WQ0037555_Monitoring - 12-2019_20200129

FORM: NDAR-2 10-13 NON-DISCHARGEAPPLICATION REPORT (NDAR-2) I Page If of f_

FORM: NDAR=2 10A3
NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page __Z_.of /
Did the application rates exceed the limits in Attachment B of your permit? Pe.mpliant ❑ Non -Compliant
If not a basin, were the sites kept free of vegetation and raked? compliant ❑ Non -Compliant
If not a basin, were there any instances of effluent ponding in or runoff from the sites? Compliant ❑ Non -Compliant
If a basin, were there .any instances of breakout from the berms? 59,C.Mpliant ❑ Non -Compliant
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Was the onsite automatically. activated standby power source tested and operational? 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
Operator in, Responsible Charge (ORC), Certification Permittee Certification
ORC: Michael Beck Permittee:
- Trillium,Links & Village
Certification No.: SI-991669 WW-7930 Signing Offieial: 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.
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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 Informatlon; Including the possibility of fines and Imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
i Information Processing Unit
1617 Mail<Service Center.
Raleigh, North Carolina 27699-1617