WQ0004910_Monitoring - 08-2016_20160906 (3)

NON -DISCHARGE APPLICATION REPORT Pageo(
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER:�A MONTH: O r YEAR 7�0 )
Or
FACILITY NAMV: I/LJ� (�� V � 1"'ll� COUNTY:
Formulas: Daily Loading (inches) _ (Volume apaled (gallons) x 0.1336 (COIL teeVgallon) x 12 (inchc Jfoot)►I (Ares Sprayed (ac, os) x 43,160 (aqui 1�90e01e)) OR
- Vulumc 1tpPlled (gallons) I (Area Spmyad (acres) x 27,152 (g511or1Jauc-inch)j
tiloximurn Hourly Loading (Inches) = Daily Loading (Inches) /[Time Irrigated (minulcs)/ 60 Iminutea/hour)► Monthly Loading (inches► = Sum of Dallyloadinga (inches)
12 Month Floating Total (inches) = Sujn of this monin's naontblY Loading (inches) and prgvlous 11 month's Monthly Loadings (Inches)
Avefapc Weekly Loadlnd Iinchesl
Did Irriaa69,1 occur This Facility!
Yes' No; ❑
Did Irrigation Occur On Thls'Field: Dld Irrigation Occu On This Field:
Yes: �N0: ❑ Yes: No; ❑
FIELD NUMBER:
AREA SPRAYED (acres). _515
COVER CROP: 5C
PERMITTED HOURLY RATE (Inches):
Q Z
FIELD NUMBER:
AREA SPRAYED neres : ,
COVER CROP: CLF
PERMITTEt31HOURLY RATE (inches):
D
A
T
E
WEATHER
Weather
CONDITIONS PERMITTED YEARLY RATE finches):j
Tompar`atare Storage
at Proclp,ta- Lagoon Volume Time Daily
ap Ilcmlon lion Frea.boa A lied Irrigated LoadingLoadingApplied
Maximum
Hourly
PERMITTED'YEARLY RAPE (Inches);j '52—
LA
Maximum
Volume The Daily Hourly
krri ated Loading Loading
(`P) inches feet
gallons minutes inches
inches
gallons minutes
inches inches
2
,
3
4
2,15
5
r
6
7
8
9
()
10
G
11
12
13
14
15
1s
17
18
�'
19
zo
,
z1
,
2z
24
z5
-
26
2-2-2-00 30 J 15
22
,15
27
Z 30 0,15
221200L)-,)-5
ae
22,2690 ,)5
2? 2t9� 3tJ
.75
29
0.7 7227V
2Z r PO 1, IS
Z2 2Q® 3 C)
T I S
30
2Z. 20� -15
22j2Q0D,j
5
31
Total Gallons/Monthly Loading (inches)
7
12 Month Floating Total (inches)
Q
Average Weekly Loading (inches)
" Weather Codes: C --clear, PC -partly cloudy, Cl -cloudy, R.rain, Sn-snow,
Spray Irrigation Operator in Responsible Charge (ORC)_ 1r,�/_ &Jhel/ Phon®:_ZSZ- j
ORC Certification Dumber; �� �� Check Box if ORC Has Changed: ❑
Mall ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1617
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
Ely THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORMNDAR-1 (11/2005)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has beeEgX liant
with the following permit requirements: (Vote, if a requirement does not apply to your facility put (JA) in the
compliant box. )
Co� liantMINI)
I
Page of-251-
If
rJ
1. The application rate(s) did not exceed the limit(s) specifier) 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 slte(s) aro accordance with the perm it.
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) wZas not less than the limit(s)
specified in the permit.
If the facility is non-comaliant. 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 non-compliance 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 ell qualified personnel properly gathered and evaluated the information
submitted_ Based on my inquiry of the person or persons who maruage 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."
