WQ0004115_Application_19960523

DIVISION OF ENVIRONMENTAL MANAGEMENT
GROUNDWATER SECTION
MEMORANDUM
TO: 4,, k
�j S4ec.t�lp Regional Office
FROM: Ati �d�l
SUBJECT: Application fory Per- e ewal
ail U SQ
I r
Permit Amendment
New Permit
--Facility--Name: -----=--- — -- - - -
County: -
Type of Project: s,e1LA%? / /ZX%-5 A t AV
APPLICABLE PERMIT NO. s : �WQ 00a-11Ws _GW
UIC
DEH
EPA
A to C
CUA
The Groundwater Section has received a copy of the referenced permit
application, a copy of which should have been sent to your Regional
Water Quality Supervisor - IF A COPY HAS NOT BEEN RECEIVED IN THE
REGIONAL OFFICE, PLEASE LET ME KNOW.
V/ The Groundwater__Section-_has received a copy of the referenced permit
application.--- -A copy of---the-application documents�we received_ is -
-- ---attached-
'
- - - - ---_
-- . JL-- 7-
The Groundwater Section has received a subsurface disposal project
from the Div. Env. Health's On -Site Wastewater Section. A copy of
the application has been forwarded to DEH's Regional Soil
Specialist, Please coordinate your review with
that.Soil Specialist.
_ Please--.rLeview'the application materials for completeness. If you feel
additional informat_Aon is necessary, please let me know no later than
17 l l ; :�' A copy of any formal request for additional information
twill be forwardbdr to you.
If you do not need any additional information_`to complete your
please provide your final comments by ,,ae 24) N,5V f yourequest
receive additional information, fur final comments a� due no , a
14 days after you receive the additional information.'
\TRANS.SHL
review,
and/or

William G. Lapsley & Associates, P.A.
Consulting Engineers and Land Planners
1635 Asheville Highway
Post Office Box 546 -
Hendersonville, North Carolina 28793
704-697-7334 • FAX [phone]
May 23, 1996
Mr. Ray Cox
N.C. Division of Environmental Management
P.O. Box 29535
Raleigh, N.C. 27626-0535
Ref: Request for Permit Modification
Permit No. WQ00004115
Area Addition to Golf Course Spray Irrigation System
Champion Hills Development
Henderson County,North Carolina.
William G. Lapsley, P.E.
Gary Tweed, P.E.
John B. Jeter, P.E.
Philip Ward, L.S.A.
-
Dear Mr. Cox:_;°;`
In follow up to our recent conversations enclosed please find � ..,r_
enclosed an application to modify the Wastewater Treatment Sprayer
Irrigation Permit for Champion Hills. The original permit' was::
issued allowing irrigation of treated wastewater on 5 golf holes.
The request for modification is to add all but two of the. remaining
golf holes and driving range to the permit. For your review the
following documents are enclosed-
1 - Original and four copies of non -discharge permit
application form for spray irrigation disposal systems.
2 - Application fee of $400.0.0.
3 - Five Copies of the Engineering Report detailing the
proposed modification.
4 - Soil Scientists Report on additional spray areas.
5 - Five sets of site plans showing original spray irrigation
golf holes and the proposed additional golf holes.
6 - Five sets of past 12 months monitoring data for the
effluent from the wastewater treatment system and existing
ground water monitoring wells.
With the last permit renewal for this system the requirement
to dilute the effluent was dropped allowing for direct application
of tertiary treated effluent to the golf course. The original
permit was issued with several buffer requirements, all which have
been eliminated from the current regulations with the exception of
buffers to surface waters and wells. With these changes it is felt
��a Printed of Recycled Paper

Mr. Ray Cox
May 23, 1996
Page Two
irrigation of all of the Champion Hills Golf Course fairways is
feasible. The addition of the remaining golf course to the
irrigation permit approximately doubles the available irrigation
area, thus reducing the loading from 1.09 gallons/square foot/week
to approximately 0.55 gallons/square foot/week. This will. allow
them greater flexibility in management of the system and will
reduce the need for use of the irrigation pond for storage of
treated wastewater.
We feel, that this modification will be of benefit to the
management of this facility, and should there be any questions do
not hesitate to contact our office at 704-697-7334.
Sincer y.yours
ary T weed, P.E.
cc Patrick S. O'Brien

State of North Carolina
Department of Environment, Health and Natural Resources
Division of Environmental Management
Non -Discharge Permit Application Form
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
SPRAY IRRIGATION DISPOSAL SYSTEMS
GENERAL INFORMATION:
1. Applicant's name (please specify the name of the municipality, co oration, individual, etc.):
C NA "?cO N N tt. L.S 1�Q�p?iZ.Z y Dc.J1y S SOC-4 lac , 104
Print Owners or Signing Official's name and title (the person who is legally responsible for the facility and its compliance
N.�. �I c� c S . r3�. ► �., , t% kc-4- �s .� �N a zaN tL-,*.- . Da'A'), 2,A,:,d.�,
0`1
Mailing address: In 0 Z N-1-a- i rA�J (2-AJ E ���► '` '^ _._
City: S0Ady ► LA_ L State:
• Zip:
Telephone Number: ( �� 4' ) (0�1 Op i Z
4. Project Name (subdivision, facility, or establishment name - should be consistent with project namiD oneplans,
specifications, letters of flow acceptance, Operational Agreements, etc.): u
C
5. Location of Spray Irrigation Facility (Street Address): I COO 17i-1ZN1 Ant CAV 5- 2C)A7
City: I-- ►"��ZsaNy��� State: - �°- . Zip: Za
"o
6. Latitude:Sf zcLongitude s2o
3of Spray Irrigation Facility
7. Contact person who can answer questions about application: /,
Name: GA 22_q l `w � , �' Telephone Number. ( 00 L 6oc7f) " %33`�-
8. Application Date: 1901(a
9. Fee Submitted: S 40©• [The permit processing fee should be a; specified in 15A NCAC 2H .0205(c)(5).J
10. County(ies) where project is -located:. 4 e i-�
II. PERMIT INFORMATION:
1. Application No. (will be completed by DEM):
2. Specify whether project is: new; renewal*; modification
* For renewals, complete only sections I, II, and applicant signature (on page 7). Submit only pages 1, 2, and 9 (original
and three copies of each). Engineer's signature not required for renewal without other modifications.
3. if this application is being submitted as a result of a renewal or modification to an existing permit, list the existing permit
number OD O 41 1 S" and its issue date
4. Specify whether the applicant is public or ►� private.
FORM: SIDS 07/94 Page I of 8

III. INFORMATION ON WASTEWATER:
1. Nature of Wastewater: 10 0O % Domestic;
% Other waste (specify):
% Commercial: % Industrial:
2. Please provide a one or two word description specifying the origin of the wastewater, such as school, subdivision, hospital.
commercial, industrial, apartments, etc.:
5 (4 3�. v I S. o .J — e� L— " �u I Cow. i y C-1—v 3
3. If wastewater is not domestic in nature. what level of pretreatment has been provided to ensure protection of the receiving
wastewater treatment facility: !�
4. Volume of wastewater generated by this project: ��� OOU oallons per day
'S. Explanation/C✓
of how the wastewater volume was determined: __5 5-S t4 •-s ��^3 ba 7�•-• �2o&Ab14Z
26, oo C�� 1, �� l�4 ^� ITS 1� f��Z/� ICJ✓ G?7 oc lc
C_ L, u 3 1-�ro tis Z, C c7o (,7,>`Z-_) —L-b—i It c— l 40, 000
6. Brief project description: Sii,re 4g�.o c-.4 E
IV. FACILITY DESIGN CRITERIA, FOR SINGLE FAMILY SPRAY IRRIGATION
1. Number of bedrooms: x 120 GPD per bedroom = gallons (minimum 240 GPD design flow per home).
2. Dimensions of baffled septic tank: ft. by ft. by ft.
3. Volume of baffled septic tank: gallons.
4. Check the categories that apply for the sand filter: surface; subsurface; single; dual;
in series; in parallel: recirculating; pressure dosed.
5. a) Primary sand filter dimensions: ft. by ft = square feet. .
b) Sand filter surface loading rate: D per square foot.
6. a) Secondary sand filter dimensionN
plica le) ft. by square feet.
b) Secondary sand filter surface loading rate (if pli ble) GPD per square foot.
7. Type of disinfection:
Volume of contact tank: gallons; and detention time: minutes
8. Volume of storage provided: gallons; Storage time provided: days
NOTE: A minimum of 5 days storage must be provided in the pump/storage tank.
9. Volume of pump tank: gallons; number of pumps in pump tank
10. Capacity of pumps in pump tank: GPM
11. Specify which high water alarms have been provided: audible and visual; auto dial
FORM: SIDS 07/94 Page 2 of 8

12. Specify the following information for the spray nozzles: psi; GPM
13. Specify the loading rate recommendation, as determined by the soils scientist:
inches per hour; inches per week; inches per year
14. Specify the square footage of the wetted irrigation area:
square feet,
and the cover crop:
15. Specify the loading rate that will occur on the spray irrigation field:
inches per hour; inches per week; inches per year
16. The project must conform to the following b ffers and all other applicable buffers):
a) 400 feet between wetted area a A-ariy resi en un r separate ownership;
b) 150 feet between wetted area d r pert lin s, feet in coastal areas;
c) 100 feet between wetted area a4d a tabl we ;
d) 100 feet between wetted area and drainage ways or surface waters;
e) 50 feet between wetted area and public right -of -ways;
0 100 feet between wastewater treatment units and a potable well;
g) 50 feet between wastewater treatment units and property lines.
17. If any of the buffers specified in No. IV. 16.above are not being met, please explain how the proposed buffers will provide
equal or better protection of the Waters of the State with no increased potential for nuisance conditions:
18. NOTE: If excavation into bedrock is required for installation of the septic tank or sand filter, the respective pit must be
lined with at least a 10 mil synthetic liner. The engineer's signature and seal on this application acknowledges a
commitment to meet this requirement.
19. The spray irrigation field must be fenced with a minimum two strand barbed wire fencing. Briefly describe the fencing:
V . FACILITY DESIGN CRITERIA FOR OTHER THAN SINGLE FAMILY SYSTEMS
Provide a brief listing of the components of this treatment and disposal system, including dimensions and capacities of
tanks, pumping facilities, nozzles, high water alarms; filters, lagoons, package treatment units, disinfection facilities,
irrigation system, etc.:
2. Name of closest downslope surface waters: L .7. 'Ty 4::�Trt Fbee— F6 V LJ< L_L4Dr.J �ZwtY.
3. Classification of closest downslope surface waters: — 0,0or (as established by the Environmental Management
Commission and specified on page 6 of 8 of this application).
4. If a power failure at the pump station could impact waters classified as WS,. SA, B, or SB, describe which of the measures
are being implemented to prevent such impact, as required in 15A NCAC 2H .0200:
V liQ 11 L?71 NvV C.. ►T►.► 5 i P+e��i �� 1�0w =i iZ
� n..•� fir, sa—�-Oi2__.
FORM: SIDS 07/94 Page 3 of 8

5. Specify the loading rate recommendations as determined by the soils scientist:
Recommended Maximum inches per hour Ocj C' 4, LDvS ?SQUPVZ.C-. ;Z:; PrUL `'�UL4'
Recommended Maximum inches per year
6. For industrial wastewater, an analysis of nutrients, heavy metals totals, and synthetic organics must be provided along with
appropriate calculations showing the loading rate, based on the most limiting constituent. The chemical analysis must
include, but shall not be limited to: Total Organic Carbon, Biochemical Oxygen Demand, Chemical Oxygen Demand,
Chlorides, Phosphorus, Ammonia, Nitrates, Phenol, Total Trihalomethanes, Toxicity Characteristic Leaching Procedure
Analyses: Total Halogenated Compounds, Total Coliforms, and Total Dissolved Solids.
What is the limiting non -hydraulic constituent for this waste? IQ pounds per acre per year of
7. Specify the square footage of the wetted irrigation area: �i 2 Ac ,s sq �
and the cover crop: —P:::,
8. Specify the hydraulic loading rate that will occur on the -spray irrigation field:
Maximum Application z inches per hour
Maximum Application d• �O inches per year
lbs. per acre per year of: (limiting constituent)
9. Is hydraulics the limiting constituent? 'Yes; No.
10. Specify the storage volume required by the water balance: gallons; days
11. Volume of storage provided: Zr 4-o of Ooy gallons and yields: days
NOTE: Minimum thirty days required at the design flow rate.
12. If any of the applicable buffers noted in IV.16 are not being met, please explain how the proposed buffers will provide
equal o/r� better protection of the Waters of the State with no increased potential for nuisance conditions:
+ L-1. 3 t't, Girt.. t3 .� Ca rv. rcii
13. The treatment and spray irrigation facilities must be posted and secured in some fashion to prevent unauthorized entry.
r
Briefly describe the measures being taken: I rum--rA,
14. Is the treatment facility capable of treating the wastewater to at least secondary limits prior to storage (BOD5 5 30 mg/L;
TSS S 30 mg/L; NH3 S 15 mg/L; Fecal Coliform S 200 colonies/100 ml)? No. If No, what level of fYes
treatment can be achieved?
15. Are treatment facility or spray fields located within 100-year flood plain? Yes ✓No. If Yes, briefly describe the
protective measures being taken to protect against flooding.
16. List the Field Number of any spray. fields that are located in area where the seasonal high water table is less than 3 feet
below the surface? _ /voti '!j
17. Describe the disinfection facilities that are being provided if domestic wastewater: C 14-,-o17,1 N rarT, u 1-3
FORM: SIDS 07/94 Page 4 of 8

THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF
ENVIRONMENTAL MANAGEMENT UNLESS ALL OF THE APPLICABLE ITEMS ARE
INCLUDED WITH THE SUBMITTAL
a. One original and four copies of the completed and appropriately executed application form.
b. The appropriate permit processing fee, in accordance with 15A NCAC 2H .0205(c)(5).
c. Five (5) sets of detailed plans and specifications signed and sealed by a North Carolina Professional Engineer. The plans must
include a general location map, a topographic map, a site map which indicates where borings or hand auger samples were taken, a
map showing the land application site, buffers, structures, and property lines; along with all wells, surface waters (100-year flood
elevation), and surface drainage features within 500 feet of the land application site. Each sheet of the plans and the first page of
the specifications must be signed and sealed.
d_ Five (5) copies of an Operational Agreement (original and 4 copies) must be submitted if the wastewater treatment and disposa:
facilities will be serving single family residences, condominiums, mobile homes, or town houses and if the subject facilities wil'
be owned by the individual residents, a homeowners association, or a developer.
e. Five (5) copies of all reports, evaluations, agreements, supporting. calculations, etc. must be submitted as a part of the supporting
documents which are signed and sealed by the NC Professional Engineer. Although certain portions of this required submittal
must be developed by other professionals, inclusion of these materials under the signature and seal of a NC Professional Engineer
signifies that he has reviewed this material and has judged it to be consistent with his proposed design.
f. Five (5) copies of the existing permit if a renewal or modification.
g . For Single Family Systems (a through f above- plus g. 1, 2, 3)
1) A letter from the local health department denying the site for any permit that the health department has the authority to issue.
2) A soils scientist report (signed) which describes the soil type, color, texture through the B horizon, and recommended loading
rates with supporting calculations.
3) A signed and notarized Operation and Maintenance Agreement.
h . For Other Than Single Family (a through f above plus h. 1, 2, 3, 4, 5, 6)
1) A water balance analysis showing annual amount of wastewater that will need to be applied and the amount of land necessary
to receive the wastewater at the given loading rate. Storage requirements must be addressed and supporting calculations
provided.
2) A soils scientist report (signed) which includes texture, color, and structure of soils down to a depth of seven feet, depth,
thickness and type of any restrictive horizons, hydraulic conductivity in the most restrictive horizon, Cation Exchange
Capacity (CEC), depth of seasonal high water table, soil pH, and soils map (if available).
3) For systems treating industrial waste or any system with a design flow greater than 25,000 GPD a Hydrogeologic Report
providing the extent and lithologic character of the unconfined aquifer, transmissivity and specific yield of the unconfined
aquifer, thickness and permeability of the first confining bed, groundwater quality and direction of movement, and an
evaluation of impacts of the disposal system on water levels, movement and quality.
4) An agronomist report (signed) which states the type of vegetation that is planned for the spray fields, along with management
and harvest schedules.
5) Proposal for groundwater monitoring.
6) An analysis, of the wastewater, including heavy metals totals and synthetic organics, along with calculations for the most
limiting constituents.
FORM: SIDS 07/94 Page 5 of 8

This form must be completed by the appropriate DEM regional office and included as a part of
the project submittal information.
INSTRUCTIONS TO NC PROFESSIONAL ENGINEER:
The classification of the downslope surface waters (the surface waters that any overflow from the facility would flow toward)
in which this spray irrigation system will be constructed must be determined by the appropriate DEM regional office.
Therefore, you are required, prior to submittal of the application package, to submit this form, with items 1
through 7 completed, to the appropriate Division of Environmental Management Regional Water Quality Supervisor (see
page 8 of 8). At a minimum, you must include an 8.5" by II" copy of the portion of a 7.5 minute USGS Topographic Map
which shows the location of this spray irrigation system and the downslope surface waters in which they will be located.
Identify the closest downslope surface waters on the attached map copy. Once the regional office has completed the
classification, reincorporate this completed page and the topographic map into the complete
application form and submit the application package.
1. Applicant (specify name'of the municipality, corporation, individual, etc.): CNA
2. Name & complete address of engineering firm: (A) ► L-L- 1 1k rvN 6:% �-.�t�SL ivy 1 A�-,&!!s A,
Telephone number: ( 204
�-
3. Project name:
4. Name of closest downslope surface waters: (i . 7 • 'rr ��4�-r�+ R:� Jt�> IC- 4Jr Lc.du Cj-2xue-
5. County(ies) where the spray irrigation system and surface waters are located: �"4 �� E,rZS0%1.
6. Map name and date: %bzS t.SttUZ
NC Professional Engineer's Seal, Signature, and Date: �111ee2084
S • �(//j
Ott,
TO: REGIONAL WATER QUALITY SUPERVISOR
Please provide me with the classification of the watershed where these sewers will be constructed, as identified on the attached
map segment:
Name of surface waters: To
Classification (as established by the Environmental Management Commission): C:
Proposed classification, if applicable: A" -
Signature of regional office personnel:
(All attachments must be signed)
Date: l)
FORM: SIDS 07/94 Page 6 of 8

