WQ0033804_Monitoring - 12-2019_20200123

-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I of T
EP0-rwQ_0033804
Facility Name: Laurel Mountain Retreat
County: Buncombe
Month: December
Year: 2019
Did irrigation occur
at this facility?
Flel[f Name
5 1,4
----=-�-
Field Name:
113
Meld Name
2 r`
Field Name:
3
'A�ee
couercop
fl 2 '
�;
Area (acres):
Cover Crop:
p:
0.19
"Area (8cies)t
Cover- Gro p�
0.34
Area (acres):
Cover Crop:
p:
0.45
❑� YES E No
HOUrly Rate (in)
fl:2 .
Hourly Rate (in):
0.2
Hourly Rate (in)
02
Hourly Rate (in):
0.2
A4n>ai R {)n)'
23 53:
Annual Rate (in):
23.53
Annual R1t:{in)
v3;
Annual Rate (in):
23.53
Weather
Freeboard
Fiea irarlgaed?
❑ x Na
Field Irrigated?
El (] No
i'ielci Irrigatd7
C} `1Es CttO
Field Irrigated?
El YES O No
o
V`.S
0)
w
d
G.
°d,��
o
O
c m
Q;
r
y"i
EIt<n
ice, 3�
c;
;' a,
O tp
d v
E m
a CL
v
d °:
_Ern
o�
a, c
,� `n
M
E rn
3 ci
E o
'X O �0
m
a
m
E
r
�,. c
o
' 10
tM
3
E o'.
�x. p
d o
E d
a
v
d ::
E
rn
>. c
IC
E rn
c
E o
'X O (0
°F
in
ft
ft`an
`, Irf . _�
gal
min
in
in��
in °-.,.
.min
�n
in
gal
min
in
in
0.,00
0
0
0.00
0.00
fl !
0°
0 00
0 00
0
0
0.00
0.00
2
SN
36
2
,y0y,r'
;,0�'
r000
':O DO
0
0
0.00
0.00
O;DO, .
, '.0,00 ;'
0
0
0.00
0.00
3
PC
42
0
�',05'!�
q'
, , p;fl0'
r"'0 q0:
0
0
0.00
0.00
��,'.� Q �'':�
,. CI',;DaOfl
. ;
,,0 00 ,;i
0
0
0.00
0.00
4
PC
50
0xD,
..
µ''tb00„�A
r43OQ., F
0
0
0.00
0.00
�} ..�s:pfl
`r`0O0
`i
0
0
0.00
0.00
5
C
55
0
7.5
U a
, 0�
0',00�
0,00„ .;';
- 0
0
0.00
0.00
: 0
_ 0
0 90 _.
00 _
. 0
0
0.00
0.00
6
PC
44
0
0.<
0
4;0,0, ,
-fl 00
0
0
0.00
0.00
0.
0: ,
p 00
i'0:00`
0
0
0.00
0.00
7p;00
0
0
0.00
0.00
0 „ = fi,'
_ 0 : ,
' O q,0
'0 fl0 ;`,
0
0
0.00
0.00
80
0
0
0.00
0.00
Q . „
p_; _
0
0
0
0.00
0.00
9
PC
66
0.13
0
00
.00
y Q `,
_ 0 #
OE00 r
00 ..,-
0
0
0.00
0.00
10
R
60
0.5
0°; ,r
�.
_ ,Q" ,
, , } O.flO
'' 0.00
0
00
.00
"0 d
0 :`
p000
OO '+;
0
0
0.00
0.00
11
PC
40
0.13
7.5
0
.00
0
0
0.00
0.00
12
C
39
0
, Q:z;
�Qa
0
0.00
13
PC
41
0.25,11
�1"
p;00 ..
0 00` `
0
0
�0.
Q ,,, ^
:0 ��
000`..,Q.Off
.;
0
0 '� E
.
0.00
14
. Q x>
fl
000
0
0
0
CB 0
0
fl
_O';,0�1
A 00
0
0
OcR �` a
F Q.00
15
�,..0a�
OF
u,0, d,�. ,
., t:�4 OQ
0
C0.00
2 ao
0 .
0
Oa'Q0
?0 .00,
0
0��
00�'
a �D
16
CL
66
0.5
O ,t";
0
: OiOp, ,
0.00 '
0
`�.00
0
0 ..,
O
00t)
,'b Q0 .
0 h
i3O
0�0 °
17
R
52
1
0.
