WQ0012690_Monitoring - 05-2021_20210630

FORM:
Permit No.: V
NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page _L_ of a
Q0012690
I Facility Name: Mount Mitchell State Park
County: Yancey
Parameter Code
Sampling Type:':,
Recorder
Sample Frequency:,

: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page C9 of a
Sampling Person(s) II Certified Laboratories
Name: Robert Kramer Name: KACE Environmental, Inc.
11
Name: Name: CT''s t � Y1C',
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑✓ 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
actlonW taken. Attach additinnal shaatq if narpccanr
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: / Y,} �. �YQYYIlZ Y
Permittee: rn+. M —r-K-P-101t_e POLK,
Certification No.: `IIco��1O
Signing Officiafl'"d �Y&W QYMCC- CnA rvnmer1h1) d_ -
Grade:. I Phone Number: l $� �5� ^ , $)�
Signing Official's Title: P"'I h0Yj 2Qj
Has the ORC changed since the previous NDMR? ❑yes ❑� No
Phone Number: (Sa8) lD J? -) 80 Permit Expiration:
'—Q CV-% I
1.,. 10 II/A ,-i. A
Signature Date
gnature Date
/Icertify,
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
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

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FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page a of
Did the application rates exceed the limits in Attachment B of your permit? 21Compliant ❑Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? OCompliant ❑Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? QCompliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? EDCompliant ❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ECompliant []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
ORC: i firn 1btavex
Certification No.: qQ' DS-4a
Grade: Si Phone Number: (S&) U51') 000
Has the ORC changed since the previous NDAR-1?
❑Yes ENo
Signature ' Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: M�. Ki�I) aoV Pad,
Signing Official:go6 ,d kY-oLnu_r -2y- �CE Gho nunrrer;W.
Signing Official's Title: ALL+hori ZM
Phone Number: (OHO) (J57-ygo
Signature
'Reprea4-ive.
Permit Exp.:
Date
I edify, under penalty ofiaw, theft this document and all attachments were prepared under my direction or supervision in accordance
vith 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