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Name and Complete Address of Engineering Finn: �✓ a �-�- �'� �— L��S�-"- `I `JS�-' P' ' �5� t 1•
P. C) , r >O x le_z�
City: L�&^rotIZSO/11ViLLJ► . State: %� .� Zip:
Telephone Number: .334
Professional Engineer's Certification:
attest that this application for �� A ? a AL,-5
pc_ . !�• ,—� N
has been reviewed by me and is accurate and complete to the best of my knowledge. I further attest that to the best of my knowledge
the proposed design has been prepared in accordance with the applicable regulations. Although certain portions of this submittal
package may have been developed by other professionals, inclusion of these materials under my signature and seal signifies that I have
reviewed this material and have judged it to be consistent with the proposed design.
North Carolina Professional Engineer's Seal, Signature, and Date:
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Applicant's Certification:
i
I, 7A i Z1 , U C, S - G_1?-,-1ZI r,-/.l —,attest that this application for C! L A w, ram' o ^J 4 a L-L—S
�r2c7�;L2 OLJ tiJivfLS -. O ,0
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application package
will be return incomplete
Signature Date
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANAGEMENT
WATER QUALITY SECTION
PERMITS AND ENGINEERING UNIT
POST OFFICE BOX 29535
RALEIGH, NORTH CAROLINA 27626-0535
TELEPHONE NUMBER: [phone]
FAX NUMMBER: [phone]
FORN-1: SIDS 07/94 Page 7 of 8

DIVISION OF ENVIRONMENTAL. MANAGEMENT REGIONAL OFFICES (11/93)
Asheville Regional WQ Supervisor
59 Woodfin Place
Asheville, NC 28801
[phone]
Fax [phone]
Avery
Macon
B uncombe
Madison
Burke
McDowell
Caldwell
Mitchell
Cherokee
Polk
Clay
Rutherford
Graham
Swain
Haywood
Transylvania
Henderson
Yancy
Jackson
Fayetteville Regional WQ Supervisor
Wachovia Building, Suite 714
Fayetteville, NC 28301
[phone]
Fax [phone]
Washington Regional WQ Supervisor
Post Office Box 1507
Washington, NC 27889
[phone]
Fax [phone]
Beaufort Jones
Bertie
Lenoir
Camden
Martin
Cbowan
Pamlico
Craven
Pasquotank
Currituck
Perquimans
Dare
Pitt
Gates
Tyrell
Greene
Washington
Hertford
Wayne
Hyde
Mooresville Regional WQ Supervisor
919 North Main Street
Mooresville, NC 28115
[phone]
Fax [phone]
Raleigh Regional WQ Supervisor
Post Office Box 27687
Raleigh, NC 27611
[phone]
Fax [phone]
Chatham
Nash
Durham
Northampton
Edgecombe
Orange
Franklin
Person
Granville
Vance
Halifax
Wake
Johnston
Warren
Lee
Wilson
Wilmington Region. WQ Supervisor
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
[phone]
Fax [phone]
Anson
Moore
Alexander
Mecklenburg
Brunswick
Bladen
Robeson
Cabarrus
Rowan
Carteret
Cumberland
Richmond
Catawba
Stanly
Columbus
Harnett
Sampson
Gaston
union
Duplin
Hoke
Scotland
Iredell
Cleveland
Montgomery
Lincoln
Winston-Salem Regional WQ Supervisor
8025 North Point Boulevard, Suite 100
Winston-Salem, NC 27106
[phone]
Fax [phone]
Alamance
Rockingham
Alleghany
Randolph
Ashe
Stokes
Caswell
Surry
Davidson
Watauga
Davie
Wilkes
Forsyth
Yadkin
Guilford
New Hanover
Onslow
Pender
FORM: SIDS 07/94 Page 8 of 8

ENGINEERING REPORT.
MODIFICATION TO WASTEWATER TREATMENT SPRAY IRRIGATION SYSTEM
CHAMPION HILLS
HENDERSON COUNTY, NORTH CAROLINA.
Prepared for, c'
CHAMPION HILLS PROPERTY OWNERS ASSOCIATION'''
.a_
HENDERSON COUNTY, NORTH CAROLINA;
Prepared by
William G. Lapsley & Associates,.P.A.
P.O. Box 546
1635 Asheville Highway
Hendersonville, N.C. 28793
704-697-7334
March 29, 1996 n S-,R��
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INTRODUCTION
Champion Hills Property Owners Association has retained
William G. Lapsley and Associates, P.A. to assist in the
preparation of permit applications to request modification the
existing wastewater spray irrigation,permit to allow the use
of the entire Champion Hills Golf Course for spray irrigation.
The original permit allows for application of wastewater only
on golf course fairways.12, 13, 14, 15 and 16. The existing
irrigation system operation is such that .spray heads can be
isolated through computerize irrigation controls to allow for
irrigation of any portion of the entire golf course. Champion
Hills, in order to improve the management of the wastewater
treatment and spray irrigation system, is seeking permission
to include the entire golf course fairways in the wastewater
irrigation system. Two of the golf holes have no fairway
areas and will. not be included. No additional flow or
irrigation facilities will need to be constructed. All
operational modifications will be made by reprogramming the
computerize irrigation equipment.
EXISTING WASTEWATER TREATMENT AND IRRIGATION SYSTEM
The existing Permit No. WQ0004115 (Copy included with
permit application) was last renewed on April 30, 1996. The
permit allows for the construction and operation of a 140,000
GPD wastewater collection, treatment and spray irrigation
system. The system consists of on site collection sanitary
sewers, several lift stations, one of two planned dual train

70,000 GPD package plants,. a .140,000 GPD tertiary filter,
700,000 GPD effluent holding pond, 2.4 million gallon
irrigation pond, and a 60-0 GPM irrigation pump station.
Enclosed is a plan (Sheet 2 of 4) of the existing layout
showing these facilities and the five golf course fairways
currently receiving irrigation of treated wastewater.
Wastewater loading is limited to 1.09 gallons/square
foot/week. At the design flow of 140,000 GPD.(980,000 gallons
• per week) approximately 20.6 acres is needed for spray field
area. The original five golf holes (#Is 12, 13, 14, 15, and
16) permitted contains approximately 21 acres of fairway
irrigation area.
PROPOSED PERMIT MODIFICATION
The proposed modification to the permit is to allow the use of
treated wastewater on the remaining golf course fairways and
the practice driving range. Enclosed are plans which have
been developed to show the remaining golf course, irrigation
system,. fairway areas, buffers, etc. By adding these
additional fairways, an additional 21 acres of land available
for irrigation which doubles the irrigation area. This
reduces the loading from 1.09 gallons/square foot/week to 0.55
gallons/square foot/week, thus improving the operational
conditions for the system. The total land available for land
application of wastewater is approximately 42 acres.

SYSTEM WATER BALANCE
Current System Design
Available Application Area
Application Rate
Allowable Application Rate
140,000 GPD
42 Acres
0.55 gallons/sq. ft./week
1.09 gallons/sq.ft./week
The entire golf course irrigation demands far exceed the
available wastewater flows. Irrigation utilizing stream water
will have to continue in addition to the utilization of
treated wastewater.
Included with this report is a soils study conducted by
Mr. Michael H. Owens, Professional Geologist, Mountain
Geology, Inc. Mr. Owens conducted the original soils
investigation for the existing five permitted holes. It was
felt that with his past involvement in the Champion Hills
Development that he was the most suited soils specialists for
the evaluation of the remaining golf course fairway areas.

DESIGN AND CURRENT PERMIT OPERATIONAL REQUIREMENTS
EFFLUENT HOLDING POND
1. Capacity - 700,000 Gallons (lined)
2. Retention Time - 5-Day Holding Capacity at 140,000 GPD
IRRIGATION POND
1. Capacity - 2,400,000 Gallons (unlined)
2. Side Stream Construction with side channel entrance from
stream. Stream water regulated by gate structure
LAND APPLICATION
1. Irrigation booster pump station pumps from either 5 day
holding pond or irrigation pond at a rate of 600 GPM.
2. Golf hole fairways 12, 13, 14, 15, and 16 are irrigated
on a rotating basis.
3. Allowable irrigation loading rate 1.09 gallons/sq.ft./week.
4. Total land area available for irrigation is 21 acres.
5. Sprinklers operate at a maximum of 42 GPM over an area of
approximately 22,166 sq.ft.(0.509 acres)
BUFFER REOUIREMENTS
1.
100
feet
between wetted area and residences or places
of
public
assembly under separate ownership
2.
150
feet
between wetted area and exterior property lines
3.
100
feet
between wetted area and wells
4.
50
feet
between wetted area and public right of ways
5.
25
feet
to surface water course, pond, or slope/fill
6.
50
feet
between wastewater treatment units & property lines
7.
100
feet
between wastewater treatment units and wells
Note: Buffers 1, 2, and 4 not required under current rules.

DESIGN AND PROPOSED MODIFIED PERMIT OPERATIONAL REQUIREMENTS
EFFLUENT HOLDING POND
1. Capacity - 700,000 Gallons (lined)
2. Retention Time - 5 Day Holding Capacity at 140,000 GPD
IRRIGATION POND
1. Capacity - 2,400,000 Gallons (unlined)
2. Side Stream Construction with side channel entrance from
stream. Stream water regulated by gate structure
LAND APPLICATION
1. Irrigation booster pump station pumps from either 5 day
holding pond or irrigation pond at a rate of 600 GPM.
2. Golf hole fairways 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,
13,14, 15, 16, and 18 are irrigated on a rotating basis.
3. Allowable irrigation loading rate 1.09 gallons/sq.ft./week.
4. Total land area available for irrigation is 42 acres.
5. Sprinklers operate at a maximum of 42 GPM over an area of
approximately 22,166.sq.ft.(0.509 acres)
BUFFER REQUIREMENTS
1. 100 feet between wetted area and wells
2. 25 feet to surface water course or pond
3. 50 feet between wastewater treatment units & property lines
4. 100 feet between wastewater treatment units and wells

SUMMARY AND RECOMMENDATIONS
Champion Hills Property Owners Associations is requesting
modification of Permit No. WQ0004115 to allow the use of the entire
Champion Hills Golf Course for the land application of treated
wastewater from the development. The original permit was issued
for only five golf holes. The additional land area will allow the
application of wastewater to be reduced and improve the overall
operational efficiency of the wastewater treatment system. It is
recommended that the request for permit modification be approved.

APPENDIX

State of North Carolina
Department of Environment,
Health and Natural Resources -
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
I
� CARE OF:
Ms. Sharon Olin
IPM Corporation
317 N. Washington Street
Henderson, North Carolina 28739
April 30, 1996
Mr.,Patrick S. O'Brien
Champion Hills Property Owners Association, Inc.
1000 Indian Cave Road
Hendersonville, NC 28739
Dear Mr. O'Brien:
[DEHNF-i
Subject: Permit No. WQ0004115 •
Champion Hills Property Owners Association, Inc.
(Formerly, Branigar Organization, Inc.)
Champion Hills Subdivision
Wastewater Collection, Treatment, Spray Irrigation
Henderson County
. In accordance with the permit name change request received on December. 15, 1995, we are
forwarding herewith Permit Number WQ0004115 as -amended, dated April 30, 1996, to Champion Hills
Property Owners Association, Inc., for the continued operation of the subject wastewater collection,
treatment and spray irrigation facilities. In accordance with the previous permit, the sampling point to test
fecal levels shall be established at a point after the effluent leaves the treatment plant, but prior to entering
the first pond. This permit is to reflect the change of ownership of the subject facilities from Branigar
Organization, Inc. to the Champion Hills Property Owners Association, Inc.
�, 1 tv ter._ : ��� .� l,o a t� .� : ,� �.:1 !► t .Vh Z 1 200-0. s"-3.11 "vid P-r-rrit
l Ill$ lJ�.ril lit .;I a.l U efffect. V .-dial lhr� d aly o ..�.+u:..il•r•i ...a.:• ..:...• ✓ �, v..•, ••.
No. WQ0004115 issued May 1, 1995, and shall be subject to the conditions and limitations as specified
therein. Please pay particular attention to the monitoring requirements in this.permit. Failure to establish
an adequate system for collecting and maintaining the required operational, information will result in future
compliance problems.
If any parts, requirements,'or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within thirty (30) days following receipt of
this permit. This request must be in the form of a written petition, conforming to Chapter 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings, P.O. Drawer
27447, Raleigh, NC 27611-7447. Unless such demands are made this permit shall be.final and binding.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

If you need additional information concerning this matter, please contact Mr. John Seymour at
[phone] ext. 546.
Sincerely,
A. Presto) Howard, Jr., P.E.
cc: Henderson County Health Department
William Lapsley & Associates
Asheville Regional Office, Water Quality Section
Asheville Regional Office, Groundwater Section
Brian Wagner, Groundwater Section, Central Office
Training and Certification Unit (No Revised Rating).
Facilities Assessment Unit

NORTH CAROLINA .
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
RALEIGH
SPRAY IRRIGATION SYSTEM PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION T•S MERELY GR_ANTF:D TO
Champion Hills Property Owners .Association, Inc.
Henderson County
FOR THE
continued operation of a 140,000 GPD wastewater collection, treatment and spray irrigation system
consisting of approximately 36,010 linear feet of 8-inch gravity sewer collection line; a 130 GPM pump
station (pump station no.1) with high water alarms, alternate power source and approximately 100 linear
feet of 4-inch force main; a 40 GPM pump station (pump station no.2) with high water alarms, grinder
pumps, and approximately 320 linear feet of 3-inch force main; a 40 GPM pump station (pump station
no.3) with high water alarms, grinder pumps, and approximately 2,000 linear feet of 3-inch force main; a
40 GPM pump station (pump station no.4) with high water alarms, grinder pumps, and approximately
1,200 linear feet of 3-inch force main; a 30 GPM pump station (pump station no.5) with high water
alarms, grinder pumps, and approximately 920 linear feet of 2-inch force main; a 15 GPM pump station
(pump station no.6) .with high water alarms, grinder pumps, and approximately 265 linear feet of 1.5-inch
force main; a 10 GPM pump station (pump station no. 7) with high water alarms, grinder pumps and
approximately 500 linear feet of 1.5-inch force main; dual 70,000 GPD package wastewater treatment
plants, each having an influent bar screen, a 25,200 gallon flow equalization tank with dual submersible
pumps and blower unit, two (2) 35,165 gallon aeration tanks in parallel, two (2) 240 cfm blowers, a
12,300 gallon clarifier, a 5,470 gallon aerated sludge holding tank, and associated piping, valves. and
appurtenances; a 130 GPM �fflumt nu:mo statien,(p»_mo station no.8) with high water alarms, alternate
power source and approximately 306 `linear feet of 3-inch force main; a 6.70 million gallon effluent
holding pond with an artificial liner (having a hydraulic conductivity of no greater than 1 x 10-6cm/sec); a
12-inch drain line with gate valve; a 2.4 million gallon irrigation pond; a 600 GPM spray irrigation pump
station providing spray irrigation to golf course fairways 12, 13, 14, 15 and 16, all serving the Champion
Hills Development, with no discharge of wastes to the surface waters, pursuant to the subject permit name
change request received December 15, 1995, and in conformity with the project plan, specifications, and
other supporting data subsequently filed and approved by the Department of Environment, Health and
Natural Resources and considered a part of this permit.
This permit shall be effective from the date of issuance until March 31, 2000, shall void Permit
No. WQ0004115 issued May 1, 1995, and shall be subject to the following specified conditions and
limitations:

I.
PERFORMANCE STANDARDS_
H.
1. The spray irrigation facilities shall be effectively maintained and operated at all times so that
there is no discharge to the surface waters, nor any contamination of ground waters which
will render them unsatisfactory for normal use. In the event that the facilities fail to perform
satisfactorily, including the creation of nuisance conditions or failure of the irrigation area
to adequately assimilate the wastewater, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Environmental
Management, such as the construction of additional or replacement wastewater treatment
and disposal facilities.
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwaters resulting from the operation of this facility.
3. The residuals generated from these treatment facilities must be disposed in accordance with
General Statute 143-215.1 and in a manner approved by the North Carolina Division of
Environmental Management.
4. Dlversiuii (j►' %jof '.he ch*reutcCl 'astzwavr From. the treatment facilities is
prohibited.
5. The following buffers shall be maintained:
a) 100 feet between wetted area and residences or places of public assembly under
separate ownership,
b) 150 feet between wetted area and exterior property lines,
c) 100 feet between wetted area and wells,
d) 50 feet between wetted area and public right of ways,
e) 25 feet to a surface water course, pond, or slope/fill,
f) 50 feet between wastewater treatment units and property lines,
g) 100 feet between wastewater treatment units and wells.
Some of the buffers specified above may not have been included in previous permits for
this waste treatment and disposal system. These buffers are not intended to prohibit or
prevent modifications, which are required by the Division, to improve performance of the
existing treatment facility. These buffers do, however, apply to modifications of the
treatment and disposal facilities which are for the purpose of increasing the flow that is
tributary to the facility. These buffers do apply to any expansion or modification of the
high rate infiltration areas and apply in instances in which the sale of property would cause
any of the buffers now complied with, for the treatment and disposal facilities, to be
violated. The applicant is .advised that any modifications to the existing facilities will
require a pe.. inii rcluniTkatiui,.
6. Public access to the land application sites shall be controlled during active site use. Such
controls may include the posting of signs showing the activities being conducted at each
site. A sign shall be posted in plain sight in the club house showing these activities.
OPERATION AND MAINTENANCE REQUIREMENTS
1. The facilities shall be properly maintained and operated at all times.

2. Upon classification of the facility by the Certification Commission, the Permittee shall
employ a certified wastewater treatment plant operator to be in responsible charge (ORC) of
the wastewater treatment facilities. The operator must hold a certificate of the type and
grade at least equivalent to or greater than the classification assigned to the wastewater
treatment facilities by the Certification Commission. The Permittee must also employ a
certified back-up operator of the appropriate type and grade to comply with the conditions
of Title 15A, Chapter 8A, .0202. The ORC of the facility must visit each Class I facility at
least weekly and each Class I1, III, and IV facility at least daily, excluding weekends and
holidays, and must properly manage and document daily operation and maintenance of the
facility and must comply with all other conditions of Title 15A, Chapter 8A, .0202.
3. A suitable vegetative cover shall be maintained on the spray irrigation areas.
4. Irrigation shall not be performed during inclement weather or when the ground is in a
condition that will cause runoff.
5. Adequate measures shall be taken to prevent wastewater runoff from the spray field.
6. The facilities shall be effectively maintained and -operated as a non -discharge system to
prevent the discharge of any wastewater resulting from the operation of this facility.
7. The application rate for each individual sprinkler shall not exceed 22.5 inches per year. The
corresponding maximum application rate (where the wetted perimeters for any 4 sprinklers
overlap) is, therefore, 91 inches per year.
8. No type of wastewater other than that from the Champion Hills Development shall be
sprayed onto the irrigation area.
III. MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, soil or plant tissue analyses)
deemed necessary by the Division of Environmental Management to insure surface and
ground water protection will be established -and an acceptable sampling reporting schedule
shall be followed.
2. As an indicator of proper operation and maintenance, the facility shall produce an effluent
in compliance with the following limitations:
Parameter Monthly Averaaea Daily Maximumb
Flow 0.140 iv1GD
BOD5 (5-day, 20°C) 10 mg/1 15 mg/1
NH3 as N 4 mg/1 .6 mg/1
TSS 5 mg/1 10 mg/1
Fecal Coliform 5 per 100 ml
a Monthly average shall be the arithmetic mean of all samples collected during the
reporting period.
b Daily maximum shall be the maximum value of all samples collected during the reporting
period.