;�;0.'0,0,0
0d0<<-
0
00
0
D.,
�0",
;000
0:00'`
0
;;�-�,�
0.00
0.00
18
C
38
0
7.5
ifl• ?,
A,
Os00�..OZO
0
0�0.00
0
`r�0:00
0
0 "�'
0jf70�:
0.00
19
C
40
00�.
p-OQ,..
0
0.00
00
0; s
..ns
.DO .
`Ok7Qs�
0
0
fib
�0;.00
20
PC
40
0
R . , ,
•. _ C?:
O;pO
; {} Op. <
0
0.00
.00
�� r , q . ..
� ; Q:
n . fl Ql) _ ,
`'.0 00 2
' 0
0
0.00
0.00
21
4 „ ,1
0; ,
', Q,00 _
��. 0 O0 ,:.
0
0.00
0.00
�09, >,
0;�
$ "0ao0 .
`0,00 �
: 0
0
0.00
0.00
22
n. 4
fl
:q:oo
0 00'
o
0
0.00
0.0o
p
o'
; o oq
' o.oa
o
0
0.00
0.00
23
PC
51
0.25
7.5
y, 0 _{ ,
� ..
b..00 ,
, ;,01,00.
0
0
0.00
0.00
0
0
0.00
0.00
24
HM
��..
_ 0,
Q:UO.
;:; fl IIt ;.
0
0
0.00
0.0000
�;-
0
0
0.00
0.00
25
H
0,^
0
OAO
fl 00„ :,
0
0
0.00
0.00
0
0
0.00
0.00
26
H
0
D"',.0:00
0.00 r
, ",0{30`,'
0
0
0.00
0.00
Q, "'
0'
,
"':-0 00
0
0
0.00
0.00
27
CL
62
0p,0q
j. q, 00, '
0
0
0.00
0.00
q '?
D".
q;;OQ
0 Oq "
0
0
0.00
0.00
281
0:Po,!,!'
'r' 0.00" '';.
0
1 0
0.00
0.00
.0 ; '_
0`
:0':00''O.OQ`'
0
0
0.00
0.00
.411 >,
0, ,,
U.00
:O Op.:;
0
0
0.00
0.00
0 �,
t 0,,
0 OQ
'0 00,..
0
0
0.00
0.00
J31
C
57
0.13
_w�f
0
0
0.00
0.00
vQ. „ "
�� y Q
Q(00��
` r0 00
0
0
0.00
0.00
7.5-
0;.
D'00
,
; '`O p0
0
0
0.00
0.00
�� 0,
"� 0" .
06p
��!0 0$' •
0
0
0.00
0.00
Monthly Loading:q'„
0
0.00
�' 0,_,0,fl0,
•,;-
0
0.00
12 Month Floating Total (in):
0 00
0.00
OOq ,
0.00

FORM: NDAR-1 054 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 770
Did the application rates exceed the limits in Attachment B of your permit? lmpfiant. ❑Non -compliant
Were adequate measures taken to prevent effluent. ponding in or runoff from. the sites? efcompliant ❑Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑ ompliant El Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? I�compfiant El Non Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? gcompliant El 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. -Of h ial: 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
l 112-32
Signature Date Signature 1. 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
1.617..Mail Service Center
Raleigh, North. Carolina.27699-1617

U5-1b NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page G of
o.: WQ0033804
Facility Name: Laurel Mountain Retreat
county: Buncombe
Month: December
Year: 2019
fetd }+jai»e4 �'
��
Field Name:
5
i>~i�Td �Ifne
'' "' 6 -
Field Name:
7
id irrigation occur ,
Area {acres) 0 31$
Area (acres):
0.33
Area (acres}
O.A2
Area (acres):
0.38
at this facility?
CoverCap
Cover Crop:
Coder„Crop
Cover Crop:
p Yes ❑ N0
Haucly n r 02t r
Hourly Rate (in):
0.2
�touetRak�(�nj
„_. �.
Hourly Rate (in):
0.2
annual Rat�trly. 23
Annual Rate (in):
23.53
A�neliff3a�t�H(in)
? w
Annual Rate (in):
23.53
Weather
Freeboard
Field�lrrigat t'� I ;YES °�C;) N0 -'
Field Irrigated?
❑ YES O No
}elf#1crTga ed'?
UY! p NO
Field Irrigated?
❑ YES 21 N0
N
G
a.
