WQ0002648_Monitoring - 11-2023_20231221

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month: * November
WQ0002648
Seagrove Ulah Metropolitan
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2023
Upload Document*
Seagrove Ulah November 2023.pdf 2.94MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Larry T. Chilton
v6;t tJ P. 641l-ew
Reviewer: Wanda.Gerald
12/21 /2023
This will be filled in automatically

Is the project number correct?* WQ0002648
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 1/9/2024

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page t of'_
Permit No.: VVQ0002648
Facility Name: Seagrove -Utah Metropolitan
County: Randolph
Month: November
Year: 2023
PPI: 001
Flow Measuring Point: O influent ElEffluent[_1No flow generated
Parameter Monitoring Point: ElInfluent (] Effluent ❑ Groundwater Lowering [ISurface Water
Parameter Code --►
50050
00310
00940
50060
31616
00610
00625
00620
00600
00400
00665
70300
00530
m
m
E
0
O
u>
p
v
UL
c
o
E- N
L)
_
LL O
c
E
r d
O
♦+;
a)a)p
'
Z
_
n
H N
O
a
a
Oo
N O
L
'o
v N
a,
O O_ tO
MW n
rn
24-hr
hrs
GPD
mg/L
mg/L
mg/L
#/100 mL
mg/L
mg/L
mg/L
mg/L
su
mg/L
mg/L
mg/L
1
06:00
8
35,000
1.6
7.4
2
06:00
8
46,800
17.9
69.7
1.7
70
19.6
52.7
<.050
52.7
7.4
8.06
344
43.1
3
15:00
6
16,400
0.7
7.3
4
10:00
8
31,700
1.5
7.3
5
04:00
8
18,700
1.4
1 7.3
6
06:00
8
35,700
1.5
7.3
7
06:00
8
25,100
1.5
7.3
8
06:00
8
34.300
1.6
7.3
9
06:00
8
47,800
1.6
7.3
10
12:00
8
18,400
1
7..5
11
05:00
5
28,400
1.9
7.4
12
04:00
6
31,600
2.2
7_3
131
06:00
8
43,200
2
7.3
14
06:00
8
39,100
1.9
7.2
15
06:00
8
36,600
1.9
7.2
16
06:00
8
46,800
1.9
7.2
17
12:00
8
29,200
0.5
7.4
18
11:00
6
24,300
1.3
7_4
191
04:00
8
25,400
1.8
7.3
20
06:00
8
39,900
1.8
7.3
21
06:00
8
78,600
1.9
7.4
22
06:00
8
70,500
1.3
7.3
23
12:00
8
12,400
2.2
7.3
24
04:00
8
23,800
2.2
7.3
251
06:00
6
33,300
2
7.4
26
33,300
27
06:00
8
34,500
1.9
7.3
28
06:00
8
39,700
1.9
7.3
29
06:00
8
34,500
18
7.4
30
06:00
8
34,800
1.9
7.3
31
Average:
34,993
17.90
69.70
2.23
70.00
19.60
52. 00
0.00
52.70
8.06
344.00
43.10
Daily Maximum:
78,600
17.90
69.70
18.00
70.00
19.60
52.70
0.05
52.70
7.40
8.06
344.00
43.10
Daily Minimum:
12,400
17.90
69.70
0.50
70.00
19.60
52.70
0.05
52.70
7.20
8.06
344.00
43,10
Sampling Type:
Recorder
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Monthly Avg. Limit:
30,000
Daily Limit:
Sample Frequency:
Continuous
Monthly
3 X Year
5 X Week
Monthly
Monthly
Monthly
Monthly
Monthly
5 X Week
Monthly
3 X Year I
onthly

