WQ0018708_WQ0018708 Non Discharge Monitoring Report December 2016_20161201

MR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page I of 2
No.: W00018708
it No. -
Facility Name: Lake Creek Corporation
County: BI aden
I
W—F
Month:: December
Year: 2016
rParap
Intivent U, Effluent UNo flow generated
Wom
I E njEttwent QuITundwater Lowering L-iburrace vvaEer
Iluff,
PararriLeAn o oring Poin
r
P1. 01
001
Flow Measuring
00400
31616
00610
00600
00940
70300
00615
r Code —1-
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3
U
4
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va"n,
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,
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9
10
11
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A
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2,T,5 3 5
13
1
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31
Average:
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.
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8 .42
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Daily Maximum:
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Daily Minimum:
Sampling Type:
'-,�R
Grab
Grab
Grab
`G 151�1
Grab
G b
Grab
Grab
Monthly Limit
",201600I
Daily Limit:
Sample Frequency:
056tihO 6
2/month
(�J66n
4Year
4Near
4Near
oA
Wear
Iyear,
.,

03-12 . NON -DISCHARGE MONITORING REPORT (NDMR) l rage z or z
Sampling Person(s) II Certified Labors
Name: Tony Baldwin LCanpllai ✓✓jVon-
Name: Environment 1
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
if+ho fonllihr IQ nnn-nmmnliant. 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 necessary.
i
1'
l Ves i INo
Flow exceeded monthly permit limit
Operator in Responsible Charge (ORC) Certification Permlttee Certifloation
ORC: Tony Baldwin Permittee: Lake Creek Corporation ,
Certification No.: 29101 Signing Official: Steve Jones
Grade: SI Phone Number: 252-235-4900 Signing Official's Title: President
Has the ORC changed since the previous NDMR7 Phone Number: 704-676-8462 Permit Expiration: 6/30/2016
r 1"�
Signature Date Signature Q ��t/VIJI� - 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 attachment were prepa�ed n recbon o pervlsion in
accordance with a system designed to assure that all quallned personnel properly gathered and evaluat 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699.1617

NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page of
: NDAR-1 10-13
rmit No.: W00018708
Facility Name: Lake Creek Corporation
County: Bladen Month: December
Year: 2016
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Field Name:
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NUN-UMUMAK"CAt-rUtlAIRAN KCPVRI
the application rates exceed the limits in Attachment B of your permit? Dcompliant dvon-Compliant
Were adequate measures taken to prgvent effluent ponding in or runoff from the sites? 1� []Compliant Don -compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? f, ✓aompllant Don -compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? DCompliant Don-Compllant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? aompllant Don -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: Tony Baldwin
Permittee: Lake Creek Corporation
Certification No.: 29101
Signing Official: Steve Jones I
j
Grade: 1 Phone Number: 252-235-4900
Signing Official's Title: President
Has the ORC changed since the previous N -1? Des Elo
Phone Number: 704-576-8462 Permit Lp.: 6/30/16
Signature Date
-� C„y�
Sig ture Date
By this signature, I certify that this report Is accurzate and complete to the best of my knowledge.
I certify, under penalty of law, that this document and all attachments were prepa e u d y i ec io o supervision in
accordance with a system designed to assure that all qualified personnel properly gathered and evalua he information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
best knowledge belief, true, accurate, complete. I am
gathering the Information, the Information submitted is, to the of my and and
aware that there are slgniflcant 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
f
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