"'
C
w
N
N
y£ Ot Rt
ii� CA
1r� Of
D
N a
9
E
61
A
l6
d
16
C)
.G
Q.
Qt.
�rt�
.tlf A G
t �N3 i E
�szr
�.
AT i
y
oo
d d
a+
E�
�. C
C
L
E�'v
-
��
>, C
r. i
C
Ecs.
N
I.
�a
Q7
E�
E�'v
o
d
t
a
E
_Q
o
��oE�
_
a
��
��
--rn
>�
,�`a
R
o
xc�
co x o
R s:
t- ,
����
G roxo
s� E
o a
i= rn
,��
R
o o
><o�o
m z o
r��
„
°F
in
ft
ft
,,sgal' " z
,m n � �; " � iCL
n" r
� ir1 � �`
gal
min
in
in
ft�,`�` ,
r m(n• .
din ,,.
x� in >
gal
min
in
in
0
0
0.00
0.00
0 D0,":;
0
0
0.00
0.00
2
SN
36
2
0
0
0.00
0.00
0T...;'
„y.000d
".,=000,T
0
0
0.00
0.00
3
PC
42
0
0
0
0.00
0.00
0
0
0.00
0.00
4
PC
50
0
�0,�
p0"'�kit(,Q�'
0
0
0.00
0.00
�tq'
0
0
0.00
0.00
.0
��
Q00,`__000,.
5
C
55
0
7.5
:: ,y0,
0 a7.7 0`00 „ ,
_ w m _
0
0
0.00
0.00
3F94t}
'3(3'
k , 04
v i.:
0 �9r '
0
0
0.00
0.00
6
PC
44
0
0 ",
O f, , , "0 0�
�'� 0 310 `
0
0
0.00
0.000.0,0
•
0
0
0.00
0.00
7
Q, . _
, _...4 •` fJ 00,
` ..:.':
0
0
0.00
0.00..;
0
0
0.00
0.00
8
0
, . £ .. o oa, ,.ti
;?
o
0
0.00
0.00
�., ,
,.. o a
a ot, :
,,; a:oo.,z
o
0
0.00
0.00
9
PC
66
0.13
0,-a
„ ,p " r, , ;0 00;
O,OQ ,,
0
0
0.00
0.00
„Q •
, ,,,, 0„
; `,0 QD, ,
, ; 0 OQa
0
0
0.00
0.00
10
R
60
0.5
s,:U f `•. t?,OQE
£'`t3;{0 ",;
0
0
0.00
0.00
0,
0 00
'
0
0
0.00
0.00
_ ,A E_ _
<«,,.
„0
,
.x.�0,00
11
PC
40
0.13
7.5
0
0
0.00
0.00
"4,2i
27�7 3'
' d
0 09 =
"
,
; s
0
0
0.00
0.00
12
C
39
0
�'. 0 -t "
... _.
0
0
0.00
0.00
0
z Q" "
O�u
,EAs00
0
0
0.00
0.00
13
PC
41
0.25,U
0
0
0.00
0.00
0 "
�u,,,Q
a 0Q__,
; q 00"��� "
0
0
0.00
0.00
14
0;':.=000
.
0i}D`�"
0
0
0.00
0.00
0" "
. '. 0
}DD
�. 006
0
0
0.00
0.00
0
0
0.00
0.00
0 v
; s 0
�OtOR„"
0r0Q �,
0
0
0.00
0.00
16
CL
66
0.5
0„,
" q ,„. _, �l) pp , ,
00,_,;
0
0
0.00
0.00
0 ,o
;y 0
(�� ,
„ 0
Op _
0
0
0.00
0.00
17
R
52
1,
„"'0� wxf,,E
i�t'h�c ,{? 00
0
0
0.00
0.00
`Qyn
, , 0.{}0!
'� 0
00
0
0
0.00
0.00
18
C
38
0
7.5
Oyu TM '
„ ,h
0
0
0.00
0.00
3,16t
193` 87 ,
0 28
t7
09 ,"
0
0
0.00
0.00
19
C
40
0
0 _'
,�.fl " ",q OCi .
', p„i14
0
0
0.00
0.00
0 „',
,. q
;= O Off :
; 000 �:
0
0
0.00
0.00
20
PC
40
0"'
f1.,
_ :'t3 .''0 00
{)ai0 '
0
0
0.00
0.00
t?:"":
`0 ,
,0 t}!}
'� 0 00`, n
0 .