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _I, of 5-
Permit No.: WQ0002648
Facility Name: Seagrove -Utah Metropolitan Water District WWTP
County: Randolph
Month: November
Year: 2023
Did irrigation occur
Field Name:
1
Field Name:
2
Field Name:
3
Field Name:
4
this facility?
Area (acres):
2.1
Area (acres):
2
Area (acres):
2.1
Area (acres):
3.4
at
Cover Crop:
Grass
Cover Crop:
Grass
Cover Crop:
Grass
Cover Crop:
Grass
El YES ❑ No
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Weather
Freeboard
Field Irrigated?
0 YES ❑ No
Field Irrigated?
0 YES ❑ No
Field Irrigated?
[11 YES ❑ No
Field Irrigated?
P] YES ❑ NO
oTm
v
U
m
m0
°a
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c
ago
N
a
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Ta
m
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EN
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TC
o °
=o
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EN
a
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E
P ,a
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C
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J
vv
E �
�
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P
0)
c
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E
E
E d
o
� Q
d 'ao;
P -
> c
Eamu
E
J rnc
Xum aTm
OF
in
I ft
I ft
gal
min
I in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
C
37
0
5'3"
6,250
12.5
0.11
0.11
6,250
12.5
0.12
0.12
5,680
11.4
0.10
0.10
9,660
19.3
0.10
0.10
2
C
28
0
6'8"
3
C
61
0
6'0"
4
C
56
0
5' 10"
5
PC
45
0
57'
6
C
42
0
5'3"
7,500
15
0.13
0.13
7,500
15
0.14
0.14
6,816
13.6
0.12
0.12
11,592
23
0.13
0.13
7
C
47
0
6'8"
8
C
51
0
6'4"
9
PC
55
0
6'0"
3,750
1 7.5
0.07
0.07
3,750
7.5
0.07
0.07
3,408
6.8
0.06
0.06
5,796
11.6
0.06
0.06
10
CL
56
0
6'4"
11
R
47
0.05
67'
12
CL
49
1 0
5-10"
13
PC
36
0
5'5"
5,000
10
0.09
0.09
5,000
10
0.09
0.09
4,545
9
0.08
0.08
7,727
15.4
0.08
0.08
14
PC
40
0
6'4"
151
CL
41
0
610"
16
C
40
0
57'
5,000
10
0.09
0.09
5,000
10
0.09
0.09
4,545
9
0.08
0.08
7,727
15.4
0.08
0.08
17
CL
65
0
6'2"
18
PC
60
0
5-10"
19
C
40
0
57'
20
PC
38
0
5'4"
6,250
12.5
0.11
0.11
6,250
12.5
0.12
0.12 1
5,680
11.4
0.10
0.10
9,660
19.3
0.10
0.10
21
R
48
2.3
6'8"
22
R
44
0.1
5'4"
6,250
12.5
0,11
0.11
6,250
12.5
0.12
0.12
5,680
11.4
0.10
0.10
9,660
19.3
0.10
0.10
23
C
55
0
6'2"
24
C
40
0
6'0"
25
C
36
0
5'8"
26
271
R
37
0.5
5'0"
7,500
15
0.13
1 0.13
7,500
15
0.14
0.14
6,816
13.6
0.12
0.12
11,592
23
0.13
0.13
28
C
29
0
6'8"
29
C
21
0
6'4"
30
PC
28
0
6'0"
5,000
10
0.09
0.09
5,000
10
0.09
0.09
4,545
9
0.08
0.08
7,727
15.4
0.08
0.08
31
Monthly Loading:
52,500
M
0.92
52,500
0.97
47,715
0.84
81,141
0.88
12 Month Floating Total (in):
9.68
9.19
8.08
8.36

