WQ0002005_Monitoring - 07-2024_20240830 (2)

Monitoring Report Submittal
.....................................................
Permit Number#* WQ0002005
Name of Facility:*
Month: * July
Report Information
Type *
G W-59
House of Raeford Rosehill
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address: *
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2024
Upload Document*
GW - 59 July 2024.pdf 4.79MB
PDF Only
NDMR, NDAR-1, NDMLR July 2024.pdf 1.12MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Mason Drew
8/30/2024
This will be filled in automatically

Reviewer: Wanda.Gerald
Is the project number correct?* WQ0002005
Is the monitoring report accepted?* Yes NO
Regional Office* Wilmington
Reviewer: _anonymous
Review Date: 9/20/2024

FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Pegs of f
Permit No.: W00002005
FaCIW Name: House of Raeford Farms, Inc.
County: Duplin
Month: July
Year. 2024
FWd Name:
L1
F W Nana:
L2
Field Name:
L3
Field Nana:
L4
Fleld Name:
L5
Are (acres):
12.04
Ana (aerie):
12.04
Area (acne):
12.04
Ara@ (sera):
12.04
Ana (acres):
10.52
Cover Crop:
Cower Crop:
Cover Crop:
Cover crop:
Cover Crop:
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load lyp@:
PAN
Load Type:
PAN
Field Loaded?
❑ Yes ❑ No
Field Loaded?
0 Yt?5 ❑ No
Field Loaded?
[] rt=5 ❑ No
Field Loaded?
❑ lrt'.B te0
Field Loaded?
❑ YES 0 No
aIL
°>
<
3 Z
a<a
<
<
e
Z
<
1
a
<
4
3 Z
a
Month
I
m
NWac
Malec
MuleC
ib@lea
Ibalac
WW&c
Mules
qubic
I
tbslac
Ibslac
January468,000
36.3
11.8
11.8
W?,000
36.3
14.3
14.3
229,500
36.3
5.8
5.8
536,600
36.3
116
13.5
279,000
36.3
8.0
8.0
February468,000
37.4
12.1
23.9
404,6Q0
37.4
10,6
24.9
882,000
37.4
22.8
28.6
477,000
37.4
12.4
26.8
418,500
37.4
12.4
20.4
March
675,000
44.2
20.7
44.6
481
44.2
14.7
39.6
702,000
44.2
21.5
50.1
387,000
44.2
11.8
37.7
256,500
44.2
9.0
29.4
April
837,000
32.25
18.7
63.3
832,500
32.25
18.8
68.2
364,500
32.25
8.1
58.3
297,000
32.25
8.8
44.3
252,000
32.25
6.4
35.9
May
454,500
28.6
9.0
72.3
458A00
28.6
9.1
67.3
63,000
28.6
1.2
59.5
513,000
28.6
10.2
54.5
535,500
28.6
12.1
48.0
June
661,500
24.56
11.2
83.5
5W,500
24.55
10.0
77.3
652,500
24.55
11.1
70.6
634,500
24.55
10.8
85.3
567,000
24.55
11.0
59.0
July616,500
25.45
10.9
94.4
427,600
25.45
7.5
84.9
351,000
25.45
62
76.8
0
25.45
0.0
65.3
0
25.45
0.0
59.0
August
270,000
22.95
4.3
98.7
522,900
22.96
8.3
932
715,500
22.95
11.4
882
554,400
22.95
8.8
74.1
868,500
22.95
15.8
74.8
September
1,035,006
15.75
11.3
110.0
873,000
16.76
9.6
102,7
582,500
15.75
6.1
94.3
0
13.76
0.0
74.1
540,000
15.75
6.7
81.8
October
769,500
31.2
16.6
126.8
S2Y,000
31.2
11.3
114.0
805,500
31.2
17.4
111.7
405,000
31.2
8.8
82.8
810,000
31.2
20.0
101.6
November
780,500
34.05
17.9
144.5
733,500
34.05
17.3
131.3
738,000
34.05
17.4
129.1
882,000jV9.5
103.6
652,500
34.05
17.6
119.2
December 774,000 35.8
12 Month Floating PAN Load
Annual PAN Load Link
Ibal
19.2
163.7
300
163.7
661500
33.8
16.4
147,7
300.00
147.7
585,000
35.8
14.5
143.6
300.00
143.E
387000
0
113.2
531,000
35.8
15.1
134.3
300.00
134.3

FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT {NDMLR) Page 2' Of S
Permit No.: W00002005
Facility Name: House of Raeford Farms, Inc.
County: Duplin
Month: July
Year, 2024
Field Name:
L6
Find Nee.
L7
FWd Name:
L8
Field Na..
L9
Field Name:
L10
Area (acres):
8.66
Arsa (acres):
12.04
Area (acres):
12.04
Area (earn):
12.04
Area (acres):
10.52
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Laad Type:
PAN
Load Type:
PAN
Field Loaded?
E YES ❑ no
fMld Loaded?
[a YES ❑ No
Fisid Loaded?
YES ❑ No
icNld l08dad4
YES ❑ !q
Field Loaded?
❑ YES Q No
$
8
g
Ez
vd
`
ILvC
�
d
<
IL
L
>
d
<
_
cad
Month
gal
m
ibalac
Ibstac
lbsMa
Ihalaa
Ibelsc
Ibelae
Gal
MWL
ft&C
I
gel
mg&
UW&c
Ibalac
January
378,000
36.3
13.2
13.2
234,000
36.3
5.9
5.9
526,500
36.3
13.2
13.2
!SWO
1
36.3
11.9
11.9
382,500
36.3
11.0
11.0
Februa
342.000
37.4
12.3
25.5
571,5W
37.4
14.8
20.7
634,500
37.4
16.4
29.7
787.500
37.4
20.4
32.3
382,500
37.4
11.3
22.3
March
490.500
44.2
20.9
46.4
724,6W
44.2
22.2
42.9
468,000
44.2
14.3
44.0
337,500
44.2
10.3
42.6
288,000
44.2
10.1
32.4
April
346.500
32.25
10.8
57.2
M.600
32.25
13.4
56.2
441,000
32.25
9.9
53.9
50,500
32.25
12.6
55.2
508,500
32.25
13.0
45.4
May
198,000
28.6
5.5
62.6
315,000
28.6
6.2
62.6
270,000
28.6
5.3
59.2
481,d00
28.6
9.5
64.7
468,000
28.6
10.6
56.1
June
355,500
24.55
8.4
71.0
W3,5W
24.55
9.4
71.9
1,053,000
24.55
17.9
77.1
292,500
24.55
5.0
60.7
0
24.55
0.0
56.1
July
234,000
25.45
5.7
76.8
90,000
25.45
1.6
73.6
1 288.000
25.45
5.1
82.2
1 270.000
25.45
4.8
74.5
225,000
25.45
4.5
60.6
August
678,600
22.95
15.0
91.8
507AW
22.95
8.1
81.6
423,000
22.95
6.7
88.9
487,800
22.95
7.8
82.2
337,500
22.95
6.1
66.7
September
643,500
15.75
9.8
101.5
1 8UAW
15.75
9.7
91.2
355,500
1 15.75
3.9
92.8
472,5W
15.75
5.2
87.4
0
15.75
0.0
66.7
October
283,500
31.2
8.5
110.0
19%000
31.2
4.3
95.5
596,500
1 31.2
12.9
105.7
6301000
31.2
13.6
101.0
252.000
31.2
6.2
73.0
November
400,5W
34.05
13.1
123.2
643,500
34.05
15.2
110.7
643.500
34.05
15.2
120.9
612,000
34,06
14.4
115.4
H 1,228,500
34.05
33.2
108.1
December 527,400 35.8
12 Month Floating PAN Load
( ):
Annual PAN Load Limit
(ltba/ r
18.2
141.4
300
141.4
773,100
35.8
19.2
129.9
300.00
129.9
733,500
35.8
18.2
139.1
300.00
139.1
631000
35.6
13.2
126.E
128.8
0 270,000
35.8
7.7
113.8
113.8

FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Pape % of
Permit No.: WODD02005
Faeltlty Name: House of Raeford Farms, Inc.
County: Duplin
Month: July
Year: 2024
Fbld Name:
CP4
Fbid Nerve:
6A
Fold Name:
5AA
FWW Nsaw.
56
Maid Name:
6A
Area (acne):
23
Areo jacresk
6.9
Ana (acres):
5.5
Area (erns):
6.9
Area (acres):
18.02
Cover Crop:
Carer crop:
Cover Crop:
cover pop:
Cover Crop:
Load Type:
PAN
Load Type:
PAN
Load Typo:
PAN
Load Type:
PAN
Load Type:
PAN
SW Loaded?
21 YES ❑ rro
FbM1 Loaded?
[] yi5 ❑ No
Field Loaded?
❑ YEs 21 No
Field Loaded?
Yl:S ❑ r10
Field Loaded?
� YES ❑ No
<
0
s
==
c
n.
a
'x
o.�
a.
ICE
<u
vrL
a
>
>
Month
I
m
ibelac
Malec
"loc.
"Isc
1
m
nwac
nwoc
"Ise
t4elac
"ww
Ibalac
Janus
2,736,000
36.3
36.0
36.0
721,833
36.3
31.7
31.7
0
36.3
0.0
0.0
50,761
38.3
24.8
24.8
370,671
36.3
7.0
7.0
February733,500
37.4
9.9
48.0
618,714
37.4
28.0
59.0
0
37.4
0.0
0.0
41 938
37.4
21.0
48.7
317,718
37.4
6.2
13.2
March
1,426,500
44.2
22.9
68.8
721,833
44.2
38.0
98.2
0
44.2
0.0
0.0
761
44.2
30.2
77.0
379,671
44.2
8.7
21.9
April
1,062.000
32.25
12.4
81.2
506,713
32.25
19.8
118.0
0
32.25
0.0
0.0
396,721
32.25
15.5
92.5
261,231
32.25
4.4
28.3
May
1.480,500
28.8
15.4
96.6
412,476
28.6
14.3
132.3
0
28.6
0.0
0.0
292
28.6
11.2
103.7
211,812
28.6
3.2
29.5
June
1,489,5W
24.55
13.3
109.9
300,357
24.55
9.2
141.5
0
24.55
0.0
0.0r74
24.55
7.2
110.9
158,859
24.55
2.0
31.5
Ju
1,883,000
25.45
17.2
127.0
721,633
25.45
22.2
163.7
0
25.45
0.0
0.0
25.45
17.4
128.3
370,670
25.45
4.9
3e.4
August
2,218,5W
22.95
18.5
145.5
601,509
22.95
16.7
180.4
0
22.95
0.0
0.0
22.95
13.1
141.4
308,883
22.95
3.7
40.1
5epternber
1.953,000
15.75
11.2
158.7
OW301
18.75
11.6
191.9
0
15.75
0.0
0.0
15.75
9.1
150.4
312,417
15.75
2.6
42.7
October
1,750,500
31.2
19.8
176.5
402,153
31.2
15.2
207.1
0
31.2
0.0
0.0
312
11.9
162.3
206,511
3t.2
3.4
46.0
November
2,893,500
34.05
35.7
212.2
393,569
34.05
16.2
223.3
0
34.05
0.0
0.0
34.05
12.7
175.0
202,103
34.05
3.6
49.6
December 2439000 35.8
31.7
243.9
W11248
36.6
26.1
249.4
0
35.8
0.0
0.0
472,816
35.8
20.5
196,6
309,778
35.8
5.8
55.4
12 Month Floating PAN Load
243.9
249,4
fl.0
195.5
55.4
(Ibel
Annual PAN Load !.Molt
Ibsl r
300
300.00
300.00
300.00
300.00

FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) pop ! &
Permit No.: WQ0002005
FaciNty name: House of Raeford Farms, Inc.
County: Duplin
Month: July
Year. 2024
Field Name:
68
Flald Name:
field Name:
Field IW s
Fleid Name:
Area (acres):
6.7
Area (acres):
Area (acres):
Arm (scan):
Ana (acne):
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Cow Crop:
Load Type:
PAN
Load Type:
Load Type:
Load Type:
Load Type:
Field Loaded?
0 YEs ❑ no
Field Loaded?
❑ YES ❑ No
Field loaded?
❑ YES ❑ NO
FUId Loaded?
❑ Yes ❑ No
Field Loaded?
❑ YES ❑ fro
i°
y
3Z
E t
2
<
<
a
<
>
<
Month
gal
m9fL
Ibalac
lWw
9W
MOL
tbslac
ibs/ac
gal
mg1L
Ibs/ac
ibe/ac
gal
mUlL
golaa
balm
gal
mg1L
Ibe/ac
Ibelac
January
390,180
36.3
17.6
17.6
February
334,440
37.4
15.8
33.2
March
390,180
44.2
21.5
54.7
A hl
274,980
32.25
11.0
65.7
May
222,960
28.6
7.9
73.6
June
167,220
24.55
5.1
78.8
July
390,180
25.45
12.4
91.1
Au ust
325,140
22.95
9.3
100.4
September
328,860
15.75
8.4
108.9
October
217,380
31.2
1 8.4
115.3
November
212,740
1
34.05
1
9.0
124.3
December 326,080 35.8
12 Month Floating PAN Load
Annual PAN Load Limit
Ibe/a r :
14.5
138.8
300
138.8
0.0
OA
0.0
0.0