( ignature of permittee)* Date
eab��I_ I ize.4,—
( ermittee-Please prin or type)
Po
-J4 Ji-):)
ermittee Addross
9b, 6 4 e /j. e �
(Name of Signing Off iccal-P ease print or tTizc-
jPositlon
or Title)
(Phone Number) (Permit Exp. Date)
' If signed by other than the permittee, delegation of signatory authority must be on file witch the stats per 15A NCAC 28.050E (b)(2)(D)_
DENR FORM NDP.R-1 (111200$)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITES)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED,
PERMITNUMBER:� MONTH:YEAR:
FACILITY NAM$: Inj if wa'' COUNTY:
Formulas:
Deily Loading (Inches) _ (volume Applied (gallons) x 0,1336 (W* feeLfgallon) x 12 (inchcrL*Qt)) /(Area Sprayed (acres) x 43,00 (,,quare (eeLrecre)) OR
volumc Applied (gallons)/ (Area.SPMy(1d (acre;) x 27,152 (gallon /etre inch))
Maximum Hourly Loading (Inches) -Daily Loading (Inches) / (flnle Irrigated (rlinuics)100 (minutes/hour)) Monthly Loading (inches) =Sum of Dallyl-oaCdngs (inches)
1Z Month Floating Total (inches) = Sum of thi�; moron's nMonNly Lading (inehe.) and pravlous 11 nonW9 Monlhly Laadings (Incnes)
AveragcWeeklyLoading(inehca)dain the manth(dayarmdnth)Ix7(daysa+eek)
Did Irritration occur Thi F 'I' y'
" Woather Codes: C -clear, PC -partly rJoudy, CI -cloudy, R•rain, Sn-show, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC)2QL�f< �)���/ Phone: 252—
ORC Certificatlon Number: Dq?$, q Check Box if ORC Has Changed: ❑
M11all OP,IGINAL. and TWO COPIES to:
DENR
Division of Water Quality
ATTN; Information Processing Unit
1617 Vail Service Center
RALEIGH, INC 27690-1617
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
13Y THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE,
GENRFORI✓INDAR--1 (11/2005)
„ 8e, a
Yes' No: ❑
Did Irrigation Occur On Thls'Fleld;
Yes: ®� No: ❑
Did Irrigation Occur-Dn This Field:
Yes: 1!9_� No: ❑
FIELD NUMBER:
AREA SPRAYED acres ; ¢
COVER CROP: S C
PERMITTED HOURLY RATE (InQhes)-i
U,,2
FIELD -NUMBER.
AREA SPRAYED acres
COVER CROP:
PERMITTED INOURLY RATE (inches):
D
WEATHER
CONDITIONS
PERMITTED YEARLY RATE
(inches):
PERMITTED YEARLY RATE 'Z
A
A
T
E
Weather
Codo"
Tompet�ature Storage
at Poctptt7- Layoon volume
appllcallon tion Free -boa Applied
Time
Irri ated
Daily
Loadln
Maximum
Hourly
Loading
Volume Time
d lied ffrrieated
(inches);5.2-
Maximum
Daily Hourly
Loadln Loading
PF) I inches foet
gallons
minutes
inches
Inches
gallons minutes
inenes Inches
1
20711
0
4
.1
5
,
6
7
e
9
V
10
11
12
13
14
15
16
f
17
19
zo
,
21
22,
23
24
-L5-
26
D
30
r 15
22
r VS
27
Z
30
o1-1 15
22t200 30
V-4 s
2622r2L90
'12>0
,15
ZZ Zt�% =3b
,7S
29
2Z r
, t S
22 ZDG 0*
! S
30
ZZ, WO
.15
22
31
Total Sal lons/rf,onthly Loading (inchu!o)
12 Month Floating TDtai (inches)
Q
Average Weekly Loading (inches)
,
!--
" Woather Codes: C -clear, PC -partly rJoudy, CI -cloudy, R•rain, Sn-show, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC)2QL�f< �)���/ Phone: 252—
ORC Certificatlon Number: Dq?$, q Check Box if ORC Has Changed: ❑
M11all OP,IGINAL. and TWO COPIES to:
DENR
Division of Water Quality
ATTN; Information Processing Unit
1617 Vail Service Center
RALEIGH, INC 27690-1617
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
13Y THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE,
GENRFORI✓INDAR--1 (11/2005)

NON -DISCHARGE APPLICATION REPORT Psge � or J
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate (by inserting Y(es) or N(o) in the appropriate box) whether the facility has beeE221pliant
with the following permit requirements_ (Vote: if a requirement does not apply to yrour facilif}, put f4A,) in the
compliant box, )
1. The application rate(s) did not exceed the limit(s) specified) in the permit.
Compliant (Y,N)
2. Adequate measures were taken to prevent wastewater runoff from the slte(s).
3. A suitable vegetative cover was maintained on the slte(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 andlor storage lagoon(s) was not less than the limit(s)
specified in the permit,
If the facility is non-c� om�.,lia_t 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 non-compliance 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 all qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who marmge 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."