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-11) Page 3 of -5-
Permit No.: WQ0002648
Facility Name: Seagrove -Utah Metropolitan Water District WWTP
County: Randolph
Month: November
Year: 2023
Did irrigation occur
Field Name:
5
Field Name:
6
Field Name:
7
Field Name:
8
this facility?
Area (acres):
2.2
Area (acres):
2.6
Area (acres):
2.7
Area (acres):
2.4
at
Cover Crop:
P�
Grass
Cover P:
Grass
Cover p:
Grass
Cover p;
Grass
C7 YES Cl NO
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Weather
Freeboard
Field Irrigated?
O YES ❑ NO
Field Irrigated?
[) YES ❑ NO
Field Irrigated?
O YES ❑ NO
Field Irrigated?
❑ YES Rl NO
p
o
U
a)
d
as
m
CL
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o
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°
i'
y
a.
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o
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to.
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c
E o
O M
txo x 0
J
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E 2
°
O a
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m
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P:
rn
>, c
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O
J
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E v
m
ro t 0
2 J
my
E 2
c
O a
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P 'C
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- c
E v
m
K O
x J
a�v
E
°
o a
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a)
E m
rn
P
-
rn
T 'a
m
p 0
J
E Trn
E v
x o p
x J
3
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
C
37
0
5'3"
4,540
9.1
0.08
0.08
7.950
15.9
0.11
0.11
9,660
19.3
0.13
0.13
2
C
28
0
6'8"
3
C
61
0
6'0"
4
C
56
0
5' 10"
5
PC
45
0
57'
6
C
42
0
5'3"
5,448
11
0.09
0.09
9,540
19
0.14
0.14
11,592
23
0.16
0.16
7
C
47
0
6'8"
8
C
51
0
6'4"
9
PC
55
0
1 6'0"
1
2,724
5.5
0.05
0.05
4,770
9.6
0.07
0.07
5,796
11.6
0.08
0.08
10
CL
56
0
6'4"
11
R
47
0.05
6'2"
12
CL
49
0
5'10"
13
PC
36
0
5'5"
3,636
7.2
0.06
0.06
6,363
12.7
0.09
0.09
7,727
15.4
0.11
0.11
141
PC
40
0
6'4"
15
CL
41
0
6'0"
16
C
40
0
57'
3,636
7.2
0.06
0.06
6,363
12.7
0.09
0.09
7,727
15.4
0.11
0.11
17
CL
65
0
6'2"
18
PC
60
0
5'10"
19
C
40
0
57'
201
PC
38
0
64"
4,540
9.1
0.08
0.08
7,950
15.9
0.11
0.11
9,660
19.3
0.13
0.13
21
R
48
2.3
6'8"
22
R
44
0.1
5'4"
4,540
9.1
0.08
0.08
7,950
15.9
0.11
0.11
9,660
19.3
0.13
0.13
23
C
55
0
6'2"
24
C
40
0
6'0"
25
C
36
0
58"
26
27
R
37
0.5
5'0"
5,448
11
0.09
0.09
9,540
19
0.14
0.14
11,592
23
0.16
0.16
28
C
29
0
6'8"
29
C
21
0
6'4"
L30
PC
28
0
6'0"
3,636
7.2
0.06
0.06
6,363
12.7
0.09
0.09
7,727
15.4
0.11
0.11
31
Monthly Loading:
38,148
0.64
66,789
0.95
81,141
1.11
0
0.00
12 Month Floating Total (in):
6.27
K9.01
10.51

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 0 of -5 -
Permit No.: WQ0002648
Facility Name: Seagrove -Utah Metropolitan Water District WWTP
county: Randolph
Month: November
Year: 2023
Did irrigation occur
Field Name:
9
Field Name:
10
Field Name:
11
Field Name:
12
this facility?
Area (acres):
2.3
Area (acres):
2
Area (acres):
2.7
Area (acres):
2
at
Cover Crop:
P�
Grass
Cover p:
Grass
Cover p:
Grass
Cover p:
Grass
0 YES ❑ NO
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Weather
Freeboard
Field Irrigated?
Cl YES ❑ NO
Field Irrigated?
0 YES ❑ NO
Field Irrigated?
[2d YES ❑ No
Field Irrigated?
❑ YES O NO
M
o
m
oa
a)
a
F
0
d
m
u
acam
L6
ar•o
E
°°
a
;
E
0)
c
v
o
E
-CED
E� -o
x°o
° a
°°'rn°_
iE m
0)
E T
E
_
°
Em
�
Q
a_
E
~
°_
J
E im
°
a>
Ev
a
E
~a
_
�
o oXo
J
°a
E° rn
E°
co J
0o
3
OF
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
C
37
0
5'3"
5,110
10.2
0,08
0.08
4,540
9.1
0.08
0.08
8,520
17
0.12
0.12
2
C
28
0
6'8"
3
C
61
0
6'0"
4
C
56
0
5' 10"
5
PC
45
0
57'
6
C
42
0
5'3"
6,132
12
0.10
0.10
5,448
11
0.10
0.10
10,224
20
0.14
0.14
7
C
47
0
6'8"
8
C
51
0
6'4"
9
PC
55
0
6'0"
3,066
6.1
0.05
0.05
2,724
5.5
0.05
0.05
5,112
10.2
0.07
0,07
10
CL
56
0
6'4"
11
R
47
0.05
6'2"
12
CL
49
0
510"
13
PC
36
0
515"
4,091
8
0.07
0.07
3,636
7.2
0.07
0.07
6,818
13.6
0.09
0.09
14
PC
40
0
6'4"
15
CL
41
0
6'0"
16AR
40
0
57'
4,091
8
0.07
0.07
3,636
7.2
0.07
0.07
6,818
13.6
0.09
0.09
1765
0
67'
1860
0
610"
1940
0
57'2038
0
5'4"
5,110
10.2
0.08
0.08
4,540
9.1
0.08
0.08
8,520
17
0.12
0.12
2148
2.3
68"
221
R
44
0.1
5'4"
5,110
10.2
0.08
0.08
4,540
1 9.1
0.08
1 0.08
8,520
17
0.12
0.12
23
C
55
0
62'
24
C
40
0
60"
25
C
36
0
5'8"
26
27
R
37
0.5
5'0"
6,132
12
1 0.10
0.10
5,448
11
0.10
0.10
10,224
20
0.14
0.14
28
C
29
0
6'8"
29
C
21
0
64"
30
PC
28
0
6'0"
4,091
8
0.07
0.07
3,636
7.2
0.07
0.07
6,818
13.6
0.09
0.09
31
Monthly Loading:
42,933
0.69
38,148
0.70
71,574
0.98
0
0.00
12 Month Floating Total (in):
10.16
6.68
9.26

