WQ0024694_Monitoring - 07-2022_20220823

FORM NDAR 1 0&11 NON -DISCHARGE APPLICATION REPORT INDAR-11 Page i of

FORM: NDAR-108-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page C) of 3

FORM: NDAR-108-11 NON -DISCHARGE APPLICATION REPORT(NDAR-1) PageN of
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?
2 Compliant
❑ Norc ,Jfiam
2 Compliant
❑ Non-c ownt
2 unnorara
❑ uor npli.m
2 Cnnpllant
❑Nonrornprart
2 Compliant
❑ Non r Prcnt
If the facility is non -compliant, please explain in the space below the mason(s) the facility was not in compliance. Provide in your explanation the cartels) of the noncompliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permutes Certification
ORC: Ken Deaver
Perroldee:
AQUA NC
Certificaton No.: 992372
1j(_
signing Official Sk-nn O,1
Grand.: SI Phone Number: 828-657-1810
jCt"Gt�
Signing Official'srtle: nC 1_�5. ( 1
Has the ORC changed since the previous NDAR-I? ❑ Y. 2 No
Phone Number: 910-467 712 Permit Exp.: 10/34/24
� So 3- zt
Signature Date
Signature Date
By ft sgnaWre.I cMi r. Mis repon is. -male.. complHe W the balmy knoWem..
I ceAo. woor,oraft orlaw, thatthis tlowmeNandall atlacbmenkwee Prepared m.r mytlireebon u n¢ereicoo M acmNance
MM1 a system designed to secure Mat at quarrel PmsomolprWaly gaMeed and eMualal Me iMumamn oftnede6 Bazed on my
irdu dMepewnmpemonsmomanage Mesysem,"mpwsonsdiayrespcnsMleforga ngdieirtama dW
inWlmaAonsubmitted".lotetad NmygpM pandbegd,true,mcuale,andmmpleN.lamanae Mg Merearesgnirorm
penaldee Wr submiMng teen information indudNg flee poi Llny orMes and Imptsmmeirt ar Wuwng NobYolu,
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 276994 617

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page —Of —
Permit No.: W00024694
Facility Name: Brighes Creek Golf Club
County. Polk
IMonffb: July
Year. 2022
PPI: 002
Measuring Point: ❑ wmee O 96um[ C ooB gmoaaO
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FORM: NDMR D3-12 NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s)
Name: Rickie Daniels
Name:
Name: Water Tech Labs
Name:
Page_
Of
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? PrCbwlbla ❑ Nm-c«mlbnt
If the facilhy 3 noncompliant, please explain in the space bebw the mason(s) the factlily was not in compliance. Provide in your explanation the detain) of the noncomplisnne and describe the cenecGve
Operator in Responsible Charge (ORC) certification
PemtiNee certification
ORC: Rickie Daniels
Penni tea: AQUA NORTH CAROLINA
Certification No.: 1009769
f
Signing Official: V pCc�c�
Grade: 3 Phone Number: 704507-3415
Signing offiew,ariige: In Pr/ 54¢.j
Has the ORC changed since the previous NDMR7 ores dwo
Phone Number 919.4 712 Permit Fspiration: 10.31.2024
mni,ie Daniels -
pp
/tea/ EA s-"%_?-ZZ
Signature Date
Signature Date
Byfessgnahnn"Ic Vhone repels so nnsand onnk m Ne besllolmykmMNge.
IveMy, nna, Iy alarv. thems dmmm[a ll.mcM1men — pepareC ladx mr dinntm asupervsbn in a tie
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mYim�my«tMpttamwpemwrs Mc mara9etle syslam. «tM6apasu¢NegyresP«ewar«galF '�g tlp e(p1111am ,ft
edp�metimsLLmitletl"s.mMe bovefmrkualee ev 1I�e4e1. Mn.aau�ate. ant! ¢mgale. I am msae fvnN _siansont
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Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center