WQ0028693_Monitoring - 10-2019_20191130

08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I of VJ
o.: 28693
7w4.Q
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: October
Year: 2019
Did irrigan occur
ame
01
Field Name:
023
Field Name:
04
Area '
3 09
Area (acres):
4.35
Area (acres)`
4'32
Area (acres):
4.26
at this facility?
r µCover Cro
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Cover Crop,
p
Blue rassBent ras
9 9
Cover Cro
Blue rass/Ben ra_
Cover Crop:
P
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9 9
❑� YES ❑ NO
Hourly Rate {in}
q 15
Hourly Rate (in):
0.15
Hourly Rate lin }
0 15.
Hourly Rate (in):
Y
0.15
Annual Rate (in}
3 18 2
Annual Rate (in):
18.2
Annual Rate(in)
1 182
Annual Rate (in):
18.2
Weather
Freeboard
Field Irrigatetd?
YE5} NQ
Field Irrigated?
l7 YES ❑ No
Field Irrigated?
DYES O No ,..
Field Irrigated?
❑YES O No
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0.00

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION, REPORT (NDAR-1)
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 maintainedon all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Page
O Compliant ❑ Non -Compliant
I] Compliant ❑ Non -Compliant
M Compliant ❑ Non -Compliant
O Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance With the specified freeboard heights in 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:
Michael :Beck :
Permittee:
Mountaintop Golf &Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade:
SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ Yes 21 No
Phone Number: (82 ) 251-1900 Permit Exp.: 8/31/19
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 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 Quality .
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

F-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page L of ! Z
00028693
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: October
Year: 2019
irrigawtion
Did occur
at this facility?
p YES ❑ NO°YNa#gin)
Field Name:
06
Ftieltiattle� r 07
Field Name:
08
GAeacras 337;� ( j
Area (acres):
3.95
;Area (acresjr 4 02 , ?
Area (acres):
2.31
Vi,`"CoveCro `Blue rass/Bent ras
9
Cover Crop:
p
slue rass�Bent ras
9 9
(. Cover Cro BIUe'"rass/Bent ras'
p .,. at
cover Crop:
P
Blue rass/Bent rass
9 9
d115
Hourly Rate (in):
0.15
HOyry Rat+ (ink 0 t5 :>
Hourly Rate (in):
0.15
r
{ALtnulFtat${iit) 1$2,ir
Annual Rate (in):
18.2
Y
14�rualyRate�(aiitj �n v 1 18
Annual Rate (in):
- 18.2
Weather
Freeboard
'' F(eldtinrl
ated � ' CI N0
Field Irrigated?
❑ YES 21 No
ieldl
r gafed? C1 YES i30
Field Irrigated?
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Monthly Loading:
12 Month Floating Total (in):
0<r.:
0s 0 ;?;°
0
0
0.00
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATIONREPORT (NDAR-1) Page
Did the application rates exceed"the limits in Attachment B of your permit? o Compliant El Non -Compliant
Were adequate measures taken to prevent effluent.ponding in or runoff from the sites? o Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained, on all sites as specified in your permit? o Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ❑ Compliant ❑ Non -Compliant
Were all freeboards maintained in.accordance with the specified freeboard heights in 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. Attach additional sheets if nerassary
Operator in Responsible Charge (ORC), Certification
Permittee Certification
ORC:. Michael Beck
Permittee: .
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWlW930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ Yes I] No
Phone Number: [phone] Permit Exp.: 8/31/19
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 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

uu-"I'l NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page -� of "�o.:8693
702
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: October
Year: 2019
Did irrigation
�l±iald Name
09 x
Field Name:
10r
Id awe
11
Field Name:
12
occur
J1te�a {acrs)�
2 77
Area (acres):
2.22
Area (aars)
2 16
Area (acres):
3.88
this facility?
caverCr
- °P
Blue` rasa Bent ras`
9 l�
Cover Crop:
P�
Blue rass/Bent ras
g g
cover Croy
Blue rass/Ben �a
g
Cover Crop:
p
Blue rasa/Bent rass
9 9
at
O YES ❑ No
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� i Q 15:< , '
Hourly Rate (in):
0.15
Hputl r R t� (m)
0 15 �`
Hourly Rate (in):
0.15
A>#Ife(itt)s
l2
Annual Rate (in):
18.2
Annual Raie►(in)r4_
18 2
Annual Rate
18.2
(in):
Weather
Freeboard
a iriigaied?
Q0 No
Field Irrigated?
❑ YES O No
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El
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9
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FORM: NDAR-1 08-11
NON-DISCHARGE:APPLICATIOMREPORT (NDAR-1)
Page qmw
Did the application rates exceed the limits in Attachment B of your permit?
o Compliant ❑ Non -Compliant
Were adequate measures taken to prevent, effluent ponding in or runoff from the sites?
o Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained, on all sites as specified in your permit?
o Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
o Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance With the specified freeboard heights in 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. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
Permittee:
Mountaintop -Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: Si WWIV Phone Number: (828),251-1900
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ;❑ Yes No
Phone Number: [phone] Permit Exp.: 8/31/19
WLVA,ti-A5-I61 if 3b�-�
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 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