The effluent from the subject facilities shall be monitored, by the Permittee, at the point
prior to discharge to the long term holding pond for the following parameters:
Parameter Sampling Point Sampling Frequency Type of Sample
Flow
BOD5 (5-day, 20°C)
NH3 as N
TSS
Fecal Coliform
Settleable Matter,
Residual Chlorine
NO3
TDS
TOC
Chloride
Influent or Effluent
Continuous
Recording
Effluent
*2/Month
Composite
Effluent
*2/Month
Composite
Effluent
*2/Month
Composite
Effluent (prior to 1st pond)
*2/Month
Grab
Effluent
Daily
Grab .
Effluent
Daily
Grab
Effluent
**Triannually
Grab
Effluent
**Triannually
Grab
Effluent
**Triannually
Grab
Effluent
**Triannually
Grab
The effluent pH shall not be less than 6.0 standard units nor greater than 9.0 standard
units.
* 2/Month sampling frequency only during the months of April through October. During
the remainder of the year, these parameters shall be monitored monthly.
** Triannual sampling shall be conducted during March, July and November.
If Groundwater sampling indicates or predicts problems with the compliance with
Groundwater Standards, this permit will be modified to include additional and/or more
restrictive limitations.
3. Adequate records shall be maintained by the Permittee tracking the amount of wastewater
disposed. These records shall include, but are not necessarily limited to the following
information:
a. date and time of irrigation,
b. volume of wastewater irrigated,
c. zone irrigated,
d. length of time zone is irrigated,
e. continuous weekly, monthly, and year-to-date hydraulic (inches/acre) loadings for each
zone,
f. weather cofididcnii-,. a-,d
g. maintenance of cover crops.-
4. Three (3) copies of all operation and disposal records (as specified in condition III 3) on
Form NDAR-1 shall be submitted on or before the last day of the following month. Three
(3) copies of all effluent monitoring data (as specified in condition III 2) on Form NDMR-1
shall be submitted on or before the last day of April, August and December. All
information shall be submitted to the following address:
NC Division of Environmental Management
Water Quality Section
Facility Assessment Unit
Post Office Box 29535
Raleigh, NC 27626-0535
4

5. A record shall be maintained of all residuals removed from this facility. This record shall
include the name of the hauler, permit authorizing the disposal or a letter from a
municipality agreeing to accept the residuals, date the residuals were hauled, and volume of
residuals removed.
6. A maintenance log shall be maintained at this facility including but not limited to the
following items:
a. Daily sampling results including residual chlorine, settleable matter, and dissolved
oxygen in the aeration basin and at the clarifier weir.
b. Visual observations of the plant and plant site.
c. Record of preventative maintenance (changing of filters, adjusting belt tensions, alarm
testing, diffuser inspections and cleanings, etc.).
d. Date of calibration of flow measurement device.
e. Date and results of power interruption testing on alternate power supply.
7. Noncompliance Notification:
The.Permittee shall report by telephone to the Asheville Regional Office, telephone number
[phone], as soon as possible, but in no case more than 24 hours or on the next
working day following the occurrence or first knowledge of the occurrence of any of the
following:
a. Any occurrence at the wastewater treatment facility which results in the treatment of
significant amounts of wastes which are abnormal in quantity or characteristic, such as
the dumping of the contents of a sludge digester; the known passage of a slug of
hazardous substance through the facility; or any other unusual circumstances.
b. Any process unit failure, due to known or unknown reasons, that render thefacility
incapable of adequate wastewater treatment such as mechanical or electrical failures of
pumps, aerators, compressors, etc.
c. Any failure of a pumping station, sewer line, or treatment facility resulting in a by-pass
directly to receiving waters without treatment of all or any portion of the influent to
such station or facility.
d. Any time'that self -monitoring information indicates that the facility has gone out of
compliance with its permit limitations.
Persons reporting such occurrences by telephone shall also file a written report in letter
form wit:-,;,-, 15 days following first knowled-ge cif.thy,.uccurreuce..: This. report must outline
the actions taken or proposed to be taken to ensure that. the problem does not recur.
I V . GROUNDWATER REQUIREMENTS
1. Monitor wells MW#1 and MW#2 shall be sampled every March, July and November for
the following parameters:
NO3 Ammonia Nitrogen
TDS TOC
pH Water Level
Chloride Fecal Coliforms
Orthophosphate Total Suspended Solids
Volatile Organic Compounds- In November only (by Method 1 or 2 below)
Method l: Method 6230D (Capillary - Column), "Standard Methods For The
Examination of Water and Wastewater", 17th ed., 1989
5

Method 2: Method 502.2"Methods For The Determination Of Organic Compounds
In Drinking Water", U.S. EPA-600/4-88/039
The measurement of water levels must be made prior to sampling for the remaining
parameters. The depth to water in each well shall be measured from the surveyed point on
the top of the casing.
The measuring points (top of well casing) of all monitoring wells shall be surveyed to
provide the relative elevation of the measuring point for each monitoring well.
If TOC concentrations greater than 10 mg/1 are detected in any downgradient monitoring
well, additional sampling and analysis. must be conducted to identify the individual
constituents comprising this TOC concentration. If the TOC concentration as measured in
the background monitor well exceeds 10 mg/l, this concentration will be taken to represent
the naturally occurring TOC concentration. Any exceedances of this naturally occurring
TOC concentration in the downgradient wells shall be subject to the additional sampling
and analysis as described above.
If an; v-1^ri1� ri?ani.� compounds are detected by Method 6230D, or the equivalent Method
502.2, then the Asheville Regional Office Groundwater -.Supervisor, teltphont number
[phone], must be contacted immediately for further instructions regarding any
additional follow-up analyses required. The results of all initial and follow-up analyses
must be submitted simultaneously.
The results of the sampling and analysis shall be sent to the Groundwater Section, Permits
and Compliance Unit, P.O. Box 29535 Raleigh, N.C. 27626-0535 on Form GW-59
[Compliance Monitoring Report Form] every April, August and December.
2. Any additional groundwater quality monitoring, as deemed necessary by the Division, shall
be provided.
3. The COMPLIANCE BOUNDARY for the disposal system is specified by regulations in
15A NCAC 2L, Groundwater Classifications and Standards. The Compliance Boundary is
for the disposal system constructed after December 31, 1983 is established at either (1) 250
feet from the waste disposal area, or (2) 50 feet within the property boundary, whichever is
closest to the waste disposal area. An exceedance of Groundwater Quality Standards at or
beyond the Compliance Boundary is subject to immediate remediation action in addition to
the penalty provisions applicable under General Statute 143-215.6A(a)(1).
In accordance with 15A NCAC 2L, a REVIEW BOUNDARY is established around the
disposal systems midway between the Compliance Boundary and the perimeter of the
wv ste. rlisCesat. �r?�.. Any exce;�danee of standards at the Review Boundary shall require
remediation action on the part of the'permitfee.
4. Within sixty (60) days of permit issuance, the permittee shall submit two original copies of
a.scaled map (scale no greater than 1":100') signed and sealed by a state licensed land
surveyor that indicates all of the following information:
a. the location and identity of each monitoring well,
b . the location of the waste disposal system,
c. the location of all property boundaries,
d. the latitude and longitude of the established horizontal control monument,
e. the relative elevation of the top of the well casing (which shall be known as the
"measuring'point"), and
f. the depth of water below the measuring point at the time the measuring point is
established.

The survey shall be conducted using approved practices outlined in North Carolina General
Statutes Chapter 89C and the North Carolina Administrative Code Title 21, Chapter 56.
The surveyor shall establish a horizontal control monument on the property of the waste
disposal system and determine the latitude and longitude of this horizontal control
monument to a horizontal positional accuracy of +/- 10 feet. All other features listed in a.
through e. above shall be surveyed relative to this horizontal control monument. The
positional accuracy of features listed in a. through e. above shall have a ratio of precision
not to exceed an error of closure of 1.foot per 10,000 feet of perimeter of the survey. Any
features located by the radial method will be located from a minimum of two points.
Horizontal control monument shall be installed in such a manner and made of such
materials that the monument will not be destroyed due to activities that may take place on
the property.. The map shall also be surveyed using the North American Datum of 1983
coordinate system and shall indicate the datum on the map. All bearings or azimuths shall
be based on either the true or NAD 83 grid meridian. If a Global Positioning System
(GPS) is used to determine the latitude and longitude of the horizontal control monument, a
GPS receiver that has the capability to perform differential GPS shall be used and all data
collected by the GPS receiver will be differentially corrected.
.*-The maps and -,uiy supporting documentation shall b6 sent to `the Groundwater Section,
N.C. Division of Environmental Management P.O. Box 29535 Raleigh, N.C..27626-
0535.
5. No land application of waste activities shall be undertaken when the seasonal high water
table is less than three feet below land surface.
V . INSPECTIONS
1. Adequate inspection, maintenance, and cleaning shall be provided by the Permittee to
insure proper operation of the subject facilities.
2. The Permittee or his designee shall inspect the wastewater treatment and disposal facilities
to prevent malfunctions and deterioration, operator errors and discharges which may cause
or lead to the release of wastes to the environment, a threat to human health, or a nuisance.
The Permittee shall keep an inspection log or summary including at least the date and time
of inspection, observations made, and any maintenance, repairs, or corrective actions taken
by the Permittee. This log of inspections shall be maintained by the Permittee for a period
of three years from the date of the inspection and shall be made available upon request to
the Division of Environmental Management or other permitting authority.
3. Any duly authorized officer, employee, or representative of the Division of Environmental
Management may, upon presentation of credentials,, enter and inspect any property,
premises or place on or related to the uisposal site or facility at any reasonable time for the
purpose of determining compliance with this permit; may inspect or copy any records that
must be maintained under the terms and conditions of this permit, and may obtain samples
of groundwater, surface water, or leachate.
V I. GENERAL CONDITIONS
1. This permit shall become voidable unless the facilities are constructed in accordance with
the conditions of this permit, the approved plans and specifications, and other supporting
data.
2. This permit is effective only with respect to the nature and volume of wastes described in
the application and other supporting data.

3. This permit is not transferable. In the event there is a desire for the facilities to change
ownership, or there is a name change of the Permittee, a formal permit request must be
submitted to the Division of Environmental Management accompanied by an application
fee, documentation from the parties involved, and other supporting materials as may be
appropriate. The approval of this request will be considered on its merits and may or may
not be approved.
4. Failure to abide by the conditions and limitations contained in this permit may subject the
Permittee to an enforcement action by the Division of Environmental Management in
accordance with North Carolina General Statute 143-215.6(a) to 143-215.6(c).
- 5. The issuance of this permit does not preclude the Permittee from complying with any and
all statutes, rules, regulations, or ordinances which may be imposed by other government
agencies (local, state, and federal) which have jurisdiction.
6. A set of approved plans and specifications for the subject project must be retained by the
Permittee for the li"- of the prcjC't.
7. The annual administe;-ing and compliance fze ,rust * - i,aid by te VVILMii thirty
days after being billed by the Division. Failure to pay the fee accordingly may cause the
Division to initiate action to revoke this permit as specified by 15 NCAC 2H .0205 (c)(4).
8. The Permittee, at least six (6) months prior to the expiration of this permit, shall request its
extension. Upon receipt of the request, the Commission will review the adequacy of the
facilities described therein., and if warranted, will extend the permit for such period of time
and under such conditions and limitations as it may deem appropriate.
9. The operational agreement between the permittee and the Environmental Management
Commission is incorporated herein by reference and is a condition of this permit.
Noncompliance with the terms of the operational agreement shall subject the permittee to all
sanctions provided by North Carolina General Statute 143-215.6(a) to 143-215.6(c) for
violation of or failure to act in accordance with the terms and condition s of this permit.
Permit issued this the 30th day of April, 1996
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
A. Preston Howard,. Jr., P.E. Director
Divisive of L;7i-i:,nn;�.ntal Mc�i�g�mc l.t
By Authority of the Environmental Management Commission
Permit Number WQ0004115

1325 Dills Cove Rd. Phone & Fax
Sylva, NC 28779 MOUNTAIN GEOLOGY, INC. (704) 586-39SS
CHAMPION HILLS GOLF COURSE
PRELIMINARY SOILS EVALUATION
for
EFFLUENT SPRAY IRRIGATION
(Fairway Holes 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 18, and Practice Range)
SUMMARY
Soil, saprolite, and till material were evaluated at 31 boring locations Soil texture is predominantly a
sandy clay loam to loam; saprolitc texture is loam to sandy loam; and the fill material is a mixture of the
soil and saprolite.
Groundwater saturation was indicated in four locations, at depths greater than three feet.
I recommend a weekly maximum application rate of 1.09 gallons per square foot.
METHOD OF EVALUATION
Golf course construction has resulted in a variety of soil material in the project area. Soil profiles are
poorly exposed in several of the cuts along the fairways and in some of the cart paths. During March and
April, 1996, these cuts were examined in a cursory manner and detailed examinations were made at 31
sites along the fairways. The attached map shows the detailed boring locations. Material was collected
and examined from surface to 84+ inches deep. Sample descriptions are attached. Field observations
include the nature of the material (fill, soil, saprolitc), texture, indications of groundwater.
SOIL CHARACTERISTICS
Three material types underlay the project area; soil, saprolite, and fill. Soil is the predominant
material in 20% of the locations, mprblite 35%: and fill 45%.

Boring depths range from 11 to 89 inches. In the cut areas (soil and saprolite) termination depths
were at refusal, typically on bedrock/ weathered bedrock, or boulders. In the fill, refusal was on
boulders or wood.
Soil textures range from clay to sandy loam and are predominantly (75)% sandy clay loam - loam and
coarser. Only 25% of the soil samples had textures in the clay loam - sandy clay loam range. Saprolite
textures are 60% sandy loam and 40% silt loam to loam. The fill is a heterogeneous mixture of soil and
saprolite approximately 55% of the saprolite samples had textures coarser than loam and 45% had a
finer texture.
Groundwater indications are.present in four locations: at site 7 -1, the soil is reduced at an 87 inch
depth; at 8 - 2 the soil is mottled at 45 inches and reduced at 65 inches; in 18 - 1 the soil is mottled at 50
inches; and, in 18 - 2 water was present in fill material at 40 inches.
INTERPRETATIONS & RECOMMENDATIONS
Soil Conservation Service information suggests the minimum permeability for this material is 0.6
inch/hour, and in the 0.6 to 2.0 inch/hour range, These rates are significantly greater than the current
maximum application rate of 1.09 gallon per square foot /wk.
I recommend the current application rate of 1.09 gallons per square foot /wk, be extended to the areas
examined in this evaluation.
2�MIZ104�A
+jt+11100 r8"P pi
e�50rg:�,
MICHAEL H. OWENS
:
'� SEAL
= 1086
Attachments:
I - Boring Location Maps
'�., 9E(� N 0 �.•
II - Soil Boring Logs

Attachment II
Champion Hills Golf Course
Soil Boring Logs
Fairway &
interval
material
texture
comments
boring #
(inches)
1-1
0-2
Sod
2-27 TD
Fill
L-SL
TD Rk/Bldr
1-2
0-14 TD
Fill
SCIL
TD Rk
• 1-3
0-8
Turf & Sand
9-21TD
Soil/Sp
SL-LS
TD Rk
14
0-2
Turf
2-13TD
Fill
SCIL
TD Bldr
2-1
0-8
Fill
SL
841TD
Sp
Slt L-SL
TD Rk
2-2
0-3
Soil
SL
3-24 TD
Sp
S1tL-SL
TD Rk
3-1
0-9
Fill
SL
0-19
Soil
SCIL
19-31
Sp
Slt L-SL
3148TD
Sp
LS
TD Rk
3-2
0-29
Fill
L-SL
29-84
Soil
CIL - SCIL
84-88TD
SP
L-SL
3-3
0-19
Fill
CIL - SCIL
19-23TD
Sp
LS - SL
TD Rk
3-4
9
Fill
SCIL - L
9-14 TD
Sp
SL - LS
TD Rk
4-1
0-55 TD
Fill
1/3 'SC1-SC1L
1/3 SCIL - L
1/3 SL - LS
55-89 TD
Sp
Slt L - SL - S
5-1
0-2
Sod & Sand
2-62
Fill
SCIL
62-64TD
Sed
S & Gvl
TD Gvl
Page 1- of 3

fairway &
boring #
interval
(inches)
material
texture
comments
5-2
0-1
Sod
1-15
Fill
SCIL
15-22
Fill
L-SL
22-43 TD
Fill
SL-S
TD Bldr
5-3
0-2
Sod
2-13
Soil?
SCIL
13-33
Soil
SL - S
33-87TD
Sp
SCIL-SL
6-1
0-2
Sod
2-21TD
Soil
SCIL
TD Bldr
6-2
0-2
Sod
-
2-88TD
Soil
L - SL
7-1
0-2
Sod
2-18
Fill
SCIL
18-75
Fill
40% CIL
40% SCIL
20% S
75-87
Soil
CIL - SCIL
87-89 TD
Soil
CIL - SCIL
Reduced
7-2
0-1
Sod
1-48TD
Fill
80% S
TD Bldr
20% SCIL
. 7-3
0-29TD
Fill
80% S
TD Bldr .
20% SCIL
8-1
0-9
Fill
SCIL
9-11 TD
Sp
L - SL
TD Rk
8-2
0-5
Fill
SCIL-L
5-32
Soil
SCIL
32-45
Soil
L - SL
45-65
Soil/sed
50% S
Interlayed/
50% CIL-SCIL
bedded
65-70
SoiUsed
SCIL
Reduced
70-87TD
SoiUsed
75% SCIL
Reduced
25% S
1-2".beds w/
water
Page 2 of 3

fairway &
interval
material
texture
comments
boring #
(inches)
8-3
0-9
Fill
SC1L
9-17 TD
Sp
L-SL
TD Rk
9-1
0-36
Fill
S
36-54 TD
Fill
70% S
30% SC1L
54-84TD
Soil
SC1L
10-1
0-2
Sod
2-607D
Fill
70% SL
30% SC1L-L
TD Bldr
10-2
0-2
Sod
249TD
Fill
SL
TD Wood
10-3
0-21TD
Sp
S
TD Rk
18-1
0-50
Fill
S
50-64
Soil
C1L-SCIL
Reduced
64-66TD
Sed
S & Gvl
TD Gvl
18-2
0-12
Fill
50% CIL
50% S
12-G7
Fill
S
Water @
40" (5/8/96)
67-86 TD
Soil/Sed
S
Reduced
18-3
0-14. TD
Fill
SC/L
TD Bldr
PR- 1
0-11
Fill
S
(practice
11-19TD
Sp
S
TD Rk
range)
PR - 2
0-27TD
Fill
70% S
30% SC/L
TD Rk
Notes
Soil Structures
Subangular blocky in clay, clay loam, sandy clay loam, and loam.
Granular in sandy loam, loamy sand, and sand.
Soil Colors
Unless noted in logs, soil colors are indicative of oxidation.
Restrictive Horizons
None encountered.