FORM. NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page __� of S
Did the mass loading rates exceed the limits in Attachment B of your permit? C1 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: Joseph Teachey Permittee: House of Raeford
Certification Number: 14930 Signing Official:
Grade: SI Phone Number:
Has the ORC changed since the previous NDMLR?
Nicole Reynolds
[phone] Signing Officials Title: Plant Manager
❑ yes 2 No Phone No.: [phone] Permit Exp.
Signature
By tMs signature, I certify that this report is accurtate and complete to the best of my knowledge
10/31 /31
Date Signature Date
I certify, urtdar 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 impnsonment for knowing vidalans.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of g
Permit No.: W00002005
Facility Name: House of Raeford - Rose Hill WWTF
County: Duplin
Month: July
Year. 2024
PPI: 001
Flow Measuring Point: ❑ IrAuent (] Effluent ❑ No now genaVad
Parameter Monitoring Point: ❑ IrNt a 0 Efterk ❑ Gmw&aber IovrertM ❑ surace watar
Parameter Code 0
MM
00310
00681
00880
00940
50060
31616
00610
00625
00820
00600
00400
OOad6
W009C
70300
OOM
0''
o
v
ij
r
r
E
E
Z
r
r
allo
a;
24-hr
hrs
OPD
mg1lL
rng1L
m
rng1L
m
01100 mL
m
mok
malL
su
Mg&
m
MOIL
m
1
07:00
8
610,000
33
0.17
63
38
71.2
<0.02
71.27
8
10.8
28.9
231
2
07:00
8
820,000
3
07:30
8.5
590,000
4
07:30
8
830,000
5
07:30
8.75
400,006
61
08:00
2
0
7
08:00
2
370,000
8
07:30
8.75
6W,W0
0.24
8.42
9
07:30
8
610,000
10
07:30
8
800,000
11
07:00
9
620,000
121
07:30
8.5
350,000
13
08:00
2
0
14
08:00
2
340,000
15
07:00
9
620,000
16
07:30
8
620,000
17
07:30
8.25
600,000
181
07:30
8
610,000
31
0.1
:-2420
38.7
47.4
<0.02
47.47
7.78
6.19
22
90.7
19
07:30
8
410,000
20
08:00
2
0
21
08:00
2
350,000
22
07:00
9
800,000
0.29
8.02
23
07:30
8.75
600,000
24
07:30
8.5
BMW
26
07:00
9
800,000
26
07:30
8
830,000
27
08:00
2
3W,000
28
08:00
2
370,000
29
07:30
8
8001000
0.21
7.89
301
07:00
9
8301000
31
07:30
8
820000
Average:
489,355
32.00
0.20
7.94
38.35
59.30
0.00
59.37
8.50
25.45
160.85
Daily Maximum:
030,000
33.00
0.29
63,00
38.70
71.20
0.02
71.27
8.42
10.W
28.90
231.00
2!ft Minknum:
0
31.00
0.10
63.00
38.00
47.40
0.02
47.47
7.78
6.19
22.00
90.70
Sampling Type:
Reoorder
Grab
Gnu
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Ofab
Grab
Grab
Grab
Monthly Limit:
800,000
Daily Limit:
Sample Frequency:
Continuous
2 X Month
Anmw&y
Annualy
3 X Year
6 X Week
2 X Month
2 X Month
2 X Month
2 X Monttt
2 X Month
5 X Week
2 X Month
2 X Month
3 X Year
2 X Month

