WQ0030245_Monitoring - 12-2019_20200131

NDMR 03-12 NON -DISCHARGE MUNI I UMINU mcrum t tivurrrry
Sampling Person(s)
Name: Dale Wike Name: Environmental, Inc
Name: Name: Pace Analytical
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of 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 necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Dale Wike Permittee: Town of Rosman
Certification No.: 1000267 Signing Official: Brian E. Shelton
Grade: SI Phone Number: 828-586-5588 Signing Official's Title: Mayor
Has the OR hanged since the previous NDMR? ❑Yes ❑
No Phone Number: 828-884-6859 Permit Expiration:
l �( 2-6)
Signature
Signature Date
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 an direction or he informal 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

y
-.-
a

VNDAR-1 08-11 NON-DISCHAKGt AVVLIUA t lUly r[crvrx r Vvwm1` I I
plication 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?
DCompliant ❑Non -Compliant
OCompliant ❑Non -Compliant
[ZCompliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? Compliant ❑Nan -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 21compliant ❑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
ORC: Dale Wike
Certification No.: 1000267
Grade: SI " Phone Number: 828-586-5588
Has the Ot32�1;hanged since the previous NDAR-1? ❑Yes ONO
i I.ii 1?o
Signature
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: Town of Rosman
Signing Official: Brian E. Shelton
Signing Official's Title: Mayor
Phone Number: 828-884-6859 Permit Exp.:
Signature
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 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617