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page r of L
Permit No.: WQ0002648
Facility Name: Seagrove -Utah Metropolitan Water District WWTP
County: Randolph
Month: November
Year: 2023
Did irrigation occur
Field Name:
13
Field Name:
14
Field Name:
15
Field Name:
16
this facility?
Area (acres):
2.2
Area (acres):
2.1
Area (acres):
3.4
Area (acres):
3.8
at
Cover Crop:
P�
Grass
Cover p:
Grass
Cover p:
Grass
Cover p:
Grass
❑ YES ❑ NO
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Annual Rate (in):
38.4
Weather
Freeboard
Field Irrigated?
Ci YES ❑ NO
Field Irrigated?
2 YES ❑ NO
Field Irrigated?
❑ YES ❑ No
Field Irrigated?
[21 YES ❑ NO
o
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ft
ft
gal
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in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
C
37
0
5'3"
45,640
9.1
0.76
0.76
4,540
9.1
0.08
0.08
10,790
21.6
0.12
0.12
11,930
23.9
0.12
0.12
2
C
28
0
6'8"
3
C
61
0
6'0"
4
C
56
0
510"
5
PC
45
0
57'
6
C
42
0
5'3"
5,448
11
0.09
0.09
5,448
11
0.10
0.10
12,948
26
0.14
0.14
14,316
28.6
0.14
0.14
7
C
47
0
6'8"
8
C
51
0
6'4"
9
PC
55
0
6'0"
2,724
5.5
0.05
0.05
2,724
5.5
0.05
0.05
6,474
13
0.07
0.07
7,158
14.3
0.07
0.07
10
CL
56
0
6'4"
11
R
47
0.05
67'
12
CL
49
0
5'10"
13
PC
36
0
5'5"
3,636
7.2
0.06
0.06
3,636
7.2
0.06
0.06
8,636
17.2
0.09
0.09
9,545
19.1
0.09
0.09
14
PC
40
0
6'4"
15
CL
41
0
6'0"
161
C
40
0
57'
3,636
7.2
0.06
0.06
3,636
7.2
0.06
0.06
8,636
17.2
0.09
0.09
9,545
19.1
0.09
0.09
17
CL
65
0
6'2"
18
PC
60
0
5110"
19
C
40
0
57'
20
PC
38
0
5'4"
4,540
9.1
0.08
0.08
4,540
9.1
0.08
0.08
10,790
21.6
0.12
0.12
11.930
23.9
0.12
0.12
21
R
48
2.3
6'8"
221
R
44
0.1
5'4"
4,540
9.1
0.08
0.08
4,540
9.1
0.08
0.08
10,790
21.6
0.12
0.12
11,930
23.9
0.12
0.12
23
C
55
0
67'
24
C
40
0
6'0"
25
C
36
0
5'8"
26
27
R
37
0.5
60"
5,448
11
0.09
0.09
5,448
11
0.10
0.10
12,948
26
0.14
0.14 1
14,316
28.6
0.14
0.14
28
C
29
0
68"
29
C
21
0
64"
30
PC
28
0
6'0"
3,636
7.2
0.06
0.06
3,636
7.2
0.06
0.06
8,636
17.2
0.09
0.09
9,545
19.1
0.09
0.09
31
Monthly Loading:
79,248
1.33
38,148
0.67
90,648
0.98
100,215
0.97
12 Month Floating Total (in):
6.78
6.36
9.34
9.23