Permit No.: W00002005

20
21
22
23
24
25
26
27
28
29
30

s �
24-hr hrs I mgOL
24
2s
26
27
28
29
30
31

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page i� of
Sampling Person(s) Certified Laboratories
Name: Jay Baker Name: Enviromental Chemist
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? C/ 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: Joseph Teachey
Permittee: House of Raeford
Certification No.: 14930
Signing Official: Nicole Reynolds
Grade: SI Phone Number: [phone]
Signing Official's Title: Plant Manager
Has the ORC changed since the previous NDMR? ❑ Yes C No
Phone Number: [phone] Permit Expiration: 10/31/2031
ignature Date
ignature Date
By this signature. I certify that this report is accurrale and complete to the best of my knowledge.
I iry, 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 bekef, 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 Mall Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Pop of S
Permit No.: WQ0002005
Facility Name: House of Raeford Fames, Inc
County: Duplin
Month: July
Year: 2024
Did irrigation occur
at this facility?
❑ YE ❑ No
Field Name:
5-A
Field Name:
5-AA
Field Nam:
5-B
Field Name:
8-A
An» (wm):
6.9
Area (acres):
5.5
Area (acres):
6.9
Area (acres):
16.2
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Hourly Rate (in):
Hourly Rabe (In):
Hourly Rate (In):
Hourly Rate (in):
Annual Rats (In):
60
Annual Rabe (In):
60
Annual Rate (in):
60
Annual Rate (In):
50
Weather
Freeboard
Field kripded?
❑ YES ❑ No
Field Irrigated?
❑ YES ❑ No
Field Irrigated?
❑ YES ❑ No
Field Irrigated?
❑ YES ❑ No
f-
en
>
><
a
>
3 a
><
3
°F
In I
It
1t
Gal
mil
In
in
gal
min
in
In
go
min
in
In
gal
min
In
in
1
R
75
1.1
4.5
2
C
66
0
4.5
103.119
300
0.56
0.11
80,823
300
0.43
0.09
52,953
300
0.12
0.02
3
C
64
0
4.66
103,119
300
0.55
0.11
80,823
300
0.43
0.09
52,953
300
0.12
0.02
4
C
72
0
4.75
5
C
77
0
4.66
6
C
85
0
4.75
7
CL
95
0
4.91
1 103,119
300
0.55
0.11
80,823
300
0.43
0.09
52,953
300
0.12 1
0.02
8
CL
73
0.5
5.12
9
CL
75
0
5.12
10
C
78
1 0
4.91
111
CL
81
0
5
12
R
69
2.3
4.75
13
CL
87
1.5
4.58
14
C
93
0.75
4.5
15
C
73
0
4.56
1 103,110
300
0.55
0.11
1
80,823
300
0,43
0.09
52,953
1 300
0.12
0.02
15
C
75
1 0
14.91
17
PC
71
0
5.08
18
C
72
0
1 5
19
CL
72
1.75
4.71
20
CL
82
1.15
4.37
21
CL
88
0.4
4.33
221
CL
72
0
4.33
103,119
300
0.66
0.11
80,823
300
0.43
0.00
52,953
300
0.12
0.02
23
CL
70
0.15
4.33
24
R
74
2.3
4.08
25
CL
79
0.5
4
26
CL
74
3.1
3.75
27
C
78
0.2
3.66
281
C
84
0
3.62
103,119
300
0.66
0.11
80,823
300
0.43
0.09
52,953
300
0.12
0.02
29
CL
73
0
3.83
103,119
300
0.55
0.11
$0,823
300
0.43
0.09
52,953
300
0.12
0.02
30
CL
1 74
0
4.04
31
CL1
71
1 0
14.16
Monthly Loading:
12 Month FloatingTotal (In :
721,833
3.86
28.14
0
0.00
7.06
585 761
3.02
18.53
370,671
0.84
22.71

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 2 of S
Qttt tt
House of _ ..
Did Irrigation Occur
at this facility?
MMMMIMMMM.MMMIMMMMM

351000 1.07 0 F22
00 0 0.00
24.21 2820.03

I Permit No.: WQ0002005 I
90,011:113 mm-OV, , 2!!. 213131jil 0.88
ic 97 1862 - 71
F .7 1�1� ---- 270,000 OJBV3
,76
43.14
F -059

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 5 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?
❑� Compliant
❑ Nort-Compliant
0 Compliant
❑ Non -Compliant
Compliant
❑ Non -Compliant
❑� Compliant
❑ Non -Compliant
0 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: Joseph Teachey
Permittee:
House of Raeford
Certification No.: 14930
Signing Official: Nicole Reynolds
Grade: SI Phone Number: [phone]
Signing Officials Title: Plant Manager
Has the ORC changed since the previous NDAR-17 ❑ Yes F No
Phone Number: [phone] Permit Exp.: 10/31/31
�� z
�liti
Signature Date
s 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