0
0.00
0.00
21
0,;:.�'.,`{),A00r„o�b
OQO„;
0
0
0.00
0.00
�,�.�:
"p
;..,QOU,
"OOQy_?
0
0
0.00
0.00
zzpan
��,.
o
0
0.00
0.00_..
0
0
0.00
0.00
23
PC
51
0.25
7.5
0
`,S ti t�lJ
�€x�'„
0
0
0.00
0.00
"
I?;..
•", �_
9 ....�
• p,()
0
0
0.00
0.00
24
H
>.-..0 00. ,
.' tk_OQ -
0
0
0.00
0.00
4
^ 0
ft (t3
0.0t1 ` '
0
0
0.00
0.00
25
H.Oa:'E
-; '1,,OOs`;
"
0
0
0.00
0.00
0
0
0.00
0.00
26
H
�`Ox
:. i#" p 00
'.` 0£00 "r
0
0
0.00
0.00
0 ~F� , .
0- " -
" ..,0 00, "
:; 0.00. `-
0
0
0.00
0.00
27
CL
62
0
0'S , ,
0 ., z_ A 00_'
"ti i}0,
0
0
0.00
0.00
Q -��
0
00,
, , Q 00 s„
0
0
0.00
0.00
28._,E'#,
9,op4 ,,=
0
0
0.00
0.00
" _t
o Qt.."
0
0
0.00
0.00
29
x OR'-
r;4`04, E
.:44i-0-1 !E
0
0
0.00
0.00
�£
�b, .,
,0.
3 Q
Q 0,
0
0
0.00
0.00
30
C
57
0.13
Or,
p , „ C100 , ,
wz ,ila
0
0
0.00
0.00
0 „�,
Q£
-."" O,Oft ."0;00
,'r
0
0
0.00
0.00
31
7.5
A'
<•:.'0 00 : ,
: '(f }0
0
0
0.00 _
0.00
0.00
4, + 1,t!
18;440'; '
2$8�96
i 41, �.
1 6 `
0 09" '°`
0
0
0.00
0.00
Monthly Loading:
Q;, ";,
. p 00 -:_
0
0
0.00
12 Month Floating Total (in):
-, 00 r
0:00
& ,u
0.00

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT'(NDAR-1) Page7ol
Did the application rates exceed the limits in Attachment B of your permit? Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? lompliant ❑Non -Compliant
Was a suitable vegetative cover.maintained on all sites as specified in your permit? ER'Compliant ❑ Non -Compliant
.Were all setbacks listed in your permit maintained.for every application to each permitted site? grCompliant ❑ Non -Compliant
Were all freeboards maintained „in accordance with the specified freeboard heights in your permit? Compliant El Non -Compliant
If the facility is non -compliant, please explain in the space below the a 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 A 900 Permit Exp.: 1/31/22
k..3L?,,O
f
I/23A0
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

r-WQ003804
U5-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page -7 of_�
3Facility Name: Laurel Mountain Retreat county: Buncombe Month: December Year: 2019
F�e)d Name E3 Field Name: Field game Field Name:
Did irrigation occur Area (ay es) 0.44 Area (acres): Area (acres): Area (acres):
at this facility? Cover'Crop Cover Crop: Cover Crop: Cover Crop:
0 YES ❑ No ;Hourly Rate (in), 0.2 Hourly Rate (in): Hourly Rate (in): Hourly Rate (in):
Annual.Rate:(in): 21,53 Annual Rate (in): Annyai Rat :(in): Annual Rate (in):
Weather Freeboard � F(:eld' Irrigated?' b YES 2 No Field Irrigated? ❑ YES ❑ No Field irrigated? d Yes Z] N0 ; Field Irrigated? ❑YES ❑ No
°c 3° mO m Em ¢ pa aE,:,meamya om R mE �vcm
V Nc m °A
° °= E �_E'a E oo. °rn°° ° ° o f oxE a m
CL
F- 0..
OF in ft ft gal' ?nin In in . gal min in in gal min,:` ;'.W, n . gal min in in
1 0 0 6,00 , 0,00,
2 SN 36 2 0: 0 i'`0 00 : 0.00
3 PC 42 0 0 0 QD 0 0q
4 PC 50 0
5 C 55 0 7'7" 0" ;'0 0 00,4a 0 00
6 PC 44 0 0` r 0 0 00 0 00
7 04:., O
8 0 0 =0,00 0,00
-_--
®M
mUM�
----
®i�---
®-____
----
®_----
�_©__-----
®m
-_--
�Qm�__-�--
®___®_
Monthly
Loadin_M
12 Month Floating Tot

FORM: NDAR-1 05-16 NON -DISCHARGE ' APPLICATION` REPORT (NDAR-1)
Page
Did the application rates exceed the limits in Attachment B of your permit?