List of Abbreviations
Bldr
Boulder
CL
Clay
CIL
Clay Loam
Gvl
Gravel
L
Loam
LS
Loamy Sand
Rk
Rock
S
Sand
SC1L
Sandy Clay Loam
Slt L
Silty Loam
Sed
Sediment
SL
Sandy Loam
SP
Saprolite
TD
Termination Depth

Lvr mos
ow Qf
56.
WAIMA Of LUIA
L-4 S—"W.
.1 P."n,
LAMW - 3V#7'7," hVM
PLAT UN st.,Jo't
alMaou -POT FOR
CHAMPION HILLS
PROPERTY OWNERS
cl, ou" um. P-
I I-V me= omAom ma aj^ w. ASSOCIATION, INC.
TOP or 7#71 n Y
41.7
CRAB CREEK TOWNSHIP
HENDERSON COUNTY
IAUI*4' NORTH CAROUNA
SEE NOTE 15 M'43'07*
58. 12' SCALE 1 50'
MARCH ZBth, 199d
A&
S 68*14149"r
44 52.02,
UnLoff PQW
3 Elpo
jv
wo or cAsm
2.86 ACRES allr. PG. In op . nvr
TOTAL El/ 0-1 ot. UP 4 .
7-5l.W
400
E.EP
pup
Nov�" PUPW h WA FdW04ED LAND SURWIM
f -MMIUL.W tm Skft of Kft clwv**plal Not Nh d—
fft
b.9 tm b..'amm. ,A —wm trove*..bdpd 1h6 N.f.".4 U.rr, W—Ekn bwW Ift No* _ -a. PgL.Ue�
th. '06. 'd P go d.Adw 1. It-JANL-
J_ W4AS 6y COCwr "TE COWWATPK
0"IHC CIKW" h314 PROPM
06SM ASSOCWXW. W-
rw bKv4QW ookwaulKA �c.
9XAWCL%Y dAW ON
X.C.MX GW ainJK NAD 1"1.
a4f *,7a i%Wl" V DaV BOW 797. FNX 717 W BE K="yo 0" W" DEED &WK #a FW 17&
W !:R
•
4,04UX"T
V-P-w 11 ".r* n
1.~ w
AD, 10
noun= um modyan
50 0 So loo fw
GRAPtuC SCALE - FEET
A..
LOCATION MAP (NTS)
REFERENCES:
PaD.
RIMY By
O.B. 797, PR?I y
a& w Fr. 170
STACY KENT RHODES
PLAT;
NC RLS 2959
TAX 10 RDTRENCE.-
VAGWNER & RUODL9
00-047-77-7<m1-w
L*Q SuMycfts. ric.
PAM CHEF;
CHECKED BV• aGl
130 JOEL ffRGr UP.c
"DWOMMI� hCXTH CM7L1 26792
REVM40N&'
PH)OC- 7L4-693-102.2
DRAWN BY: 0r.r--rZEl

L --
NON DISCHARGE WASTEWATER MONITORING REPORT Page of
PERMIT NUMBER: �2 C.r_' LI Il 171 " I 1 ` MONTH: _ C,�1 YEAR: 1C_
FACILITY NAME: l _lac. r` _]L�LL�,--_____ . CLASS: COUNTY:
Operator
Time 2400•
Clock
•
•
Daily Rate I
(Flow)
System
pH
Chlorine
:��
,
. .. .
parameter .. .,. dunits below
MEvmwm�®©�1
ff"I
®"►®R
ME
m
• •
I�G'!�®fir
®®�®
®ice!
• .
�©®®�®®�®®
Emma
•
�[�1�����
e'
fir!®®��
OPERATOR IN RESPONSIBLE CHARGE (ORC) >1M MG11 \ .i 2.n'1 GRADE PHONE
CHECK BOX IF ORC HAS CHANGED ❑ _
CERTIFIED LABORATORIES (1) _e.irC'� �__Jp;Y�.(`, f r1/_%�r (2)
PERSON(S) COLLECTING SAMPLES
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT. X _____ _______________ __
DEHNR (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
P.O. BOX 29535 BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
1 RALEIGH, NC 27626-0535 AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NDMR 1 (7/94)

FACILITY STATUS:
Please check one of the following
1. All monitoring data and sampling frequencies meet permit requirements. ,��
L7 compliant
I. All monitoring data and sampling frequencies do NOT meet permit requirements.
If the facility is non -compliant, please explain in the space below the reason(s) the facilitywas not in compliance with Its
❑non -compliant
permit. Provide in your explanation the date(s) of the noncompliance and describe the c
additional sheets if necessary. orrective action(s) taken. Attach
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision i
accordance with a system designed to assure that qualified personnel properly
submitted. Based on my inquiry of the person or persons who manage the system, or those pe sathered andlons directly rthe � pons ble 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" P
(Pcrmittce -Please print or type)
qS�ignatur �ferrnittee)*4��
n
IUb� T, �1,:;,, C���; �d
+ (Date)
��73'i
(Pcrmtttcc Address)
l
�D`�J ��'�—C' L'� .3 bn c. —3
(Phone Number) (Permit Exp. Date)
PARAMETER CODES
01002 Arsenic
31504 Colifonn, Total 01067 Nickel
01022 Boron
odium
00094 Conductivit Y 00600 Nitrogen, Total
00310 BODS
AR
01042 Copper
01027 Cadmium
00630 NO2&NO3 ulfide
00300 Dissolved Oxygen YS (i0620 NO3 DS
00916 Calcium
31616 Fecal Colifonn 00556 Oil -Grease
00940 Chloride
emperature
01051 Lead
[00530TSS
00400 pH KN
50060 Chlorine, Total
Residual
00927 Magnesium 32730 Pl(cnols
OC
01034 Chromium
719(H) Mercury 00665 Phosphorus, Total
SS00340
COD
(?0fi10 Nli3 as N <00)37 Potassium nc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. I.• � only- Init. f i nat d in hereporting
1?ermil for renorling • In S� t 5 r e�g� t
fac
** If signed by other than the permittee, delegation of signatory authority must be on file with the slate per 15A NCAC 2I3.0506 (h) (2) (U).

Influent
NPDES NO: DISCHARGE NO: MONTH: �C,6' YEAR:
J "-P-f - s
FACILITY NAME: I (jA- �jl' COUNTY:LIP 11 (
son
•
Rm==mmmm=mmmmmmm
m�mmmmmMmmmmmmmm
mm.
mmmmmmmmm

NON DISCHARGE APPLICATION REPORT Page _L. of
SPRAY IRRIGATION SITE(S)
PERMIT NUMBER: 1 )LC "4//� TOTAL NUMBER OF FIELDS: _� MONTH: __�L___ YEAR: QS
�J�� — --
FACILITY NAME: r __—
Y I ------------ CLASS: __ � --
F�-�-I �,.4Ld-_. _ _ COUNTY:
Formulas
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic fccUgallon) x 12 nnchcs/fotri)I / [Area Sprayed (acres) x •13,500 (square fccVacre))
Maximum Hourly Loading (inches) = Daily Loading (inches) / (Time Irrigated (minutes) / 60 (minutes/hour)] Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous I I month's Monthly loadings (inches)
Average Weekly Loading (inches) = [Monthly Loading (inches/month) / Number of days in the month (days/month)] x 7 (days/weck)
FIELD NUMBER: FIELD NUMBER:
AREA SPRAYED (acres); C AREA SPRAYED (acres):
COVER CROP: P S COVER CROP:
Permitted HOURLY Rate (inches). Permitted HOURLY Rate (inches):
D
A
7
E
WEATHER CONDITIONS
Storage
Lagoon
Freeboard
I
Permitted WEEKLY Rate (inches): 3 •�
Permitted WEEKLY Rate inches
Wcathcr
Code•
Temp.
at
ap lication
Precipi-
Cation
Volume
Applied
Time
Irrigated
Maximum
Hourly
Loading
Daily
Loading
Volume
A lied
Time
Irri atcd
Maximum
Hourly
LoadingLoading
Daily
('F)
inches
fees
allons
minutes
inches
inches
galloms
minutes
inches
inches
1
2
3
C (j
d
(C.:
4
5.
6
8
9
10
11
12
13
14
1 5
16
17
18
19
.
20
21
22
23
24
25
26
27
28
29
30
31
Monthly Loading (inches)
12 Month Floating Total (inches)
Average Weekly Loading (inches)
• Weather Codes: S-sunny, PC -partly cloudy, CI -cloudy, R-rain, Sn-snow, SI-sleet
OPERATOR IN RESPONSIBLE CHARGE (ORC) � ( 5------� GRADE 1L PHONE70Y'&�J
CHECK BOX IF ORC HAS CHANGED ❑ 1wmen ate ll-)
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP -,
DIV. OF ENVIRONMENTAL MGT.
--------- -----------------------
DEHNR (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
P.O. BOX 29535 BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
RALEIGH, NC 27626-535 AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NDAR-1 (7/94)

FA(`ILITY STATUS:
Please in (by checking the appropriate box) whether the facility has
with the following permit requirements: (Note: If a requirement does not
compliant box.) Y been com y pu or non-com
apply to yourfacrliry put (NA) in the
1. The application rate(s) did not exceed the limit(s) specified in the permit. °m lia�ncmi
I Adequate measures were taken to prevent wastewater runoff from the site
(s).
3. A suitable vegetative cover was maintained on the site(s) in accordance with
the permit.
F
4. All buffer zones as specified in the permit were maintained during each
application.
® E_
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the
"I"it(s) specified in the permit
If the facility is non -compliant, please explain in E.
permit. Provide to your explanation the date(s) of the noncompliance and describe
P the space below the reason(s) the facility was not in compliance wit'
additional sheets if necessary.
the corrective action(s) taken. Att<
---------------
"I certify, under penalty of law, that this document and all attachments were
accordance with a system designed to assure that qualified personnel properly gathered
submitted. Based on my inquiry of the person or persons who manage the system, Pared under my direction or supervision in for gathering the information, the information submitted is, to the best of m n and evaluated the information
complete. I am aware that there are significant penalties for submitting false information,
persons directly responsible
and imprisonment for knowing violations." e knowledge and belief, true, accurate, and
ion, including the possibility of fine
(Permittee Address)
I
Please print or type)
.-,
(Phone Number)
(Permit Exp. Date)
If signed by other than the permiltee, delegation of signatory authority must be on rite with the state
per 15A NCAC 213.0506 (b) (2) (D) _

NON DISCHARGE WASTEWATER MONITORING REPORT Page — L of --L
PERMIT NUMBER: _1,O__Q_DO0 MONTH: P L,• YEAR:)-
FACILITY NAME: ` r uLIY�� I U (1_ � CLASS: -- COUNTY: jj�_a e CS
Sampled
Operator
III
Arrival
into I
EI •11
SystempliChlorine
i•D
1
y�
IA�I
m
...
�umR,
mom
®•
: 0
1WA
Mp
M.
FA
FM
UFLKAIUR IN RESPONSIBLE CHARGE (ORC) rn GRADE -1 L PHONE (74 0%-0003
CHECK BOX IF ORC HAS CHANGED ❑
CERTIFIED LABORATORIES V. t (2)
PERSON(S) COLLECTING SAMPLES
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV, OF ENVIRONMENTAL MGT. X_�'— �1—
DEHNR (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
P.O. BOX 29535 BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
RALEIGH, NC 27626-0535 AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NDMR-1 (7/94)

FACILITY STATUS:
Please check one of the following:
1. All monitoring data and sampling frequencies meet permit requirements.
1. All monitoring data and sampling frequencies do NOT meet permit requirements.
compliant
❑ non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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"
Zg
ittee- Please print or type)
nature of Permit ee)** (Date)
000 1nodinn Caue RA 7T'iJilkr'1sL' 0181,3% Loq)69 _ UQ(.: ��j �5
(Permittee Address)
(Phone Number) (Perntiit Exp. Date)
PARAMF.TF.R CnnFc
01002 Arsenic
31504 Coliform, Total
01067 Nickel
00929 Sodium
01022 Boron
00094 Conductivity
00600 Nitrogen, Total
00931 SAR
00310 BOD5
01042 Copper
00630 NO2&NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00620 NO3
00515 TDS
00916 Calcium
31616 Fecal Colifonn
00556 Oil-Grcasc
00010 Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Chlorine, Total
00927 Magnesium
32730 Phcnols
00680 TOC
Residual
01034 Chromium
71900 Mercury
00665 Phosphorus, Total
00530 TSS
00340 COD
00610 N113 as N
00937 Potassium
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536.
The monthly average for Fecal Coliform is to be reported as a GGOMf. f RIC mean. Use only units designated in the reporting facilitLs
permit for reporting data.
** if signed by other than the permitlee, delegation of signatory authority must he on file with the slate per 15A NCAC 213.0506 (b) (2) (t)).

-
Influent
NPDES NO: :
,,,'
L
DISCHARGE
NO:!_ MONTH : �r
i
FACILITY NAME:
� .f ;
I� �•�_T
� �-,
COUNTY
00400
00010
00545 00310
00610
00500 00530 00340
t
� _
u
C u
ENIER PARAMETER CODE ABOVE
S
UNITBELOW
8 NAM E AND
0 o
mN
E=
0
~C
T
NRS ITS
°C
MI/L
MC/L
MC/L
f'r^C U
MC/L
MC L MC L
2
.;
:
4
6
10
12
14
;.
e
t9 :
I
22
rq
/FRAGE
TIAY. MAXIMUM
g
)NTHIY MINIMUM
IE TYPE Cor G
F'rr-rn .SIR -_I
1111841

NON DISCHARGE WASTEWATER MONITORING REPORT Page __L of J
PERMIT NUMBER: _Q_(x;L�ll s _ MONTH: / V YEAR: I /J
FACILITY NAME: �4 _ i L-fZ—, __ CLASS: _ � COUNTY: �2ad--f {-_�_L„ 1
Operator
Timc On
•into
®®�
: • fr ..
Enter parametcr code a .. ,
../�
®•
%
�%��-%ate®%�����®
- s
���/�
NAM
OPERATOR IN RESPONSIBLE CHARGE (ORC)
CHECK BOX IF ORC HAS CHANGED ❑ M
CERTIFIED LABORATORIES (1)t^(���-_�
PERSON(S) COLLECTING SAMPLES
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-0535
NOMR-t (7/94)
GRADE T- PHONE1.7L� I ]-LCl�ry
(2)
X--- ----- -
(SI ATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

EAuLITY STATUS:
Please check one of the following:
1. All monitoring data and sampling frequencies meet permit requirements. Tr
compliant
1. All monitoring data and sampling frequencies do NOT meet permit requirements.
❑ non -compliant
If the facility is non -compliant, please explain in the space below the reasons) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
`.`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 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"
�MM�'S 5,a-rnC S Jrl U, M cl't
((Permittee Pleaseprintor type) '
(Signature of Per iitlee)** (Daatt y�
i1 (e)
IUC?O T—�A',.,,� CfiUP
(Permittee Address) (1W_2L 97`0LX r I +
(Phone Number) (Permit Exp. Date)
PARAMETER
CODES
01002 Arsenic
31504 Coliform, Total
ickel
00929 Sodium
01022 Boron
00094 Conductivity
itrogen, Total
F00630
00931 SAR
00310 BODS
01042 Copper
02&NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00620 NO3
00515 TDS
00916 Calcium
00940 Chloride
31616 Fecal Coliform
01051 Lead
00556 Oil -Grease
p(}40q pit
00010 Temperature
00625 TKN
50060 Chlorine, Total
Residual
00927 Magnesium
32730 Phenols
00680 TOC
01034 Chromium 71900 Mercury 00665 Phosphorus. Total 00530 TSS
11
00340 COD 00610 Nl l3 as N 00937 Potassium c
010I2 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536.
The monthly average for Fecal Coliforrn is to be reported as a GFOMI;T 121C mean. �Jsc only units decinn�tr•rl
Ilerinit for re ortinn 1a1� In (lie rr porting facility s
** If signed by other than the pern iltee, delegation of signatory authority must be on file with the stale per 1SA NCAC 26.0506 (b) (2) (D).

NON DISCHARGE APPLICATION REPORT Page _ y of
SPRAY IRRIGATION SITE(S)
PERMIT NUMBER: _ _ TOTjAL NUMBER OF FIELDS: — f — MONTH:YEAR:
I S FACILITY NAME: _ ka ,SY� �—�� - —__
----------------- CLASS: -
Formulas ----- COUNTY:E
— Daily ��2----
1,rading (inches) = I VDlume Applied (gallons) x 0.1336 (cubic fccugallun) x 12 (mche-s/Rwt)I / IArca Sprayed (acres) x 43.560 (square fecVacrc)I
Maximum Hourly Loading (inches) = Dady loading (inches) / (Time Irriga(cd (minutes) / 60 (minutcs/hour)I
12 Month Floating Total (inches) = Sum of this months Month) Loading Monthly Loading hes (inches) =Sum of Daily Loadings (inches)
y g (inches) and previous 1 I month's Munddy Landings (inches)
Average Weekly Loading (inches) = (Monthly Loading (incttes/month) / Number of days in the month (days/month)I x 7 (davc/wr� ,,
OPERATOR IN RESPONSIBLE CHARGE (ORC)c:2�
GRADE �<
CHECK BOX IF OR�
C HAS CHANGED ❑ ' _ PHONE
v l fYl1'RCr) i r'1'r)
Mad ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
NDAR•1 (7/941
X- _� ��
--------------------------------
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

FACILITY STATUS:
Please indicate (by checking the appropriate box) whether the facility has been compliant or non-
compliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.)
compliant
non-
compliant�
1. The application rate(s) did not exceed the limit(s) specified in the permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
3. A suitable vegetative cover was maintained on the site(s) in accordance with
[]El
the permit.
4. All buffer zones as, specified in the permit were maintained during each
application. }
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the El
limit(s) specified in the permit.
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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."
LJ�}i���S �; ,,��rn�s (�Nvlea,vm�tiTot N1cmt
(Permittee- Please print or type)
of Per
(Date)
/li0(1 1 iYl to ; 61 ye /t1,1,1 h Li(- 7 P %3 i 7D4 - (oq 9 DU h 3 bPC.
(Permittee Address) (Phone Number) (Permit Exp. Date)
" If signed by other than the permittee, delegation of signatory authority must be on file with the stale per 15A NCAC 213.0506 (b) (2) (D).

