WQ0019665_Monitoring - 07-2022_20220829

FORM'. NDMR 03-12 NON -DISCHARGE MONITORING Kt=VUK I (NUMM)
16
[,tMAR,
IMM100 tln
­1M
11", �
MORE
16
omw
17
'8
i8
R.
INN
is
r20
............. ........... . . . . .
RPM
2
21
I'M
IN`
N } NM-1
�A
I NW�
22
A,
t
231
n
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rot
30
31
Daily Maximum:
7
Daily Minimum:
t i..
Sampling Type:
.'Recorder Grab
Grab
Grab
Grab
NO
Grab
'-j
Grab
Monthly Avg. Limit
Daily Limit:
Sample Frequency:.
P
Per -Event
Y'
4 x Year
4:kYe&I
4xYear
4 x Year
Pe�Event
3 x Year

N(JN-DISCHARGE APPLICATION REPORT (NDAR-1)
Page _1 of I,
Did the application rates exceed the limits in attachment B of your permit? ❑ Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑ Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑ Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ❑ Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach nririitinnal chcate If nc.e­ _
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: TOSEPH �, SADLEI? Permittee: SWAN OQA9 TER SWITARV 01STRIC.T
Certification No.: W W Z (SS'i 1 SI IS %Sa Signing Official: -J'
E FFER 1 /STCkES BERRY
Grade: Tr" Phone Number: (DSJ,) q y3 543 5 Signing Official's Title: SSG/ %EM
Has the ORC changed since the previous NDAR-1? J ❑ Yes ❑ No Phone Number: (a �2.) 5 42- l090 1 Permit Exp.: C) 6
AAA 4_,L4� o 8 ? 22
Signature Date Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I certify, under penalty of law, that this document and all attachments were prepared under my direction or supers ision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted Is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that here are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

ti
FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page_(_ Of
WQ00196650
Did irrigation occ.,
-
. • •
ULfLY
---Teld me:, Field N
- - -
at this facility?
Area (acres):
i
Area es):
:�-
4-
Hourly Rate (in):
1
Hourly Rate (in):
--
.ate (in
Field 'Irriciated?
Field Irrigate d?
Field Irrigated?
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� .I Isz.1�►+�.�ais■
� •••
■[5��JL�
� •
RME
1

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2. of�_
Sampling Person(s)
Name: Tc5F-PI-I F. SAOLEe
Name:
Certified Laboratories
Name: E V IRO u m ENT S I A%C
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? [Compliant ❑Nan -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge'(ORC) Certification
Permittee Certification
ORC: -7'QSEl? rl F, 5RoL-ER,
Permittee: SWAN OVAQT'Ef? SAIUITARy 13ISTRICT-
Certification No.: W W 2 1 JCS 1 `1 SI I S 6 5 O
Signing Official: TE F F E R V S rOT ES L3 E R R V
Grade: Phone Number: S 2) 9 L43 — 5 3 S
Signing Official's Title: SEC TRt' A S
Has the ORC changed since the previous NDMR? ❑Yes []No
Phone Number: �52) 5t+� I Permit Expiration: n $ — 3 j ^ Z 02-6
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penally of law, that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel property gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617