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page s of 4
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
R1 Compliant ❑ Non -Compliant
R] Compliant ❑ Non -Compliant
2 Compliant ❑ Non -Compliant
R] Compliant ❑ Non -Compliant
El Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Larry T. Chilton Permittee: Segrove Ulah Metropoplitean
Certification No.: WW,SI Signing Official: Michael T. Walker
Grade: 2 Phone Number: 336-302-3782 Signing Officials Title: Secretary
Has the ORC changed since the previous NDAR-1? ❑ yes O No Phone Number: 336-873-7738 Permit Exp.: 4/30/27
-aoa10 A J�
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 supervision in accordance
V with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
nquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 05-16
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _/ of S
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
P) Compliant ❑ Non -Compliant
R1 Compliant ❑ Non -Compliant
O Compliant ❑ Non -Compliant
(A Compliant ❑ Non -Compliant
2 Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Larry T. Chilton
Permittee:
Segrove Ulah Metropoplitean
Certification No.: WW,SI
Signing Official: Michael T. Walker
Grade: 2 Phone Number: 336-302-3782
Signing Officials Title: Secretary
Has the ORC changed since the previous NDAR-1? ❑ yes [J No
Phone Number: 336-873-7738 Permit Exp.: 4/30/27
/ .kywyzz
Z
Signature Date
Zrpenalty
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
1 certify, of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 3 of .I -
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
O Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
21 Compliant ❑ Non -Compliant
M Compliant ❑ Non -Compliant
2 Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Larry T. Chilton
Permittee:
Segrove Ulah Metropoplitean
Certification No.: WW,SI
Signing Official: Michael T. Walker
Grade: 2 Phone Number: 336-302-3782
Signing Officials Title: Secretary
Has the ORC changed since the previous NDAR-1? ❑ Yes 2 No
Phone Number: 336-873-7738 Permit Exp.: 4/30/27
/ Z7�
Signature Date
Signature Date
By this signature, I certify that this report is accurrale 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 supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page A of S
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
C] Compliant ❑ Non -Compliant
[21 Compliant ❑ Non -Compliant
O Compliant ❑ Non -Compliant
0 Compliant ❑ Non -Compliant
I] Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Larry T. Chilton
Permittee:
Segrove Ulah Metropoplitean
Certification No.: WW,SI
Signing official: Michael T. Walker
Grade: 2 Phone Number: 336-302-3782
Signing Official's Title: Secretary
Has the ORC changed since the previous NDAR-1? ❑ Yes O No
Phone Number: 336-873-7738 Permit Exp.: 4/30/27
-2111A v
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 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

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page I of _s
Sampling Person(s) Certified Laboratories
Name: Russell Welch Name: Cameron Testing
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ Compliant 121 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
., 1—k.) i.n .. aun auui —1. a .. Y.
We are out of compliance on our influent. We are permitted for 30,000gpd. We have seen an increase of flow into the plant due to a local truck stop closing, (Quick-Check/Hardees). This business had an On -
site waste treatment system stherfore we never saw their flow. Now that they have closed, travelers and truckers are using the Interstae Rest Stops more than ever. The flow from the two reststops are part of our
system. The hope is that another owner will resume operations at this truck stop which should reduce our flow under our permitted allowance.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Larry T. Chilton Permittee: Seagrove Ulah Metropolitan
Certification No.: WW,SI Signing Official: Michael T. Walker
Grade: 2 Phone Number: 336-302-3782 Signing Official's Title: Secretary
Has the ORC changed since the previous NDMR? ❑ yes CJ No Phone Number: 336-873-7738 Permit Expiration: 4/30/2027
/,?— dI-
Signature Date
By this signature, I certify that this report is accurrale and complete to the best of my knowledge.
Signature Date
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 properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617