NON DISCHARGE WASTEWATER MONITORING REPORT Page __L oI
PERMIT NUMBER:
FACILITY NAME: MONTH: _ p
CLASS:
', z lvrst,! Lr� t Mj" l
CHECK BOX IF ORC HAS CHANGED
CERTIFIED LABORATORIES (1)
PERSON(S) COLLECTING SAMPLES
IImail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
IDIV. OF ENVIRONMENTAL MGT.
DEHNR
IP.O. BOX 29535
1RALEIGH, NC 27626-0535
NDMR-1 (7194)
YEAR: —_
GRADE __1E PHONE OLJ L '-j?-CO6,3
(2) --
X----�
(SIGNATURE OF OPERATOR IN RESPONS113LE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE

FACILITY STATUS:
Please check one of the following:
1. All monitoring data and sampling frequencies meet permit raluirements
1. All monitoring data and sampling frequencies do NOT. meet permit requirements.
❑ compliant
P non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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"
•+ ,7r m P s EnV,
(Permittee - Please print or type) 4
-tea OgYd'o-
( ignature of 11ermt tee)** (Date)
1600 :�r,r C"r Cage I'd. f1V361 (--?-'I) C17-("0DLc:.. ?,�� r)<f
(Permittee Address) (Phone Number (Permit Exp. Dale)
PARAMETER CODES
01002 Arsenic
31504 Coliform, Total
01067 Nickel
00929 Sodium
01022 Baron
00094 Conductivity
00600 Nitrogen, Total
00931 SAR
00310 BOD5
01042.Copper
00630 NO2&NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygclr
00620 NO3
00515 TDS
00916 Calcium
31616 Fecal Colilonn
00556 Oil-Grcase
WO10 Temperature
00940 Chloride
01051 lxad
(W00 pli
00625 TKN
50060 Chlorine, Total
00927 Magnesium
32730 Phenols
00680 TOC
Residual
01034 Chromiuni
71900 Mercury
00605 Phosphorus, Total
00530 TSS
W340 COD
00610 N113 as N
W937 Potassium
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536
The monthly average for fecal Col iform is to he reported as a GIiOMI; RK' mean. t_lse only units designaled in the reporting facility's
permit for reporting data.
** If signed by other than the pernittee, delegation of signatory authority must be on file with the stale per [SA NGAC 215.(I5(16 (h) (2) (U).

Influent
NPDES NO.
W
%l1J
DISCHARGE
NO:_ �f.' %� MONTH'
�Gl(`i\71
YEAR.
FACILITY NAME: -1
�;I\
`1`
_
,
COUNTY �
00400
00010
J00545
00310 100610
00500
00530
00340
E
ENTER PARAMETER CODE ABOVE 8
NAME AND
V
3_
v
0
UNITS BELOW
2
o
u N
9
1 �
u
oU
O
C urn
QEEE o
F.
E
o �
1
C u
C N N
pO
F
V F-
a
F- v
Vf
o
M N
Q Z
o C
H %n C
U
pV
o
HRS
STD
UNITS
oC
MIL
MG/ L
MG/L
MG/L
MG/L
MG/L
;.. .
-7777777
_:777
2
3
4
5
6
8
777
10
it
?!
-77777
12
7777777777777
14
>1f
16
1T
7777
18
777777
20
s�
px7
22
23
24
25
26
28
29
30
31
AVERAGE
MONTHLY MAXIMUM
U
MONTHLY MINIMUM
SAMPLE TYPE Co,G
I)I \1 Firm %112
11 1 '•ti l i

NON DISCHARGE APPLICATION REPORT Page
SPRAY IRRIGATION SITE(S) I
PERMIT NUMBER: �CvGp(= �{(L_�_ TOTALNUMBEROF FIELDS: _ MONTH: _ -- YEAR: IS__
FACILITY NAME: __LJ44 111�I;Zp__ k h 1 I 1
r �----------------- CLASS:��----- COUNTY: h�ndLSL i ---
Formulas
Daily Loading (inches). _ [ Volume Applied (gallons)*x 0.1 336 (cubic fccugallon) x 12 (inches/foot)[ / (Area Sprayed (acres) x •11,560 (square (ect/acre)l
Maximum hourly Lr)ading (inches) = Daily leading (inches) / [Time Irrigated (minutes) / 60 (mmutcdfhourll Monthly leading (inches) =Sum of Daily leatlmgs I inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Ieadings (inches)
Average Weekly Loading (inches) _ [Monthly Loading (inches/mondt) / Number of days in the month (days/mondt)I x 7 (days/wcck)
FIELD NUMBER: Orr 19ELD NUMBER:
AREA SPRAYED (acres): Ca AREA SPRAYED (acres):
COVER CROP: ItAff rG. SS COVER CROP:
Permitted IIOURLY Rate (inches): // Permitted HOURLY Rate (inches):
WEATHER CONDITIONS Permitted WEEKLY Rate (inches): 3 • p Permitted WEEKLY Rate (inches):
D
A Temp. Storage Maximum
Maximum
T Weather at Precipi- Lagoon Volume Time hourly Daily Volume Time Hourly Daily
E Codeapplication tation Freeboard Applied Irrigated Loading Loading Ap lied Irrigated loading Loading
CF) inches feet gallons minutes inches inches gallons minutes inches inches
i -
2
3
4
5
6
8
9
10
1 1 '
12
18
r814ZS. `OJ C I O JUy S O
19
20
21
22
23
24
251 ,.
26
:
27
28
29
30
31
Monthly Loading (inches)
12 Month Floating Total (inches)
Average Weekly Loading (inches)
Weather Codes: S-sunny, PC -partly cloudy, Ckloudy, R-rain, Sn-snow, SI-sleet
OPERATOR IN RESPONSIBLE CHARGE ORC t 1� 71�v�.c' �-
( ) _��
r�s`--�—_ • GRADE �PHONE
CHECK BOX IF ORC HAS CHANGED 2--
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT. X__'�
DEHNR (SIGNATURE OF, PERATOR IN RESPONSIBLE CHARGE)
P.O. BOX 29535 BY THIS SIGNATURE, I,CERTIFY THAT THIS REPORT IS ACCURATE
RALEIGH, NC 27626-535 AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NDAR-1 (7/94)

FACILITY STATUS:
Please indicate (by checking the appropriate box) whether the facility has been compliant or non -compliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.)
non-
. _compliant compliant
1. The application rate(s) did not exceed the limit(s) specified in the permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s). MV
3. A suitable vegetative cover was maintained on the site(s) in accordance with [�/]
the permit. El
4. All buffer zones as specified in the permit were maintained during each
'application. 1�1 El
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the M
limit(s) specified in the permit. Lni
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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."
S ¢ t)Dxpes
(Permittee- Please print or type)
(Date)
n
161)0 °ll7i�,
.�/1. (��, r' 7�.,� �!/I����, ti�C Z�73�a i�1��..
(Permittee Address)
(Phone Number) (Permit Exp. Date)
' If signed by other than the permittee, delegation of signatory authority must be on file with the stale per ISA NCAC 211.0506 (b) (2) (D).

NON DISCHARGE WASTEWATER MONITORING REPORT
Page � of
PERMIT NUMBER: _j(� L• C:O�-{ l - MONTH: -__ / `I
FACILITY NAME: C�c�rn'-1-� _(-_„__ -- CLASS:
T ��---- COUNTY:
YEAR:
®--
r .
,. ,
to
•11
Residual••
Chlorine
20*C
UrtKAtUH IN RESPONSIBLE CHARGE (ORC) }}{A((u .XL(11 �_ GRADE 'L— PHONE L. 1�'-�/��
CHECKBOXIFORCHASCHANGED"Q/ u�'�'L'C'�j
CERTIFIED LABORATORIES (1) _'�(n ���i�}�5 �{�U-��(2) -
------------
PERSON(S) COLLECTING SAMPLES
Mail ORIGINAL and TWO COPIES to:
!ATTN: COMPLIANCE. GROUP
DIV. OF ENVIRONMENTAL MGT.
:DEHNR
1P.O. BOX 29535
'RALEIGH, NC 27626-0535
NOMR-1 (7/94)
X _ __
(SI NATURE OF ERAT IN SPONSIBLE CHARGE)
BY THIS SIGNATURE, I CER IFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

FACILITY STATUS:
Please check one of the following:
1. All monitoring data and sampling frequencies meet permit requirements. ❑ compliant
1. All monitoring data and sampling frequencies do NOT meet permit requirements. ❑ non -compliant
If the facility is non-compliart, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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"
t—
(Permittee - Please print or type)
(Signature of Permittee)" (Date)
Iobb d'tctnCriu� Ra. ,� II1_rNC, 2S7.2-3 j hoy1(Aj-nc�r_3 e.c.3) '9S
(Permittee Address) (Phone Number) (Permit Exp. 1 ate)
PARAMETER CODES
01002 Arsenic
31504 Coliform, Total
01067 Nickel
00929 Sodium
01022 Boron
00094 Conductivity
00600 Nitrogen, Total
00931 SAR
00310 BOD5
01042 Copper
00630 NO2&NO3
00745 Sulfide
01027 Cadmium
003W Dissolved Oxygen
00620 NO3
00515 TDS
00916 Calcium
31616 Fccal Colironn
W556 Oil-Grcasc
00010 Temperature
00940 Chloride
01051 Lead
00400 pli
00625 TKN
50060 Chlorine, Total
00927 Magnesium
32730 Phcnols
00680 TOC
Residual
01034 Chromium
71900 Mercury
00665 Phosphorus, Total
00530 TSS
00340 COD
00610 NI13 as N
tx)937 Potassium
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536.
The monthly average for Fecal Coliform is to be reported as a GGONI i IZIC mean. Use only units designated in the reporting facility's
Vermit for re o[orrting data.
** if signed by other than the permittee, delegation of signatory authority must be on rile with the slate per iSA NCAC 213.0506 (h) (2) (D).

Influent
NPDES NO: (,(�(x) (2W q I I > DISCHARGE NO:. 0 C) MONTH : I�
YEAR:��
I� 1I
FACILITY NAME: i-\ n I �% ��� A I �-j COUNTY :1 t e (1(l_ (—Sc,,-,,
00400
00010
00545
00310
00610
00500
100530
00340
ENTER PARAMETER CODE ABOVE & NAME AND
w
v
UNITS BELOW
u ?
C u
c u
a
u
°v
mE
o0O
u
u
- —
v
C
8
HRS
UNITS
°C
MIL
MG/L
MG/L
MG/L
MG/L
MG/L
-777777
4
6
7
<
8
'
p'
7777
10
n
om
12
14
16
20
21
22
1 36
r C
23
24
25
26
27
28
TO
30
31
AVERAGE
MONTHLY MAXIMUM
� !�
MONTHLY MINIMUM
-
SAMPLE TYPE C or G
M %I Form %1 it-'
( I I x•1 i

NON DISCHARGE APPLICATION REPORT Faye 0} -A
SPRAY IRRIGATION SITE(S)
PERMIT .NUMBER: W QOct)4 < < �OTAAL NUMBER OF FIELDS: MONTH:. ('C:;�_YEAR:.
FACILITY NAME: Cw•t9n! 11�� — _ ___ _________ CLASS: -----._ COUNTY:-��{�I�2'-�"`�
Formulas
Daily fe)ading (inches) = (Volume Applied (gallons) x 0.1 336 (cubic fccVgalIon) x 12 (mches/h>ot)l / IArea Sprayed (acres) x 43.560 (square. Iect/acre)I
Maximum Flourty lending (incties) = Datly Ix,ading (inches) / I'I'imc Irrigated (nunutcs) / 60 (n)inuteslhour)I ,Monthly Loading (inches) = Surn ul 1)ady IA):oLngs (inches) .
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous I I month's Monthly Wadings (inches)
Average Weekly Loading (inches) = IMonthly la)ading (inches/month) / Number of days in the month (days/month)l x 7 (days/week)
FIELD NUMBER: col
FIELD NUMBER:
AREA SPRAYED acres): .5(
AREA SPRAYED acres):
COVER CROP: Vic r—
COVER CROP:
Permitted IIOURLY Rate (inches):
Permitted HOURLY Rate (inches):
D
A
T
E
WEATHER CONDITIONS
Storage
lagoon
Freeboard
Permitted WEEKLY Rate (inches): 3• 6 L' 1
Permitted WEF,KLY Rate (inches):
Weather
Code.
Temp.
at
application
Prccipi-
tation
Volume
Applied
Tit me
Irrigated
Maximum
Hourly
loading
Daily
Loading
Volume
Applied
Time
Irrigated
Maximum
Hourly
Loading
Daily
Loading
I•F)
inches
feet
gallons
minutes
inches
inches
gallons
mi nuies
inches
inches
1
2
3
4
5
6
7
..
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
S
"lZ
o
350,000
27
$
U ::.
So; ta0>7
..
-, .
28
2s
30
31
Monthly Loading (inches) (� C
12 Month Floating Total (inches)
Average Weekly Loading (inches)
Weather Codes: S-sunny, PC -parity cloudy, CI -cloudy, R-rain, Sn-snow, SI-sleet
OPERATOR IN RESPONSIBLE CHARGE (ORC) "S(rttf - _n Qt?t-Y-) _ GRADE PHONE�� 3
CHECK BOX IF ORC HAS CHANGED ❑
Mail ORIGINAL and TWO COPIES to:
ATT
I DIV. OF ENVIRONMENTAL
GROUP ----------------------
DIV. OF ENVIRONMENTAL MGT. X___________________
DEHNR (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
P.O. BOX 29535 BY THIS, SIGNATURE, I CERTIFY THATTHIS REPORT IS ACCURATE
RALEIGH, NC 27626-535 AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NDAR-1 (7/94) .

FACIIITYSTATUS:
Please indicate (by checking the appropriate box) whether the facility has been comPnliant or non-comnliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in file
compliant box.)
L The application rate(s) did not exceed the limit(s) specified in the permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
I A suitable vegetative cover was maintained on the site(s) in accordance with
the permit.
4. All buffer zones as specified in the permit were maintained during each
application.
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the
limit(s) specified in the permit'.
non-
compliant com�nit_
F ❑
Q
�
V9 ❑
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
" 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 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."
L"-QMC-S F,v v.
(Permittee- Please print or type)
/� // , ,Xignature of Perm{(tce)*
Ca
(-,e Gar/ t �y (Date)
tic '7 y ic1 �l 6d� a n (Permiltee Address) � 97
� 10 C , 311 c" l-
(Phone Number) (Permit Exp. Date)
• If signed by other than the permittee, delegation of signatory authority must be on rile with the state per 15A NCAC 213.0506 b 2

NON DISCHARGE WASTEWATER MONITORING REPORT Page --1 °t ---1--
PERMIT NUMBER: Q--VMONTH: u-n Z YEAR:
FACILITY NAME: �a-zy-y�yja -<1 CLASS: -- COUNTY: - sL
1_
OPERATOR IN RESPONSIBLE CHARGE (ORC) Si rr\ (ri0 n lJ LM GRADE T
CHECK BOX IF ORC HAS CHANGED ❑
CERTIFIED LABORATORIES (1) ����i me.s �� f�q (2)
PERSON(S) COLLECTING SAMPLESJ�ILl�l{
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-0535
NOMR-1 (7/94)
PHONE 061 3
(( GNF OPERATOR IN RESPONSIBLE CHARGE
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

FACILITY STATUS:
Please check one of the following:
1. All monitoring data and sampling frequencies meet permit requirements.
L All monitoring data and sampling frequencies do NOT meet permit requirements
Ltd' compliant
❑ non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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"
1 i _me.5 --T- �o_xf\k s 8n v,
%(Permittee - Please print or type)
�
Signature of P rmittee)-- (Date)
JD00 . tridla,-, ayety(Q(joq)�g7-00%_3 T)cc.. 31E 95'
(Permittee Address) (Phone Number (Permit Exp. Date)
PARAMETER CODES
01002 Arsenic
31504 Coliform, Total
01067 Nickel
00929 Sodium
01022 Boron
00094 Conductivity
00600 Nitrogen, Total
00931 SAR
00310 BODS
01042 Copper
00630 NO2&NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00620 NO3
00515 TDS
00916 Calcium
31616 Fecal Coliform
00556 Oil -Grease
00010 Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Chlorine, Total
00927 Magnesium
32730 Phenols
00680 TOC
Residual
01034 Chromium
71900 Mercury
00665 Phosphorus, Total
00530 TSS.
00340 COD
00610 NH3 as N
.00937 Potassium
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only units designated in the reporting facility's
permit for reporting data.
** If signed by other than the permittee, delegation of signatory authority must be on rile with the state per ISA NCAC 2B.0506 (b) (2) (D).

NON DISCHARGE APPLICATION REPORT Page I of _ I
SPRAY IRRIGATION SITE(S)
PERMIT NUMBER: U%�G2�b41(5 -_ TOTAL NUMBER OF FIELDS: MONTH: (— YEAR: _i5_
FACILITY NAME: C14 �MPION G{ �L(-s__eL
CLASS: _ � __ COUNTY: LteNC'&25o*% _
Formulas
Daily Loading (inches) _ (Volume Applied (gallons) x 0.13.16 (cubic leet/galIon) x 12 (inches/f000l / [Area Sprayed (acres) x 43.560 (square fecUacre)l
Maximurn Hourly Loading (inches) = Daily Loading (inches) / ITime Irrigated (minutes) / Ell (minutcs/houol Monthly (evading dnchusl = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Lording (inches) and previous I I month's Monthly Loadings (inches)
Average Weekly Loading (inches) = (Monthly Loading (inches/month) / Number of days in the month (days/month)I x 7 (days/week)
FIELD NUM13ER:•
SPRAYED (acres):
SPRAYEDAREA
AREA
COVER•P:
COVER CROP:
110URLY Rate (inches):
HOURLYPermitted
Permitted
WEATHER CONMT12LL__�
Weather a ,at Precipi-
Storage
Lagoon
Permitted WEEKLY Rate (inchcs�__3_ i
'Permitted WEEKLY Rate (inches):
i
VolumeTemp.
Maximum
Hourly
FrOa.un.m
Loading
e�®ate--��o��■��
LoadingMonthly
12 Month Floating Total (inches)
Average Weekly Loading (inches)
Weather Codes: S-sunny, PC -partly cloudy, CI -cloudy, R-rain, Sn-snow, SI-\\sleet \
OPERATOR IN RESPONSIBLE CHARGE (ORC) U l) JCtYYIP _ GRADE - PHONE
CHECK BOX IF ORC HAS CHANGEDj'
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT. X __ _ _ __ _ _ _ _ __
DEHNR (SIGNA RE OF OP TOR RE ONSIBLE CHARGE)
P.O. BOX 29535 BY THIS SIGNATURE, I CER THAT THIS REPORT IS ACCURATE
RALEIGH, NC 27626-535 AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NDAR-1 (7/941

FACILITYSTATUS:
Please indicate (by checking the appropriate box) whether the facility has been compliant cir non -compliant
with the following permit requirements: (Note: 1f a requirement does not apply to your facility put (NA) in the
compliant box.)
non-
compliant compliant
1. The application rate(s) did not exceed the limit(s) specified in the permit. 21� ❑
2. Adequate measures were taken to prevent wastewater runoff from the site(s). LY'
3. A suitable vegetative cover was maintained on the site(s) in accordance with
the permit.
4. All buffer zones as specified in the permit were maintained during each
application.
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the []
limit(s) specified in the permit.
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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."
(Permitf& Address)
(Permittee- Please print or type)
e of Permittee)*
20g.-6 t91'&6 3
(Phone Number)
:�12C►lis
(Date)
C
(Permit Exp. Date)
* If signed by other than the permitlee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b) (2) (D).

