maintained on all sites as specified in your permit? p compliant ❑ Non -compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? p compliant ❑ Non-compllant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? Ec6mpllant ❑ Non -compliant
If the facilitv 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. Attacn aooltionai sneets Ii
Operator In Responsible Charge (ORC) Certification
ORC: ' Ken Deaver
Certification No.: 922372
Grade: SI Phone Number: . [phone]
Has the ORC changed since the previous NDAR-1? ❑ Yes l] No
]iniLt w��� 10/29/21
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 G. Kramer for KACE Environmental, Inc.
Signing Officials Title: Authorized Representative
Phone Number: [phone] Permit Exp.:
/SratureDate
I certify, under penalty of law, that thisent 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 forgathering 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