C'Compliant
❑Nor -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
compliant
❑ Non -Compliant
Was a suitable -vegetative cover maintained on all sites as specified in your permit?
1. ompllant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
d1compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
Compllant
❑ 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 additinnal sheaf- if nacPccary
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
YLAI/-/ Za
zp
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-L)lbUHA,',( aE MONITORING REPORT (NDMR) Page _ - of 'G
W00033804
-Facility Name: ..Laurel Mountain Retreat
county: Buncombe
Month: December
Year: 2019
PPI: 001
Flow Measuring Point: ❑ Influent 91 Effluent ❑ No flow generated
Parameter Monitoring Point: ❑ Influent l] Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code —►
SW50
N
00310
31$16
00610
,',QLQ65
00620
OQ6Q0,'
00400
0065
00530
000�"
>
ti t' til i
� `
IAi
f C
a two a„�
d
dCf E ate..
�. Q G
i }
R • i
00
A
(� C
'
O1
C
�'N thy+ "[
l..� �'�.(",},{yQ.�� J
^}F"'�+wKM1iry ,5.. �.
..di
L
`' = m °
a'�L i
i
i
C•
i 9
� 111 ,a,• 'r
'O N
,.�. C �O
K
�C
E
-
.
4
QU v,
...
lk
'
#.� :
.q,
y 0
dT
I
,R`S'�A J-
`JZ
k
O
O
24-hr
his
:Gf?D _..<
mg/L ..#J1OOmL
mg/L
r /C ._
9
. mg/L9/L''
.,
su
�,,,�
,rrlg/L
mg/L
NTU .
3
4
919
5
11:30
0.5
,r 557 s
4"c2'0
0.349�
2 Q?
12.4'$
7.2�I:
<2.5
6
YY'yar��
8i
MIN
9
.'
r � 7
des cx�3
10753
$`� sn
qua#zer`E3:
wk
11
13:45
0.5
7.2
na
12
13451��'h�a
f
an�7S l�'
k
t v
14
t}51 ��t11
�$
^ 9s%f
,�.
��ik 2
R 1 �ySY
iR sid6
16
1y
: •4517
It
18
12:40
0.33
u
7
tJ,4
x -
19It
�� a 430
a ,
21
22
23
' 13:00
0.25
430
7
a.
24
5$9
t
25
589
`} r1 •� w
r%.
26
� Vail F E
5 �T : r'�:'
��1�
f
�` �
i 1w5
5 `U
27
28
29gw
>
r:
4
y, ;
30
589 °
et
9 5
T
31
13:30
0.25,�5$9,t
7
x
Average
'559 ;
4.00
1 00 ;
0 34
1'2Q'
12.40
13 $0
z Opp r_
0 00
Daily Maximum
4.00
0.34
1°-2 -
12.40
:1�3 80 �,'
7.20
t2 0.,0',.4
2.50
Daily Minimum
430 x`:1ti
4.00
2;p0 . <;
0.34
x:� 4 20R,_;;
12.40
r{13, 80
7.00
K2!0Q ;:
2.50
i 20
Sampling Type
Ca1Gilated'
Grab
Grab
Grab
Grakt;t
Grab
;,'ab ,a`
Grab
,
Gr�eb
Grab
; ..•
Recpr
Monthly Limitee`Perrrii(
10
1.4 `t
4
rw''
M
•
777
5
Daily Limit
w �„ r
15
25„ A
6
;, 1
6-9
10
Sample Frequency
Monthly
4 X Year
L4 X Y3ar
4 X Year
.4 X Year"',;,
4 X Year
4 X Year
Weekly
4 X Yeac ,=
4 X Year
;Coni+n,Uous

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT-(NDMR) Page
Sampling Person(s) 11 Certified Laboratories
Name: Robert Barr 11 Name: Pace Analytical, Inc.
Name: Kevin Bryan 11 Name:
1
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 9 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 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 NDMIR? ❑ Yes ❑ No
Phone Number: 828-251-1900 Permit Expiration:. 1/31/2022
O
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