WQ0004115_Monitoring - 12-2019_20200117

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10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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FacilityName: CHAMPION HILLS, POA
County: Henderson
Month: December
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PFR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page -6-1 of
hPea pp
tcationn rates exceed the limits in Attachment B of your permit? ElCompliant ❑Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? FZ]Compliant [:]Non-com pliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? RICompliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? Elcompliant ❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ElCompliant ❑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.
to stream.
Operator in Responsible Charge (ORC) Certification
I ORC: Karl Griffiths
Certification No.: 15613
Grade: Phone Number:
IHas the ORC changed since the p
828 696 1962
❑Yes 1]No
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:
Champion Hills, POA
Signing Official: Karl Griffiths
Signing Official's Title: ASSISTANT SUPERINTENDANT
Phone Number: 828 6961962 11 Permit Exp.: 1/31/24
1 /17/20 1 /17/20
i
Date Sign at 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 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 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Sampling Person(s)
Certified Laboratories
Name: Danielle Hunter Name: Pace Analytical
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 21 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 Danielle Hunter Permittee: Champion Hills POA
Certification No.: 1007992 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 M No Phone Number: 828-696-1962 Permit Expiration: 1/31/2024
VV W v 1'2�''2,0
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
V V 06---
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 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