NON DISCHARGE WASTEWATER MONITORING REPORT Page c or_-
PERMIT NUMBER: ���{.-UC'I '`I ' `.__JMONTH: 1�,i YEAR:
FACILITY NAME: (�LL'7Xt[^YLljlt �s�CLASS: _� COUNTYsiL�
1)
o
t
e
Operator
Arrival
Time 24W
Clock
Operator
Time On
Site
ORC
on
Site?
5(M)50
(X41M I WW) 1 00310 1 W610 W530 31616
DD(o'JZ)
Daily Rate
(Flow)
into
Treatment
Svstcm
pH
Sampled
Residual
Chlorine
at the point
DOD-5
20'C
prior to_irri
NH3-N
tion
TSS
Fecal
Col iform
(Geometric
Mean*)
Sampled at the point prior to irrigation
Enter parameter code above name" and units below
(
/ V
FIRS
Y/N
MCD
UNITS
UG/L
MG/I.
MG/t.
MG/1-
/](X)ML
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
1 UZ 0
.�
29
30
31
Average
Maximum
5,
Minimum
.
Monthly Limit
Composite (C) / Grab (G)
OPERATOR IN RESPONSIBLE CHARGE (ORC) Krzf
CHECK BOX IF ORC HAS CHANGED C�- n
CERTIFIED LABORATORIES (1)
PERSON(S) COLLECTING SAMPLES
!Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-0535
GRADE "]I PHONE
(2)
X ___ZTUREOFOPER
_________ _________
(SIGN OR IN SPO SIBLE CHARGE)
BY THIS SIGNATURE, I CERTI AT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NDMR-1 (7/94)

FACILITY STATUS:
Please check one of the following:
1. All monitoring data and sampling frequencies meet permit requirements. compliant
1. All monitoring data and sampling frequencies do NOT meet permit requirements. ❑ non -compliant
If the facility is non -compliant, please explain in the space helow the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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 subinitting.false information, including the possibility of fines and
imprisonment for knowing violations"
&I . t,-)4 �0,
(PermitI.4 Address)
(Permittee - Please print or type) U
b gnu o d
( nature of Permitted)` (Date)
�S-1�2���� -�,C;� � Vic• 3 } , �`�9s
(Phone Number) (Permit Exp. Date)
PARAMETER CODES
01002 Arsenic
31504 Coliforni, Total
01067 Nickel
00929 Sodium
01022 Boron
00094 Conductivity
00600 Nitrogen, Total
00931 SAR
00310 BOD5
01042 Copper
00630 NO2&NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygcn
00620 NO3
W515 TDS
00916 Calcium
31616 Fecal Coliform
00556 Oil-Grcasc
000M Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
5W60 Chlorine, Total
00927 Magnesium
32730 Phenols
00680 TOC
Residual
01034 Chromium
71900 Mcrcury
W065 Phosphorus, Total
00530 TSS
M340 COD
00010 N113 as N
00937 Potassium
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536.
The monthly aVerage for Fecal Coliform is to be reported as a GEOME-FRIC mean. Use only units designated in the reporting facility's
permit for rl orling data,
** If signed by other than the permiltee, delegation of signatory authority must be on file with the stale per 15A NCAC 2B.0S06 (b) (2.) (D).

_ Influent _
NPDES NO: y'�� � r'' I �1 !.- � DISCHARGE( NO: L C` � MONTH : J `'` YEAR:
FACILITY NAME: L '��C�r�'U L r `= COUNTY:
11 m
111
Emmo1
It mm
1 1
____
ENTER PARAMETER CODE ABOVED
BELOWUNITS
Immimmulmosoll
mm0®m®®®®mmm
-a
mm=lmmmmmmmmmmmmm
�ommmmms�
mmmmmmm
mmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmm
mmmmmm
mmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmm
mmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmm
•
mmomm-mmmmmmmmmmm
mmmmmmmmmmmmmmmmm
mmmmmsmmmmmmmmmmm
•
�■
mmmmmmmmmmmmmms

NON DISCHARGE WASTEWATER MONITORING REPORT Page _L_ of _L
PERMIT NUMBER: `� I- �- 0 0 0 - ` (I MONTH: l�V L) J— YEAR:
FACILITY NAME: �r���! L=----- CLASS: —�_ COUNTY:
OPERATOR IN RESPONSIBLE CHARGE (ORC) Coo r `/ ( r Mn r
CHECK BOX IF ORC HAS CHANGED-
rF:RTIFIF❑ LARORATORIES (1) _
PERSON(S) COLLECTING SAMPLES
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-0535
C7GZ r`-' V (crzi
GRADE — PHONE `;f Q 2-3 �RBy
(2)
X --4 -- - —
(SIGN RE OF OPERA IN RESPONSIBLE CHARGE)
BY T S SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NOMR-1 (7/94)

FACT1,1TY STATUS:
Please check one of the following:
1. All monitoring data and sampling frequencies meet permit requirements. 9
compliant
1. All monitoring data and sampling frequencies do NOT meet permit requirements. ❑ non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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"
HYDROLOGIC, INC.
P.O. BOX 18029
ASHEVILLE, NC 28801
(Permittee Address)
(Permittee - Please print or type)
ea �aa9S
(Si nature of Permittee)** (Date)
PARAMETER CODES
�o� as�f si�9
(Phone Number) (Permit Exp. Date)
01002 Arsenic
31504 Coliform, Total
01067 Nickel
00929 Sodium
01022 Boron
00094 Conductivity
00600 Nitrogen, Total
00931 SAR
00310 BOD5
01042 Copper
00630 NO2&NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00620 NO3
00515 TDS
00916 Calcium
31616 Fecal Coliform
00556 Oil -Grease
00010 Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Chlorine, Total
00927 Magnesium
32730 Phenols
00680 TOC
Residual
01034 Chromium
71900 Mercury
00665 Phosphorus, Total
00530 TSS
00340 COD
00610 NH3 as N
00937 Potassium
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only units desiignated in the reporting facility's
permit for reporting data.
** If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b) (2) (D).

INFLUENT
NPDES NO. Woo 00f-4 (1 -5 DISCHARGE NO. 60 MONTH Ao YEAR
FACILITY NAME CA arl chi 1 H( I I COUNTY he-i"I de - --GO rl
v
ff IT, I ml,
ff IT, mil
V, lm_
•
Far r"T
Average
Minimum
DEM Form MR-2 (12/93)

NON DISCHARGE APPLICATION REPORT Page 1— of
SPRAY IRRIGATION SITE(S)
PERMIT NUMBER: w Q� %� TOTAL NUMBER OF FIELDS: MONTH: YEAR:
FACILITY NAME: Ch��� QL'—�- — _ CLASS: _-TT NTY: �� t)
Formulas
Daily Loading (inches) = (Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / (Area Sprayed (acres) x 43,560 (square feet/acre)]
Maximum 1lourly Loading (inches) = Daily Loading (inches) / (Time Irrigated (minutes) / 60 (minutes/hour)]. . Monthly Loading (inches) = Stun of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous I I month's Monthly Loadings (inches)
_ ..._ . __ ,._ r. _ rxn, n,t t .anima rioches/month) / Number of days in the month (days/month)] x 7 (days/week)
Weather Codes: S-sunny, PC -partly cloudy, CI -cloudy, R-rain, Sn-snow, SI-steel a
OPERATOR IN RESPONSIBLE CHARGE (ORC) �"''' ��� CL�r-- GRADE PHONE70
CHECK BOX IF ORC HAS CHANGED ❑
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
X---- -zE,
----4P�ETC;RWI�N�RESPQNSISLE
----------- — ----
(SIGN OF CHARGE)
BY IS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE.
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NDAR-1 (7/94)

FACILITY STATUS:
Please indicate (by checking the appropriate box) whether the facility has been compliant or non -compliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.) non-
compliant compliant
1. 1fie application rate(s) ;did not exceed the limit(s) specified in the permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s):
3. A suitable vegetative cover was maintained onthe site(s) in accordance with
El
the permit.
4. All buffer zones as specified in the permit were maintained during each a
11
application.
5. The freeboard in he treatment and/of storage lagoon(s) was not less than he
limit(s) specified in he permit.
not in
with
If he facility is non -compliant, please explain in the spacebelow
and describe he corrective
ve action(s) compliance
Attach s
permit. Provide in your explanation he dates) of
additional sheets if necessary.
"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 qualified personnel properly gathered and evaluated the information
submitted Based on myinquiry of thesubmitted is, to h beersons who st of me the y sknowledge anor those d belief, true, aersons ccurate,
for gathering he information, he information
complete. I.am aware that here are significant penalties for submitting false information, including he possibility of fines
and imprisonment for knowing violations.
/-1YDjZ0L06-1G 4 QV9
HYDROLOGIC, INC. (Permittee- Please print or type)
P.O.. BOX 18029
gSHEVILLE, NC 28801 41�tureof Permittee)*
(Date)
�o -ash sl �2
(Phone Number) (Permit Exp. Date)
(permittee Address)
* If signed by other than the permittee, delegation of signatory authority must be'on file with the state per 15A NCAC 2B.0506 (b) (2) (D).

REPORT OF ANALYSES
CHAMPION HILLS PROJECT NAME: CHAMPION HILLS
FULL CARE DATE: 09/05/95
Attn: DEBBIE MCCARSON
(Page 1 of 1)
SAMPLE DELIVERY TO LAB
LAB. No. DATE TIME SAMPLER DATE TIME .MATRIX
69994 08/24/95 0800 GARY 08/24/95 1100 WW
- CLIENT STATION ID: CHAMPION HILLS
LAB #: 69994
BOD mg/l 5.4
FECAL COLIFORM col/100ml 118
TOTAL SUSPENDED SOLIDS mg/l 2.0
AMMONIA NITROGEN mg/l 0.3
LABORATORY DIRECTOR
P.O. BOX 18029 / ASHEVILLE, NC 28814 / 122 LYMAN STREET / ASHEVILLE, NC 28801 / [phone] / FAX: [phone] / TOLL FREE:1-800-231-8889

REPORT OF ANALYSES
CHAMPION HILLS .
FULL CARE
Attn: DEBBIE MCCARSON
(Pagg 1 of 1)
SAMPLE
LAB No. DATE TIME SAMPLER
68718 08/04/95 1340 LONNIE
PROJECT NAME: CHAMPION HILLS
DATE: 08/16/95
DELIVERY TO LAB
DATE TIME MATRIX
08/04/95 1534 WW
CLIENT STATION ID: CHAMPION HILLS
LAB #: 68718
BOD mg/l 2.6
FECAL COLIFORM col/100ml < 2
TOTAL SUSPENDED SOLIDS mg/l 2.6
AMMONIA NITROGEN mg/l 0.2
LABORATORY DIRECTOR

Page _ � of
NON DISCHARGE WASTEWATER MONITORING REPORT
PERMIT NUMBER:
�Q J `�1 �`
MONTH: Q__
YEAR:
FACILITY NAME:
CLASS: JE COUNTY:
OPERATOR IN RESPONSIBLE CHARGE (ORC) �'�^��/ ( _rC < < r� GRADE PHONE l0`f L'sj�!
-CHECK BOX IF ORC HAS CHANGED �] � S�1%� I
CERTIFIED LABORATORIES (1)• !"7
PERSON(S) COLLECTING SAMPLES
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-0535
r
X C'// - - 0
(SIG RE OF OP IN RESPONSIBLE CHARGE)'
BY TH S SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE
NOMR-1 (7/94)

FACILITY STATUS:
Please check one of the following: /
1. All monitoring data and sampling frequencies meet permit requirements. C compliant
1. All monitoring data and sampling frequencies do NOT meet permit requirements. ❑ non -compliant
if the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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"
HYDROLOGIC, INC.
(Permittee - Please print or type)
P.O. BOX 18029
ASHEVILLE, NC 28801 {Sig ature of Permittee)** (Date)
(Permittee Address)
PARAMETER CODES
`7o�/—a5U S/& 9
(Phone Number)
(Permit Exp. Date)
01002 Arsenic
31504 Coliform, Total
01067 Nickel
00929 Sodium
01022 Boron
00094 Conductivity
00600. Nitrogen, Total
00931 SAR
00310 BOD5
01042 Copper
00630 NO2&NO3
00745,Sulfide '
01027 Cadmium
00300 Dissolved Oxygen
00620 NO3
00515 TDS
00916 Calcium .
31616 Fecal Colifotm
�00556 Oil -Grease
00010. Temperature
00940 Chloride
01051 Lead
00406 'pH
00625. TKN
50060 Chlorine, Total
00927 Magnesium
32730 Phenols
010 TOC
Residual
01034 Chromium
71900 Mercury
00665 Phosphorus, Total
00530 TSS
00340 COD
00610 NH3.as N ..,.._
00937 Potassium.
01092 Zinc_ .. _ .
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536.
The monthly average fo ecal Coliform is to ba.repo a as a GEOMETRIC mean. Use only units designated in the reporting facility's
permit for reporting data.
** If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b) (2) (D).

NON DISCHARGE APPLICATION REPORT Page ( of 1
SPRAY IRRIGATION SITE(S) �^L
PERMIT NUMBER: 4( ( S� TOTAL, NUMBER OF FIELDS: MONTH: YEAR: 19�1 J
FACILITY NAME:-�,�(s^^� CLASS: COUNTY:
Formulas
Daily Loading (inches) = (Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inchcs/foot)] / (Area Sprayed (acres) x 43.560 (square fecVacrc)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / (Time Irrigated (minutes) / 60 (minutesfhour)] Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous I 1 month's Monthly Loadings (inches)
Average Weekly Loading (inches) = (Monthly Loading (inches/month) / Number of days in the month (days/month)] x 7 (days/week)
Weatter Codes: S-sunny, PC -partly cloudy, CI -cloudy, R-ratn, Sn-snow, St -sleet
OPERATOR IN RESPONSIBLE CHARGE (ORC) =
CHECK BOX IF ORC HAS CHANGED ❑
(SIGVISIGNATUIRE,
E OF OPERATOR IN RESPONSIBLE CHARGE)
BY I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
-GRADE PHONE W- S7/&

FACILITY STATUS:
Please indicate (by checking the appropriate box) whether the facility has been compliant or non -compliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.)
non-
comoliak compliant
1. The application rate(s) did not exceed the limit(s) specified in the permit. 14 ❑
2. Adequate measures were taken to prevent wastewater runoff from the site(s). ❑ ❑
3. A suitable vegetative cover was maintained on the site(s) in accordance with ❑ ❑
the permit.
4. All buffer zones as specified in the permit were maintained during each ❑ ❑
application.
S. The freeboard in the treatment and/or storage lagoon(s) was not less than the ❑ ❑
limit(s) specified in the permit.
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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."
(Permittee Address)
(Permitte6- Please print 6type)
A�-t/x� flit l e-3d -9s
(Signature of Permittee)# - ---- -- -- - ---- - (Date)
(Phone Number) (Permit Exp. Date)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b) (2) (D).

CHAMPION HILLS
FULL CARE
Attn: DEBBIE MCCARSON
(Page 1 of 1)
SAMPLE
LAB No. DATE TIME
70960 09/08/95 0800
BOD
FECAL COLIFORM
TOTAL SUSPENDED SOLIDS
AMMONIA NITROGEN
REPORT OF ANALYSES
PROJECT NAME: CHAMPION HILLS
DATE: 09/18/95
DELIVERY TO LAB
SAMPLER DATE TIME MATRIX
GARY 09/08/95 1215 WW
CLIENT STATION ID: CHAMPION HILLS
LAB #: 70960
mg/l < 2.0
col/100ml 4*
mg/l 1.2
mg/l 0.1
LABORATORY DIRECTOR

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INFLUENT
NPDES NO. Doo <l 1l S DISCHARGE NO. MONTH 5e"2 YEAR I 9�
C �1 5
FACILITY NAME 10 n (�J COUNTY r-5 o n
00400
00010
00310
00610
00530
w
ENTER PARAMETER CODE ABOVE NAME AND
UNITS BELOW
F
O
UcAV
E-
zV
A
QCa
a
C)
OU
E-
F
HRS
HRS
UNITS
° C
1 MG/L
1 MG/L
1 MG/L
Average
Maum ,
........ .....:... .
Minimum
DEM Form MR-2 (12/93)

NON DISCHARGE WASTEWATER MONITORING REPORT Page. ( of
PERMIT NUMBER: �� MONTH: OG� YEAR: cl
FACILITY NAME: CLASS: ' COUNTY: jjepcer1;50Y�
5(X)50
064M 5(X)60 W310 00610
(X)530 31616
_Sam_ pled
at -the -punt prior
to im ,
Eton - _
Sampled at the pomt�nor to irrigation_
Daily Rate
Enter parameter code above name and units below
D
Operator
(Flow)
Fecal
— -
Q
a
t
Arrival
Time 2400
Operator
Time On
ORC
on
into
Treatment
Residual
BOD-5
Coliform
(Geometric
00 D 0
c
Clock
Site
Site?
System
pH
Chlorine
?0°C
NH3-N
TSS
Mean*)
HRS
Y/N
%IGD
UNITS
UG/L
MG/L
MG/L
MG/L
/100ML
00
2
2
?(
l oo
G o
1
G
3
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a . 6
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:
OPERATOR IN RESPONSIBLE CHARGE (ORC) �/ �rG �d %a GRADE' PHONE
CHECK BOX IF ORC HAS CHANGED ❑
CERTIFIED LABORATORIES (1) (2)
PERSON(S) COLLECTING SAMPLES e r O�CS
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT. X_
DEHNR (SIGNA RE OF O ERATOR IN RESPONSIBLE CHARGE)
P.O. BOX 29535 BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
RALEIGH, NC 27626-0535 AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NDMR-1 (7194)

FACILITY STATUS:
Please check one of the following: /
1. All monitoring data and sampling frequencies meet permit requirements. U�' compliant
1. All monitoring data and sampling frequencies do NOT meet permit requirements. ❑ non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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"
HYDROLOGIC, INC. (Per ittee - Please print or type)
P.O. BOX 18029 (Sig ature of Permittee)** (Date)
ASHEVILLE, NC 28801
(Permittee Address)
PARAMETER CODES
. `70V=25V s/6g
(Phone Number) (Permit Exp. Date)
01002 Arsenic
31504 Coliform, Total
01067 Nickel
00929 Sodium
01022 Boron
00094 Conductivity
00600 Nitrogen, Total
00931 SAR
00310 BOD5
01042 Copper
00630 NO2&NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00620 NO3
00515 TDS
00916 Calcium
31616 Fecal Coliform
00556 Oil -Grease
00010 Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Chlorine, Total
00927 Magnesium
32730 Phenols
00680 TOC
Residual
01034 Chromium
71900 Mercury
00665 Phosphorus, Total
00530 TSS
00340 COD
00610 NH3 as N
00937 Potassium
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only units designated in the reporting facility's
permit for rgyorting data.
** If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b) (2) (D).

