WQ0033804_Monitoring - 10-2019_20191130

1°''O NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I of
WQ0033804
Facility Name: Laurel Mountain Retreat
county: Buncom a
Month: October
Year: 2019
d irrigation occur
Field"Name
1A'
Field Name:
16
Fielc{ Name
2
Field Name:
3
at this facility?
Area {actesj
0 2a
Area (acres):
0.19
Aiwa (antes)
*� p 34`'
Area (acres):
0.45
Cover Crop
CoverCrop:
Dover Creap
Cover Crop:
O Yes ❑ NO
HoutlykRateF(m)
0 2
HourlyRate(in):
0.2
Hou'rl irate; in
Y (,)
0 2 ;•
Hourly Rate(in):
Y
0.2
Anr�uai�Fiate;(m),
W,3 53
Annual Rate (in):
23.53
Annual Rate,(in)
23 53
Annual Rate (in):
23.53
Weather Freeboard
'%-ie�kd {�sigated?
❑AYESI�NO
Field Irrigated?
❑ YES t] No
Field I{rtgated'�
C] YE 5 f i40
Field Irrigated?
❑Yes p No
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1.00

FORM: NDAR-1 05-16
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 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
2'Compliant ❑ Non -Compliant
Compliant ❑ Non -Compliant
❑mpliant
❑ Non -Compliant
X-mpliant
❑ Non -Compliant
ompliant
❑ 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
0l Ull\bf LCMUS1. fllldlill GUUIl1U1161 b1ICClb II
Operator in Responsible Charge (ORC) Certification
1,
Permittee Certification
ORC: Robert Barr
Permittee:
Laurel Mountain Retreat
Certification No.: 24262
Signing Official: Robert Barr
Grade: SI Phone Number: 828,-251-1900
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑ Yes ❑ No
Phone Number: 828-251-1900 Permit Exp.: 1/31/22
nit
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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

��- NUN-UMUMAKUt Arl'LIGAI IUN REPURT (NDAR-1) Page !.--- of
WQ0033804 Facility Name: Laurel Mountain Retreat County: Buncombe Month: October Year: 2019
d irrigation occur
Field Name
4
-----�
Field Name:
5
Fieltl Name
6
Field Name:
7
Area {acres)
0 31
Area (acres):
0.33
Area (acres)
Q 42
Area (acres):
0.38
this facility?over
at
Cro p
r %
Cover Crop:
p:
cover:Crop
Cover Crop:
❑ YES ❑ NO
Hourly Rata'(ih)
0;2`,_
Hourly Rate (in):
0.2
Ho"ugly Ratie:(inj
D:2`
Hourly Rate (in):
0.2
Annual Rate (ln)
23 53
Annual Rate (in):
23.53
A�tnsual Rate (in)
23.53
Annual Rate (in):
23.53
Weather
Freeboard
field Irrigated?
QE5p ;O iv0
Field Irrigated?
❑YES ❑ NO
Fi�il(I Irrigated?
C7"YES Ca Igo
Field Irrigated?
❑YES ❑ No
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1,7,99-
0.00

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION.REPORT (NDAR-1) Page 214
Did the application rates exceed the limits in Attachment B of your permit? IQCompliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? '-ompliant ❑ Non -Compliant
Was a suitable vegetative cover maintained ion all sites as specified in your permit? - mpliant ❑ Non -Compliant
I
Were all setbacks listed in your permit maintained for every application to each permitted site? ompliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ompliant ❑ 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 Barr
Permittee:
Laurel Mountain Retreat
Certification No.: 24262
Signing Official: Robert Barr
Grade: SI Phone Number: 828-,251-1900
Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? ❑yes ❑ No
Phone Number: 828-251-1900 Permit Exp.: 1/31/22
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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 05-16
INOWDIS,CHARGE APPLICATION REPORT (INDAR-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
Rmpliant ❑ Non-Complian
Pmpliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? pliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? PfCompliant El Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ompliant ❑ 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)ICertiflcation
Permittee Certification
ORC: Robert Barr
Permittee:
Laurel Mountain Retreat
Certification No.: . 24262
Signing Official: Robert Barr
Grade: SI Phone Number: 828-251-1900
Signing Official's Title: Signatory
Has the ORC changed since.the previous NDAR-1? ❑ Yes ❑ No
Phone Number: 828-251-1900 Permit Exp.: 1/31/22
''' 134
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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Sampling Persons)' 11 Certified Laboratories
Name: Robert Barr 11 Name: Pace Analytical, Inc.
Name: Kevin Bryan Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? LXompliant ❑ 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: Robert Barr
Permittee: Laurel Mountain Retreat
Certification No.: ' . 24262
Signing Official: Robert Barr
Grade: SI Phone Number: 828-251-1900
Signing Official's Title: Signatory
Has the ORC changed since the previous NDMR? ❑ Yes ❑ No
Phone Number: 828-251-1900 Permit Expiration: 1/31/2022
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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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617