WQ0012690_Monitoring - 06-2021_20210730

NDMR 03-1PI 2
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NON -DISCHARGE MONITORING REPORT (NDMR)
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NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page -a- of,&,
Sampling Person(s)
Certified Laboratories
Name: Robert Kramer Name: KACE Environmental, Inc.
Name: Name: Environmental Testing Solutions, Inc.
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? I] 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 Officials Title: Authorized Representative
Has the ORC changed since the previous NDMR? ❑ Yes 0 No Phone Number: (828) 657-1$10 Permit Expiration:
f Signature Date / Vt"
Signature /% U Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I certify, under penf w,that this document and all attachments were prepared under rr</(y/direction or supervision In
accordance with a syst 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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Rdicapff NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
the appl
tionn 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?
Page o% of A
❑r Compliant
❑ Non -Compliant
I] Compliant
❑ Non -Compliant
0 Compliant
❑ Non -Compliant
El Compliant
❑ Non -Compliant
El 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: Ken Deaver
Permittee:
Mt. Mitchell State Park
Certification No.: 922372
Signing Official: Rachael G. Kramer for KACE Environmental, Inc.
Grade: SI Phone Number: (828)1657-1810
Signing Officials Title: Authorized Representative
Has the ORC changed since the previous NDAR-1? I] Yes LIJ No
Phone Number: [phone] Permit Exp.:
7 o t/
L�
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 o aw, lh t this. document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that al 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