NON DISCHARGE APPLICATION REPORT Page -L- or
SPRAY IRRIGATION SITE(S)
PERMIT
FACILITY
// \\ -}-
NUMBER: TOTAL NUMBER OF FIELDS: MOO TH: �C / �Y/E�AR_:
NAME: ��Md �� l / /�. CLASS: �L_ COUNTY: IT�l�K21�Oy�
f Formulas
Daily Loading (inches)
= [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43.560 (square feet/acre))
Maximum Hourly Loading (inches)
= Daily Loading (inches) / (Time Irrigated (minutes) / 60 (minuics/hour)[ ;Monthly Loading (inches) = Sum of Daily Loadings (inches) _
12 Month Floating Total (Inches)
= Sum of this month's Monthly Loading (inches) and previous 1 I month's Monthly Loadings (inches)
Average Weekly Loading (inches)
= [Monthly Loading (inches/month) / Number of days in the month (days/month)] x 7 (daystweek)
FIELD NUMBER: FIELD NUMBER:
AREA SPRAYED acres): AREA SPRAYED (acres):
COVER CROP: COVER CROP:
Permitted HOURLY Rate (inches): Permitted HOURLY Rate (inches):
WEATHER CONDITIONS
Permitted WEEKLY Rate (inches):
Permitted WEEKLY Rats (inches):
Weather
Temp.
at
Precipi-
Volume.
Time
Maximum
Hourly
Daily
Volume
Time
Maximums
Hourly
Daily
D
A
T
Storage
Lagoon
E
Code*
application
Cation
Freeboard
Applied
Irrigated
Loading
Loading
Applied
Irrigated
Loading
Loading
CF)
inches
feet
gallons
minutes
inches
inches
gallons
rtinutes
inches
inches
'
2
3
4
6
7
8
MMEMIMME= SEEM
1E
1'7
1E
22

FACILITY STATUS:
Please indicate (by checking the appropriate box) whether the facility has been compliant or non -compliant
with the following permit requirements: (Note If a requirement does not apply to your facility put (NA) in the
compliant box.)
non-
compliant
compliant -
1. The application rate(s) did not exceed the limit(s) specified in the permit. Lam]
❑
2. Adequate measures were taken to prevent wastewater runoff from the site(s). ❑
❑
3. A suitable vegetative cover was maintained on the site(s) in accordance with ❑ ❑
the permit.
4. All buffer zones as specified in the permit were maintained during each ❑ ❑
. application.
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the ❑ ❑
limit(s) specified in the permit.
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and.describe the corrective action(s) taken. Attach
additional sheets if ndcessary.
"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 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."
HYDROLOGIC, INC.
P.O. BOX 18029
;-.'�yEVILLE, NC 28801
(Permittee Address)
Please print or type)
of Permittee)*
(Phone Number)
/=/3-5
(Date)
(Permit Exp. Date)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b) (2) M.

INFLUENT
NPDES NO. W QOOD '-i / IS DISCHARGE NO. MONTH YEAR
FACILITY NAME COUNTY
DEM Form MR-2 (12/93)

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CHAMPION HILLS
FULL CARE
Attn: DEBBIE MCCARSON
(Page 1 of 1)
SAMPLE
LAB No. DATE TIME
72623 10/03/95 0855
REPORT OF ANALYSES
SAMPLER
GARY
PROJECT NAME: CHAMPION HILLS
DATE: 10/09/95
DELIVERY TO LAB
DATE TIME MATRIX
10/03/95 1225 WW
CLIENT STATION ID: CHAMPION HILLS
LAB #: 72623
BOD mg/l 4.2
FECAL COLIFORM col/100ml < 2
TOTAL SUSPENDED SOLIDS mg/l 3.5
AMMONIA NITROGEN mg/l 0.6
LABORATORY DIRECTOR '�

CHAMPION HILLS
FULL CARE
Attn: DEBBIE MCCARSON
(Page 1 of 1)
SAMPLE
LAB No. DATE TIME
73115 10/11/95 0750
BOD
FECAL COLIFORM
TOTAL SUSPENDED SOLIDS
AMMONIA NITROGEN
REPORT OF ANALYSES
SAMPLER
GARY C
PROJECT NAME: CHAMPION HILLS
DATE: 10/20/95
DELIVERY TO LAB
DATE TIME MATRIX
10/11/95 1135 WW
CLIENT STATION ID: CHAMPION HILLS
LAB #: 73115
mg/l
2.3
col/100ml
113
mg/l
1.5
1
1 0
mg/
LABORATORY DIRECTOR

NON DISCHARGE.WASTEWATER MONITORING -REPORT Page l of %
PERMIT NUMBER: W MONTH: I o Il- YEAR:
FACILITY NAME: Gl��/J r a CLASS: �_ COUNTY:
CERTIFIED LABORATORIES (1) - (2)
PERSONS) COLLECTING SAMPLES
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT. X_
DII WR - (SIGNA E OF OP TOR IN RESPONSIBLE CHARGE)
P.O. BOX 29535 BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
I RALEIGH, NC 27626-0535 AND COMPLETE TO THE BEST OF MY KNOWLEDGE
NDMR-l.. (7/94)
- b

FACILITY STATUS:
Please check one of the following:
1. All monitoring data and sampling frequencies meet permit requirements. compliant
1. All monitoring data and sampling frequencies do NOT meet permit requirements. ❑ non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
[ certifv, 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 qualified personnel properly gathered and evaluated the information
,-ubmitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
:athering 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"
(Permit ee - Please priift or ype)
(Signature of Permittee)** (Date)
(Permittee Address) (Phone Number) (Permit Exp. Date)
PARAMETER CODES
01002 Arsenic
31504 Coliform. Total
01067 Nickel
00929 Sodium
01022 Boron
00094 Conductivity
00600 Nitrogen, Total
00931 SAR
00310 BOD5
01042 Copper
00630 NO2&NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00620 NO3
00515 TDS
00916 Calcium
31616 Fecal Coliform
00556 Oil -Grease
00010 Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Chlorine, Total
00927 Magnesium
32730 Phenols
00680 TOC
Residual
01034 Chromium
71900 Mercury
00665 Phosphorus, Total
00530 .TSS
00340 COD
00610 NH3 as N
00937 Potassium
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only units designated in the reporting facility's
permit for reporting data.
n
J
** if signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b) (2) (D).

NON DISCHARGE WASTEWATER MONITORING REPORT Page % of 1
PERMIT NUMBER: � e? r MONTH: '7Dy , YEAR: 1 r
FACILITY NAME: CLASS: _IT� COUNTY:
50050
00400 1 50060
00310
00610
1 00530 31616
Sampled
a t�mt pnor
to im
auon"
Sampled at the point poor to im aug on
Daily Rate
Enter parameter code above name and units below
D
a
Operator
Arrival
Operator
ORC
(Flow)
into
'Fecal
Coliform
/
�Q
—7
t
Time 2400
Time On
on
Treatment
Residual
BOD-5
(Geometric
e
Clock
Site
Site?
System
pH
Chlorine
20'C
NH3-N
TSS
Mean*)
HRS
Y/N
MGD
UNITS
LtG/L
NIG/L
MG/L
MG/L
/100ML
C-IL_
L
6-j
OPERATOR IN RESPONSIBLE CHARGE (ORC) GRADE —1'� PHONE 'lOI ASS
CHECK BOX IF ORC HAS CHANGED ❑
CERTIFIED LABORATORIES (1) (2)
PERSON(S) COLLECTING SAMPLES
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT. _
DEHNR (SIGIS RE OF OPE OR IN RESPONSIBLE CHARGE)
P.O. BOX 29535 BY SIGNATURE, CERTIFY THAT THIS REPORT IS ACCURATE
RALEIGH, NC 27626-0535 AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NOMR-1 (7194)

FACILITY STATUS:
Please check one of the following:
1. All monitoring data and sampling frequencies meet permit requirements. [ compliant
1. All monitoring data and sampling frequencies do NOT meet permit requirements. ❑ non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"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 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
zitherin- the information, the information subrhitted 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"
A
(Per i ' ee - Please pr nt or type)
7
(Signature of Permittee)'"* (Date)
/10 Ll r�y'Ic1..�,2 uzC(G V- _VY9 1 Sk--&rZS lD`/ --;W-S7 L,�
(Permittee Address) (Phone Number)
PARAMETER CODES
(Permit Exp. Date)
01002 Arsenic
31504 Coliform. Total
01067 Nickel
00929 Sodium
01022 Boron
00094 Conductivity
00600 Nitrogen, Total
00931 SAR
00310 BOD5
01042 Copper
00630 NO2&NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00620 NO3
00515 TDS
00916 Calcium
31616 Fecal Coliform
00556 Oil -Grease
00010 Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Chlorine, Total
00927 Magnesium
32730 Phenols
00680 TOC
. Residual
01034 Chromium
71900 Mercury
00665 Phosphorus, Total
00530 TSS
00340 COD
00610 NH3 as N
00937 Potassium
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only units designated in the reporting facility's
permit for reporting data.
- If signed by other than the permittee, delegation of signatory authority must be on rile with the state per 15A NCAC 2B.0506 (b) (2) (D).
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01- -JN 1"'L1 ,S i,>t>t T �i-YATIONS
STATION #_-- 2 OI'LIiA'l'Oli
PREDICTIVE MAINTENANCE SCHEDULE
Dt L� �' C-
a
-OUIPMEN7 TYPE SERVICE Fri 01 02 03 04 05 06 07 06 09 10 11 12 13 14 15 16
2. Grease Seal -p - - - -- I-
3. Operation j
4. Assembl tit -I -n- �---
PUMPS, 5. Clean, E:clernal -p Y - ) -
GENERAL 6. Lubricate ;," - L JC V . -_ �_ - i% -
-' _l-._ ._.._ .._ _ - -- ---
7 Bearing Temp.-
6. Allpnmant S - - - - - - -- -
9. Overhaul
_ 10. Unusual iJoisa3 - p •"' n -- - p-� - ..- _. �.-. ---
PUMPS, 1. Fraa Flow D'-
-2 Air Pressure -- - -- - - - -_ -
1_-
2
3. Clean, External - - -7-1
D
4. Lubricate '- pn'-
MOTORS & _ 5. Bearing Temp. p - -- - - - - - _- -- - -
CONTROLS 6. Ameare Load O O - - - - - _- -- --
7. R P.M. g
6 Co -
27 kTB 29 30 31
�4-
nlrol Operation D-
9. Solenoids g-
10. Clean Contocls
I. Clean Balls DA -- - -� - -- - _ -- - -- - -- -- -- - - - -- - -
2. Adjust Tension M - - -- - - - - -- -- -
BELTS & 3. Check Sheaves M - -_ -- --- -- - - - - - - -- - -- - _
CHAINS 4. All nment g5. Grease
n
6. Check Gears M - -- - - - -
1.
Pressure Test
5
2.
Check Oil
E
3.
Lubricate
p,
BLOWERS &
4.
Bearing Temp.
p
AERATORS
5,
Unusual Noises
6.
Gear Box Oil
p
7.
Adjust (as n
B.
Clean
D
DIFFUSERS
1-
Chock Frey Air
D
E,A
hn
o�1��
2. Clean (as neoded)
'
-
I.
Clean 8 Wash
D
COMM.
2.
Lubricate
M
CHLORINE
1'
Adjust
D
2.
Overhaul
S
FLOW
1.
Check & Clean
p
METER
2•
Change Charts
Ip
3.
Calibrate
g
1.
Clean Q Wash
D
TERTIARY
2.
Sand Level
g
--_ -
IPonds•
Cut WuWs
W
GENERAL ._
I
wash
w
PLANT
2
Scrub
S
_ --
3-Touch
Puinl
g
17 18
19 20
21
22 23
24 25 26

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STATION #_ --S
OY' t'Y2Ar1'O1� �� ( �" 'C.� �....�� i
I
PREDICTIVE MAINTENANCE SCHEDULE
Daat-----
- C.:
-QUIPMENI TYPE SERVICE
FR 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
E::
,landase Saal p - _ _ IQS 10 ' - --
-- 3' 0 rallon -ij - - -- -- -- - - -- -
4. Assembly 1A -- --- - - -k-
PUMPS, 5. Clean, E:dornal--
- -- I -- --- - -
GENERAL 6. Lubricale r� �...-. - - -- �-. �...._ - ---� -_.._ .✓ - -..-- --f--- - - _
7 Bearing Temp. +x--
9 Overhaul q - -- - - -- -- - - - - -- - -- - - - --
t0. Unusual iJoisay rj-
PUMPS, 1. Free Flow p` -- - - -- 1->L - _ _- - - - - - - - fl0 n 7Ta
2. Air Prbsoure p - ---
t. Condition, Gen. 'O
2 Unusual Noises - -- - - - - _ -- - .- - - -- - - -- -- - _
3 Clean, cxtbrnal -ri - - - - --
__
ua
a Lubricate
MOTORS 8 5. Bring Tamp. _ .._- - -- - - -- - - - -- - -- -- - - -- -- -- - - -
CONTROLS 6. Ampere Load-
7. -LP g --
6. Control Operation D - _- -
9. Solenoids g-
10. Clean
1. Clean Balls M -- __-�-. - - - --- -- - -- - - - - --
2. Ad)usl Tnneton M - - - - - -- -" -- - _
BELTS & 3. Check Sheaves M - - - - -
CHAINS a. All nment g
5. Grease Chain M
6. Chock Geare M
1. Pressure Tbat g -- -- -- -- -- - -- -- --
Check OII p --- - - -- 3
BLOWERS 8'• c -
�. Lubriale M- - -- - - -_ -
. brTamp.
AERATORS 5. Unusual Noises D-
6. Gear Box Oil p - - - - - - - - - -- -
7. Adjust as - - - -
6. Clean D - - --' - - -
DIFFUSERS 1• Check Free Air D
r�xxr, 2. Clean (as needed) - -- - - _ - -
A JlJrt 1.'Clean B Wash D -
COMM. 2. Lubriwle M
CHLORINE 1. Adjust D - -
2. Overhaul s
FLOW t Check 8 Clean p --
METER 2• Change Charte D -
3. Calibrate S - - -
1. Clean 6 Wash
TERTIARY 2. Sand Laval g -
3. Ponds, Cut Wubds W
GENE _
RAL � I. i Wn w - -
GENEPLAN2. scrub s --
__ -- 3.- Touch Puinl

kMjL .%,)N 1111,LS I-At"'i' NTA'l'IONS
STATION # 6 OPERATOR
.. .
�PREDICTIVE MAINTENANCE SCHEDULE
Dat
-QUIPMEN7 TYPE SERVICE FR 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 1fi 1�J 20 21 22 23 23 25 26 27 28 2y 30 31
-- -- - -- - -
3. Operation �� -- -, -- -
4. Assembly AI •-^' -- -' �
PUMPS ----- - - I -1-- -- - - - - -- - -- - -. _ _ - - - r
5. Clean, Eatarnal-
GENERAL 6. 1.ubricale--
7 Bearing Temp. - -- - - - - -- -- - t- - - - -
6. Alignment S -� - - - - - - - - - _ - - - - -- -- -- - - -- -- -
-- - --- �-
9. Overhaul A .. -- -- - -- - - -- -- -- --_ _ - -- - - - - - -.
10. Unusual -
PUMPS, 1. Free Flow p-
2. _Air Pressure_ D - - - - - - - -
t. Condition, Gen. --- D --- ----- - - - ---- -- - --- -
2. Unusual Noises p - _ - -- - -- - -- - - _
3. Clean, External - - -.- -- - - m- I •v - - -- - - - - -- - - (� - --
_ a. Lubricate -
MOTORS & _ 5. Ba:,rin4 T6mp _` p - -- - - - - - -- -- -_ - - - -- - -- -- -- -- - -
CONTROLS 6. Ampore Loud-
7. R.P.M. S-
8. Control --
lion D -
9. Solenoids g - - � - !7i� �� - - -
- ..__ - -
10. Clean Cantocls - 5 --- -- - '- - " -- '- -- --
--- - - - -
� 6 7•
_ 1. clean Balls--
2. Adjust Tansion �� - -- - -- -- - -- - -- -- - - -- -- -- -- --- - - -
BELTS & 3. Check Sheaves M - -- - - -- - - -- -- - -- - -- - -- - - -- - - --
CHAINS a. All nment s - - - - - - -- __- _ - -- - - -• - - - -- -- _ --
5. Grease _Chaln M-
6. Check Geara h1
1. Pressure Teat g-
Check 011-
3. Lubricate M - - - _ - - -- -- --_ - - -
BLOWERS 8 -- 4. Bearinn Temp. o . - - -- -- - - - -- - _ - -- -- --- - - - - - - - -
AERATORS 5. Unusual Notaes p-
6. Gear Box Oil p - - - - - - - -- - -- -- -- -- --- - _ -
7. Adjust as-
B. Clean p - - - - -- - -- -- - - - ---
DIFFUSERS I• Check Free Air p - - - - -- --
��, 2. Clean (a9 needed) - --- -_ - - - - - -
[sHly Jl�� 1. 'Clean 8 Wash p
COMM. 2. Lubricate M -
CHLORINE 1. Adjust p - - - - - - - - - - -
2. Overhaul - -•_ - -
FLOW
I.
Check 8 Clean
METER
2•
Change Charts
3.
Calibrate
1.
Clean & Wash
TERTIARY
2.
Sand Level
-
3.
Ponds. Cut WuWa
GENERAL --
1
W-11
PLANT
2
grub - -
3
Touch P, nt
J