uo-1 i NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of028693
rE.
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: October
Year: 2019
Did irrition occur
Feld Name
13
Field Name:
14Field
NamField
Name:
16
at tills facility?
Area (acres)
r 38
Area (acres):
2.81
Area (acres)
4 16
Area (acres):
1.76
cover Crop
Bluegrass/Bentgras
Cover Crop:
Bluegrass/Bentgras
Cover Crop
Bluegrass/Benfgras
Cover Crop:
Bluegrass/Bentgrass
p Yes ❑ N0
Hourly Rate
Hourly Rate (in):
0.15
Hourly Fate (fin)
0,15'
Hourly Rate (in):
0.15
Acinal
Annual Rate (in):
18.2
`Annul Rate ({)
18 2
Annual Rate (in):
18.2
Weather Freeboard
Field Irrigated?YE5
No
Field Irrigated?
❑ Yes ❑ NO
Field Irrigated?
C�YeS M U NO -
Field Irrigated?
❑Yes (] No
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FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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?
Page
O Compliant ❑ Non -Compliant
O Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained ion 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? o Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance With the specified freeboard heights in 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
Rcflnn(S) tAkP_n Af ninh arirfifinnal ehaofc if nocaeemni
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
Permittee:
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ Yes M No
Phone Number: [phone] Permit Exp.: 8/31/19
I(30
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 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

- VU- 1 I NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page J of / V
o.: W00028693
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: October
Year: 2019
Did irrigation occur
a4 Meld Name
' , 17 •
Field Name:
18
Field Nam®
19
Field Name:
20
at this facility?
Atea {acres)
3 93
Area (acres):
3.26Area,(ac'res)
3 64;
Area (acres):
r
3.96
Cover Crop
Bluegrass/Bentgtas`
Cover Crop:
Bluegrass/Bentgras
° .;pyer Crop
Bluegrass/Bentgra se
Cover Crop:
Bluegrass/Bentgrass
YES ❑ No
Hp�]rly�Rate (m)
015
Hourly Rate in
0.15
Hourl Rate m
0 15'
HourlyRate in
0.15
Annuat Rate in)
�v
18 2
Annual Rate in :
( )
18.2
�4nnual Rate (in )
' # + 18 2
Annual Rate (in):
18.2
Weather
Freeboard
Reid Irrigated?G]
,..
YES 1rj K0
Field Irrigated?
9
❑ YES p NO
Fie d icri ated?
- 9. ..
❑ Yes o
QN
Field Irrigated?
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FORM: NDAR-1 08-11
Page 1qW
Did the application rates exceed the limits in Attachment. B of your permit? o Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? o Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained;on all sites as specified in your permit? o Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? O Compliant ❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in 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
action(s) taken. Attach additional sheets if necessary.
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Operator in Responsible Charge (OR0 Certification
Permittee Certification
ORC: Michael Beck
Permittee:
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert -Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑Yes p No
Phone Number: [phone]. Permit Exp.: 8/31/19
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 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 t iere 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

NUN-U,1ZK; 1AKUt APPLICATION REPORT (NDAR-1) Page _a of
W00028693
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: October
Year: 2019
Did irrigation occur
Flatd Iarriew
21
Field Name:
22e(dN.imo
23 .
Field Name:
24
at this facility?
Area (acc®s)
5 33,
Area,(acres):
5.49
Area (acres}
2 89
Area (acres):
3.81
CoyrerCrop
U6.
Cover Crop:
Bluegrass/Bentgras
Cover Cro p
i31ue rasa/Ben ras'
9 b
Cover Crop:
p:
Blue rassBent rasa
9 9
O YES ❑ No
Hourly Rate (m}'
` 0 1
Hourly Rate (in):
0.15
Hour)y I�afei(in)
Hourly Rate (in):
0.15
�1r�nual+}fate {inj�
# 18 2,
Annual Rate (in):
18.2
�Annraf 1Rats (in}
Annual Rate (in):
18.2
Weather Freeboard
` Fiet lrai�aLl3ct?
YES + y Nr3 y`
Field Irrigated?
❑ YES O No
field Iriigasd?
p vES N0
Field Irrigated?
❑ YES p No
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0.00
O:DO
0.00

FORM: NDARA 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR4')
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?
Page
O Compliant ❑ Non -Compliant
121 Compliant - ❑ Non -Compliant
O Compliant ❑ Non -Compliant
Were all setbacks listed in your permit.maintained foe every application to each permitted site? o Compliant ❑Non -Compliant
Were all freeboards maintained in accordance With the specified freeboard heights in your permit? Rl 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
Permittee Certification
ORC: Michael Beck
Permittee:
Mountaintop Golf &Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ; ❑ Yes 0 No
Phone Number: [phone] Permit Exp.: 8/31/19
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.orsupervision 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 Quality
Information. Processing, Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617 .

