WQ0037555_Monitoring - 11-2019_20191227

rumor: rvuAn-t .I u- I a NON -DISCHARGE APPLICATION' REPORT (NDAR-2) 1 Page __J_ of J_
Permit No.: W00037555
Facility Name: Trillium Links & Village
county: Jackson
Month:. November
Year: 2019
Did infiltration occur at
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FORM: NDAR-2 10-13 NON -DISCHARGE APPLICATION' REPORT (NDAR-2) Page of
Did the application rates exceed the limits in Attachment B of your permit?
a Compliant
❑ Non -Compliant
If not a basin, were the sites kept.free of vegetation and raked?
o Compliant
❑ Non -Compliant
If not a basin, were there any instances of effluent ponding in or runoff from -the sites?
o compliant
❑ Non -Compliant
If a basin, were there any instances of breakout fromAhe berms?
o compliant
❑ Non -Compliant
Was the onsite automatically activated standby power source tested and operational?
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
actions) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee.Certification
ORC: Michael Beck ?; n r.. Permittee:
Trillium Links &.village '
Certification No.: SI-991669 WW-7930• Signing Official: Robert Barr_
Grade: SI WW-IV Phone Number: 828-251-1900 Signing Official's Title: Signatory...'
Has the ORC changed since the previous NDAR-2? ❑ Yes O No Phone Number: 828-251-1900 Permit Exp.: 5/31/21
Signature Date
By this signature, I certify that this report is;accurrate and complete to the best of my knowledge.
:YV
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. l 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
InformatiorrProcessing Unit
1617iMail Service Center
Raleigh, North Carolina 27699-1617