AFAnr1x- z-..)N IIIL,I,s 1,1 T NTATIONS
STATION �_ � � ... � �_..,
OPERATOR l r c ; ( If'.?'cl) c. f
f �
PREDICTIVE MAINTENANCE SCHEDULE
Dat �
-OUIPMEN7 TYPE SERVICE(
1._ FR O1 ]0203 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 2324 25 26 27 28 29 30 31
2. Grease Seal p-
3. Opc;ra-Burt ;� -•-`- -'t'- ✓ '� '- - -- ✓ -_
PUMPS, 5.
GENERAL s tubricate
=1 - - -- — -- -_�- —
1. Bearing Temp.-
s All gnrnent y -- - - - - - - -- -- -- -- �-- -
9. Overhaul A -- - -- - - -- -- - _ - - - - - -- - -- - - - -
_ to. _Unusual ;Joisny - - _ - - '- - -•-- - _-
PUMPS, 1. Frea Flow p - - - - - - - - - - - - - - -_ -
2 Air Pressure--
1 Condilion, Gen. '- p - --- -• - _ _ - -- -- --
2. Uou-suet Noiaa4
3. Clean, External p- -- - - - -- -- -- tll - --- -- - - - - -a -
J. lubricate M - - - - - _ - --- �- ------ - --
MOTORS & _ 5. Bearing Temp. -� _- - -- - - - - - - - - - - - - - - -- - - - CONTROLS
s. Am ere Loan-
7. 8P.M.-
s. Control Operation O-
9. Solenoids g - - K _ -- - --- -- -- - - -
10. Cl ban Canl&cts-
1. Clean Balls M- - -- - - - -- -- - - - -- - -- --
2. Adjust Tension 1 t-
BELTS & 3. Check Sheaves M -- ---- -- - -- --- - -- -- _ -
CHAINS a. All nment s ' — — — — — — _ --- -- — -- -- — — — — — — — — -- — -- — —
5. Grease Chain-
s. Check GearaI. Pressure Teal g - - - - -- - - -- -- - - -- - - -
Check Oil p -- - - - -- -
3. Lubricate
BLOWERS & -- a. Bearing Temp.
AERA_I-OHS 5. Unusual Noises p-
s. Gear Box oil p - - - -- - -- - - -
7. Adjust-
B. Clean p - - -- - - -
DIFFUSERS 1• Check Free Air p - - - - - _ _ - - - - - -
2. Clean (as needed) - - - -
A 1. 'Clean i3 Wash p - -- - - -
COMM. 2. Lubricate M
CHLORINE t. Adjust p — — -- -- -- — —
2. Overhaul S _ _ --
FLOW 1. Check 8 Clean p - -
METER 2. Chanpa Charts p _
3. Calibrate S I. Clean B Wash O -
TERTIARY 2 Sand Level s-
3. Ponds, Cut WutJ3-
GENERAL I Wa3h
PLANT 2. Scrub s
3 Touch Puint g -AE
--

c_- - - - Al - - — N I...,1,S ,, it." I, b I xi, 'I'It JINS
STATION ;OPERATOR
PREDICTIVE MAINTENANCE SCHEDULE
Datd) f()
-DUIPMEN-f TYPE SERVICE FR 01 02 03 0 - �- -l�� — — — -- — _ 4 05 06 Ol 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
1. Packing Gland ❑ I) - I / _o - - _ 28 4.,0 31-
2. Grease Seal D
3. Operation
PUMPS 4. Assembl -- - - �• - -- - - i - JC f
5. Clean, Emornal p
GENERAL _ 6 Lubricate - ��- `� - - - -- - - -- -- - -- -- --
�.__ _ _ -- -- -- -- --- --- - r �/
7 Bearing Temp
6. Alignment - -- -•1._- - _.._ - - - -- -- --- -�-- - - 9. Overhaul q - - - - - -- 7--
- _ - -- - - -
10. Unusual Noisui
PUMPS, 1. Free Flow p- - - L1 --QTI-
- r10 y� n
AIH 2 Air Pressure p - - -- -- - ram" ,LLl -- -
------------_— . - — — - - - - -- —
Condition, Gen. p- ---- - -- - _ - -- -- -- - --
2. unusual Noises D - y - - -- - - - - - - - -- - - - - - -- -
3. Clean,Exlernal p- - -- -- - -- - Ell-
4. Lubricale�p,l - - - - - - -
MOTORS & 5. BwrinQ Temp. -� - -- - - - - - _ - - - - - - -- -- - -
CONTROLS 6. Ampere Load _ = - - - - - - -
7. R P.rn. S - - - - - -
6. Control Operation D-
9. Solenoids S-
10.--
1. Clean Bella M-
2. Adjust Tension Al -- - -- -- - - - -- - - - --
BELTS & 3. Chock Sheaves —
CHAINS 4. All nment g-
5. Grease Chain MS. Check GearaI. Pressure Teat S
Check 011 `p - - -- -- -- _
3. Lubricate M
BLOWERS -4.
rina Temp.
AERATORS 5. Unusual Noses
6.
Gear Box Oil
-C
7.
Adjust (as
6.
Clean
p
DIFFUSERS
1.
Check Free Air
D
?'}�7*wnh
1�A.
lean (as neoded)
li l"1E'Clean
& Wash
D
COMM.ubricate
M
CHLORINEAdjust
❑Overhaul
SFLOWheck
& Clean
DMETERhange
CCharts
Dalibrate
glean
& Wash
DTERTIARYand
Level
Sonds,
Cut Wue' 3
WGENERALaYn
wPLANT
cruo —
s
--3
Touch Puint
5
-----1--.r.-.-.I ..- I ... I ... I I I I 1 1-1—

011- ,JN l<><>t A S 1,1P'T N1:- TIONS
S`I'A`I'ION # %
OI' AZATOIZ (
PREDICTIVE MAINTENANCE SCf IEDULE -� - -
T L/
`OUIPMENI TYPE SERVICE FR 01 02 03 04 05 06 07 08 Q9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27T2121, 30 31
Gland t,i`tG -D �� --- - --- -- -
-.
- - -- -
2. Grease Saal 3. 0 ration
----' -- -- (tea
-
4_ Assembly M _- - :_I - -r r- -
Pumps,
5. Clean, E:darnal p Y - -• -- -- -GENERAL 6 Lubncale..1L7. Bearing Temp9. OverhaulA01
_ 10. _lJnusual Noises 0PUM PS, 1. Frea Flow-
�- 2 All Pressure D -- -- -- - - _
_ 1. Condition, Gen. .� --• - - • - - --- -- - -- _ _ __ -- -- - --_
2. unusual Noises--
3. Clean. - - -- - - -- - -v -- -- -
a. Lubricate - -- ILL - Pei_ ;� ---- --- - - n- -- - -
M- - -- - - -
MOTORS & _ �5. Bwring Temp. `p -- -- - - - - - -- - - - -- - -- -- - -- -- -- - --
CONTROLS s. Anipara Loud O -- - - _- -- - - -- -- i - - - -
_7. RP.h1. g-
6. Control Operation D-
9. Solenoids S --
10. Clean Conlws _ g - - -- - --- - - ( - - -- --
1. Clean Balls F.1 --�- -. - - -- -- -- - --- - - -- -- - -
2. Adjust Tension -
BELTS & 3. Check Sheaves M - - - - - -' -- - -- -- - - -_- - -
CHAINS 4. All nment g - - - - - _- - - -- -- - - - --- - -
5. Grease Chain-
6. Check Genre h1 - - - - - -- - _ - -- -- - - - -- - -- - - -
1. Pressure Teat S - - - - - - _- _ - - - -•- -- -- _
2. Check Oil p - -- - --- -- --- -- - - -- - - -
3. Lubricate t,1 - -- - - -- - - --- -
BLOWERS & 4. Bearin Temp. p
AERATORS 5. Unusual Noises D-
6. Gear Box Oil D - - - - - - -
7. Adjust-
6. Clean p - - - - -- -- - - - -- -
DIFFUSERS 1• Check free Air p
�-� 2. Clean (as needed) -- - --- - -- - -- - -
B'I. ' Clean d Wasn D-
COMM _ 2. Lubricate ►� - - _ _ _ - -
CHLORINE 1. Adjust D - - - - - - - -
2. Overhaul S
FLOW I. Check & Clean JD -
METER 2. Change Charts D
3. Calibrate S -
1. Clean 8 Wash D -
TERTIARY 2. Sand Level S - - -
_ 3. Ponds. Cut Welds W
GENERAL 1 Wash w -
PLANT 2 scrub - s - - - -
3 Touch Puinl g
- - - - --
- --

CHAMPION HILLS
FULL CARE
Attn: DEBBIE MCCARSON
(Page 1 of 1)
SAMPLE
LAB No. DATE TIME
74730 11/02/95
BOD
FECAL COLIFORM
TOTAL SUSPENDED SOLIDS
AMMONIA NITROGEN
REPORT OF ANALYSES
SAMPLER
GARY
PROJECT NAME: CHAMPION HILLS
DATE: 11/13/95
DELIVERY TO LAB
DATE TIME MATRIX
11/02/95 1430 WW
CLIENT STATION ID: CHAMPION HILLS
LAB #: 74730
mg/l < 2.0
col/100ml * < 2
mg/l 1.2
mg/l 0.2
* - Results based upon colony counts outside t ccep ab an e.
LABORATORY DIRECTOR `

CHAMPION HILLS
FULL CARE
Attn: DEBBIE MCCARSON
(Page 1 of 1)
SAMPLE
LAB No. DATE TIME
76333 11/28/95 0820
BOD
FECAL COLIFORM
TOTAL SUSPENDED SOLIDS
AMMONIA NITROGEN
TOTAL DISSOLVED SOLIDS
CHLORIDE
NITRATE
REPORT OF ANALYSES
SAMPLER
GARY
PROJECT NAME: CHAMPION HILLS
DATE: 12/05/95
DELIVERY TO LAB
DATE TIME MATRIX
11/28/95 1215 WW
CLIENT STATION ID: CHAMPION HILLS
LAB #: 76333
mg/l 2.4
col/100ml PROTOCOL
mg/l 2.8
mg/l 1.5
2 mg/1 40.0
mg/l 3.64
LABORATORY DIRECTOR ti

o
NON DISCHARGE WASTEWATER MONITORING REPORT Page _� f
PERMIT NUMBER: co( '�i �� S MONTH: YEAR:
FACILITY NAME:�LI�S _ CLASS: ?f COUNTY:G'/1C�P/O/1
MCVf� OVA IV vnv Alm- ----- L.J
CERTIFIED LABORATORIES (1)—"�� (2)
PERSON(S) COLLECTING SAMPLES
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-0535
X_
(SIGN RE OF O T N RESPONSIBLE CHARGE)
BY IS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
NDMR-1 (7/94)

0
FACILITY STATUS:
Please check one of the following:
1. All monitoring data and sampling frequencies meet permit requirements. � compliant
1. All monitoring data and sampling frequencies do NOT meet permit requirements. ❑ non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
F
"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 qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who7ilanage 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"
- Please print or type)
(Sigtriature of Permittee)** (Date)
(Permittee Address) (Phone Number) (Permit Exp. Date)
PARAMETER CODES
01002 Arsenic
31504 Coliform, Total
01067 Nickel
00929 Sodium
01022 Boron
00094 Conductivity
00600 Nitrogen, Total
00931 SAR
00310 BOD5
01042 Copper
00630 NO2&.NO3
00745• Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00620 NO3
00515 TDS
00916 Calcium
316�6 Fecal Coliform
.00556..Oil-Grease `..
00010 Temperature
.00940 Chloride
01051 Lead
00400 'pH '
00625 TKN
50060 Chlorine, Total
00927 Magnesium
32730 Phenols
00680 TOC
Residual
0103.4 Chromium
71900 Mercury
00665. Phosphorus, Total
00530 TSS
00340 COD
00610 NH3 as N
00937 Potassium
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone], ext. 536.
The monthly average for Fecal Coliform. is to be reported as a GEOMETRIC mean. Use only units designated in the reporting facility's
permit for reporting data.
** If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b) (2) (D).

Influent _
NPDES NO: LJ2d 00 -I / 7 DISCHARGE NO: MONTH C ^ YEAR: /
FACILITY NAME: Cko rti Inn -5 COUNTY:

H Y D R 0 L 0 G I C If I N C
REPORT OF ANALYSES
CHAMPION HILLS PROJECT NAME: CHAMPION HILL
CULLIGAN OPERATING SVS DATE: 01/30/96
951 SAND HILL ROAD
ASHEVILLE, NC 28806-
Attn: DEBBIE MCCARSON
(Page. 1 of 1)
SAMPLE DELIVERY TO LAB
LAB No. DATE TIME SAMPLER DATE TIME MATRIX
79549 01/24/96 0835 GARY CRAFFORD 01/24/96 1100 WW
CLIENT STATION ID: CHAMPION HILL E
FF
LAB #: 79549
BOD mg/1 < 2.0
FECAL COLIFORM' col/100ml * < 4
TOTAL SUSPENDED SOLIDS mg/1 2.0
AMMONIA NITROGEN mg/1 0.2
* - Results based upon colony counts outside acce tabl rang .
LABORATORY DIRECTOR'
P.O. BOX 18029 / ASHEVILLE, NC 28814 / 122 LYMAN STREET / ASHEVILLE, NC 28801 / [phone] / FAX: [phone] / TOLL FREE:1-800-231-8889

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Influent
NPOES NO: LJ2 b 00 -r i1'5 DISCHARGE NO: MONTH:-
1 YEAR: ��
FACILITY NAME : -- Cha (''1 d2(O n 17 I COUNTY

T GROUNDWATER SECTK
DIVISION OF ENVIRONMEN AL MANAGEMENT -
GRO.UNDWATER
QUALITY MONITORING
P O BOX 29535
For additional forms
COMPLIANCE REPORT FORM<I> pleasewnteorcau
-
RALEIGH, NC 27620-0535
.:.:.
:. [phone]
Type or Use a ball-point pen and press firmly.
PERMIT NUMBER: (REQUIRED)
Facility Name CNA(riPIQ.Y hld'i>
Non -Discharge 'vN Q000<I 115
Address ATE Ra
NPDES
1�u�l�tzv"rtriuF, NL 2039 County
TYPE OF DISPOSAL OPERATION BEING MONITORED
Well Location rc 6� 1NWTt'
(REQUIRED)
Lagoon Septic Tank'Drain Field
Well Identification Number KVVA 2 Q %Xe LA Well Depth 13 .y Ft.
✓
Well Diameter Sample (Screened) Interval Ft. To �.Ft.
Spray Field Subsurface Low-PreSSI
Piping (LPP)
Depth to Water Level 1 .p ft. below measuring point (before sampling)
Land Application of Sludge
Measuring point is ft. above'land surface
Othef
Gallons of water pumped/bailed before sampling i0
Rotary Distributor
Field Analysis: pH (9. U Specific Conductance uMhos Temp. I I ° C
Odor Appearance 1-ui5 r a
Date Sample Collected 3 • LK - 9 C Date Lab Sample Analyzed- 2LE
Laboratory Name pA«, 7,vc-
Certification No. �'771.2
SAMPLES FOR METALS WERE COLLECTED UNFILTERED AND FIELD ACIDIFIED
t/QES NO
COD
mg/I
Coliform: MF Fecal
i • i r4pd
/100m1
Coliform: MF Total
/100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
q 1L
mg/I
pH (when analyzed)
units
TOC
5
mg/I
Chloride
►, o
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Hardness: Total
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia
o. `I5
mg/I
TKN as N
mg/I
Nitrite (NO2) as N
mg/I
Ni - Nickel
Nitrate (NO3) as N (-I,'1.1
mg/I
Pb - Lead
Phosphorus: Total as P
mg/I
Zn - Zinc
Al - Aluminum
mg/I
Pesticides/Herbicides
Ba - Barium
mg/I
(Specify Compounds)
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Other (Specify Compounds and
Fe - Iron
mg/I
Concentration units)
Hg - Mercury
mg/I
OR'iNn 91`W_r })ry7F ,-),1)c) ny')z
K - Potassium
mg/I
ir,lASrv_ih< .:�)UUa rip) L
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
Na - Sodium
mg/1
I CE TIFY THAT THIS REPORT IS TRUE AND ACCURATE. Note: Values should reflect dissolved and
�- ' axe colloidal concentrations. (see #3 on bacl
LAISee back for instructions.
Si nature of Permittee (of Authorized Agent') Date •• Submit blue, green, and yellow copies only to address abo
GW-59 REV. 6/93

Type or Use a bal
Facility Name.'! a t : Lc •�� �) .7
Address • r. , ,t ; i`
Well Location .10Y y= '';.,: +
)NMENTAL MANAGEMENT - GROUNDWATER SECTION
::P..;O. B.OX. 29535 . .
C: 27626-0535..:..:
33-3221
nt pen and press firmly. PERMIT NUMBER: (REQUIRED)
Non Discharge
NPDES
County TYPE OF DISPOSALOPERATION BEING MONITORED
I' <�7.:�., �
(REQUIRED)
Well Identification Numberi)'(; ; . ,� i ' i ::; , t I Well Depth Ft.
Well Diameter Sample (Screened) Interval <1, Ft. To I ) Ft.
Depth to Water Level I I , -, :L ft. below measuring point (before sampling)
Measuring point is ft. above land surface
Gallons of water pumped/bailed before sampling
Field Analysis: pH i Specific Conductance uMhos Temp. 1 °C
Date Sample Collected ! I I Date Lab Sample Analyzed ) I r
Laboratory Name
SAMPLES FOR METALS WERE COLLECTED UNFILTERED AND FIELD ACIDIFIED
COD
mg/I
Coliform: MF Fecal ;' ! •
Coliform: MF Total
i /100ml
/100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total '>!
pH (when analyzed)
TOC I
mg/I
units
mg/I
Chloride
mg/I
Arsenic
mg/l
Grease and Oils
Hardness: Total
Phenol
mg/I
mg/I
mg/I
Sulfate
mg/I
Specific Conductance
Total Ammonia
TKN as N
uMhos
mg/I
mg/I
Odor
Certification No.
----'-YES
Nitrite (NO2) as N
mg/I
Nitrate (NO3) as N
(: ' : mg/I
Phosphorus: Total as P
mg/I
Al - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium _
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg /I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
Na - Sodium
mg/I
I CERTIFY THAT THIS REPORT IS TRUE AND ACCURATE
Signature of Permittee (or Authorized Agent*)
Lagoon
Spray Field
Land Application of Sludge
Rotary Distributor
Appearance
Nn
Septic Tank/Drain Field
Subsurface Low -Pressure
Piping (LPP)
Other
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/l
Pesticides/Herbicides
(Specify Compounds)
ug/1
ug/I
Other (Specify Compounds and u g/I
Concentration units)
1 �l
Note: Values should reflect dissolved and
. colloidal concentrations. (see 43 on back)
See back for instructions.
Date " Submit blue, green, and yellow copies only to address above.
GW-59 REV. 6/93