- i u0-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page r 'of Gam/
o.: WQ0028693
Facility Name: Mountaintop Golf & Lake Club WWTF
County: Jackson
Month: October
Year: 2019
Did irrigation occur
I+Sield N men25 `3
a
Field Name:
26
c >le(d Narrte. 2I
Field Name:
28
ma�Area {ants} 4 '
Area (acres):
4.05ila
(acres) 3 4T
`
Area (acres):
2.28
at this facility?
`GcoVt'rCtop 8ltteyrass/Ientgras
Cover Crop:
Bluegrass/Bentgras
Cover°cro t Blve rass/Ben ras'
Cover Crop:
Blue rass/Bent rass
O YES ❑ No
Hotly Riyn), . r -� + 0�1�
Hourly Rate (in):
0.15
Hquriy i1at+� (in), a 013x
Hourly Rate (in):
0.15
1nrtiai Oats {th)j s 18,-
Annual Rate (in):
18.2
Annual fafek(in)s 1$ 2
Annual Rate (in):
18.2
�.. _�.,„ ..��y_ s
Weather
Freeboard
t"ieltl (nr�ated7 ;y C7 r NOS'
Field Irrigated?
❑YES O No
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FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR4)
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?
Page
O Compliant ❑ Non -Compliant,
O Compliant ❑ Non -Compliant
21 Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintainedfor every application to each permitted site? a Compliant ❑Noh-Compliant
Were all freeboards maintained in accordance With the specified freeboard heights in 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
actionks) taken. Attach additional sheets Irnecessary.
Operator in Responsible Charge (ORC)l Certification,
Permittee Certification
oRc: Michael Beck
Permittee:
Mountaintop Golf &Lake Club
Certification No.: 'SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? i❑ Yes O No
Phone Number: (828)-251-1900 Permit Exp.: 8/31 /19
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 dlrection 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina, 27699=1617

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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Did the application rates exceed the limits in Attachment B of your permit? o compliant ❑Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
p Compliant ❑ Non -Compliant
Was a suitable, vegetative cover maintained on all sites as specified in your permit?
o Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
o Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in 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. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Michael Beck Permittee:
Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930 Signing Official: ' Robert Barr
Grade: SI WWIV Phone Number: [phone] Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? : ❑ Yes D No Phone Number: [phone] Permit Exp.: 8/31/19
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 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

Ua-NON -DISCHARGE MONITORING REPORT (NDMR) Page -I of,
W u"
Q0028693 Facility Name: Mountaintop Golf & Lake Club WWTF County: Jackson Month: October Year: 2019
7
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001
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716
1.2
Average:
L L
0.00
1.00
16.80
00
1.22
17.7 0
3.10
Daily Maximum:
2.00
11, ,
1.00
18.00
1.31
6. -25
20.20
3,90
Daily Minimum:
J:!% 3 •2.00
1.00
15.60
.
. . ..... .
1.15
15.20
230
Sampling Type:
Composite
Grab
Grab
0drin' po �jte:
Composite
Grab
b
l000].W
Recorder
Monthly Limit:
1
14
5 I
F
Daily Limit
15
25
Sample Frequency:
V06ritiquous:1
See Permit
3 j, Year ear
3 x Year
See Permit
peepolmit
See Permit
5XW6ekt
3 x Year
See Permit
Continuous

FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Sampling Persons
p g () Certified Laboratories
Name: Michael Beck Name: Environmental Testing Solutions, Inc
Name: Name: Prisim Laboratories, Inc
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. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Michael Beck Permittee: Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930 Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone] Signing Official's Title: Signatory
Has the ORC changed since the previous NDMR? ❑ Yes O No Phone Number: [phone] Permit Expiration: 8/31/2019
P
11^Ajr__1
Signature Date
By this signature, I certify that this report Is accurrate and complete to the best of my knowledge.
Signature Date
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 -Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1611

FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Sampling Person(s)
Certified Laboratories
Name: Michael Beck Name: Environmental Testing Solutions, Inc
Name: Name: Prisim Laboratories, Inc
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. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael Beck
Permittee: Mountaintop Golf & Lake Club
Certification No.: SI-991669 WWIV-7930
Signing Official: Robert Barr
Grade: SI WWIV Phone Number: [phone] -
Signing Official's Title: Signatory
Has the ORC changed since the previous NDMR? ❑ Yes O No
Phone Number: [phone] Permit Expiration: 8/31/2019
-'�-- t b-,R5 -19
3a
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 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 Quality
Information Processing Unit
1617 (Mail Service Center
Raleigh, North Carolina 27699-1617