/ 'I a 4, 1 �/ /
7(ignature of permit#ee)* Date
l 2 11.�
( ermittee-Please print or type)
E 6 � 2
(1c-2 % A�, � ,7
ermittee Address
— /�o ,C,
//,q, ) ) , ,
(Flame tof Signing Official -P ease print or ty&'(L
{Position or Title)
(Phone Plumber) (Permit Exp. Date)
' If signed by other than the permittee, delegation of signatory authority must be on file witYn the stato per 15A NCAC 2B.050G (b)(2)(D)_
DENR FOR.IJ NDAR-1 (11/2005) -

NON -DISCHARGE ,APPLICATION REPORT Page 3 0(�
SPRAT' IRRIGATION SITE($)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED,
PERMIT NUld6ER: 1 U)� QMONTH: o tj YEAR--
FACILITY
EAR:FACILITY NAMQ; Ipj}'1t (� ��Id COUNTY: �(
Formulas;
Doily Loading (Inches) - [VQIVme applied (gallons) x 0.1236 (VOIC WL(Gallon) x 12 (inchas/feot)) I(Araa Sprayed (ac, es) x 43,00 (;quare (eel/acre)) OR
- Vulumcapptled (gallons)/ (Area Sprayed (aeras) x 27,152 (gallon ratrc nch))
Maximum Hourly Looding(inohes) =Daily Loading(Inches)/Crime Irrigaied(minutc6)/60Iminutes/hour)) Monthly Losding(inchos)=SumofDaIIYLoadnaa(inches.)
12 Month Floating To tat (inches) = Sum of Of: motnh's Monthly Larding (inches) and prgvlous 11 month's MinWy Loodings (Inones)
AyeragcWeakIyLoa cling (inches)=1Monihlyl-oading(inch:dmonrh)/Numbtrofdays in the month ld9vsrmonth1rx7rdsvaw.>ek1
" Wcathsr Codes: C -dere, PC -partly cloudy, Cl -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC); j p r� j� ���� j�/ Phone: 2-52-5_5!;�L7)W
Oi?C Certification Number; � 6 9 Check Box if DRC Has Changed: ❑
Mall OP.IGINAL. and TWO COPIES to:
DEUR
Division of Water Quality
ATTN: Information Processing Unit
1617 rOail Sclvice Center
RALEIGH, NC 27699-1617
�r r ww"' 'A av -
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
By THIS SIGNATURE. I CERTIFY THAT THIS REPORT IS ACCURATE AND
CDMPLETE TO THE DEST OF FAY KNOWLEDGE.
DENRFORMNDAR-" (11/2005)
Did Irritation occur This Facility:
Yes: No;
Did Irrigation Occur On This Field:
No: 0
Did Irrigation Occur On This Field:
Yes: 51 No ❑
FIELD NUMBER:
FIELD NUMBER:
AREA SPRAYED ewes : t AREA SPRAYED jaercs ;
COVER CRO{': S .!2 COVER CROP:
PERMITTED HOURLY RATE (Inches): I PERMITTED, HOURLY RATE (inches):
D
AMaximum
T
E
WEATHSR CONDITIONS
Weather Tomper�atrrre Storage
at Prgq'ptte- "yoon
Code, npPllcndon tion Free -boa
PERMITTED YEARLY RATE (inches)!
Volume Tiros Dally
Applied Irri abed Loadln
Hourly
Loading
PERMITTED YEARLY RATE inches); 'Z
Maximum
Volume Time Daily Hourly
Applied 0rri ated Loadln Loadln
I`pl inches feet
gallons minutes inches
Inches
gallons :minutes
inches Inches
2
,77
4
is
I
5
,
6
7
8
9
p
10
11
12
19
1d
15
16
f
17
7
19
Z0
,
21
r�
22
23
Z,
24
25
26
30 t 1 S
22 ?OU
VS
27
Z 30 01 IJj
22, 200
0,),-
2e
22t2t9C> rl5
Z2 2t9� 3D,
, �s
2502
_ ZZ, UO C2.15
Z2 Z00 3 v
115
30
2 t 200 o o .15
22t200 3z)
, l
31
Total Gallons/Monthly Loading (inchgo)
7
12 Month Floating Total (Inches)
Average Weekly Loading (incho5)
r Gln
/J,it1_
" Wcathsr Codes: C -dere, PC -partly cloudy, Cl -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC); j p r� j� ���� j�/ Phone: 2-52-5_5!;�L7)W
Oi?C Certification Number; � 6 9 Check Box if DRC Has Changed: ❑
Mall OP.IGINAL. and TWO COPIES to:
DEUR
Division of Water Quality
ATTN: Information Processing Unit
1617 rOail Sclvice Center
RALEIGH, NC 27699-1617
�r r ww"' 'A av -
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
By THIS SIGNATURE. I CERTIFY THAT THIS REPORT IS ACCURATE AND
CDMPLETE TO THE DEST OF FAY KNOWLEDGE.
DENRFORMNDAR-" (11/2005)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility_ Status;
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has beeEompllant
with the following permit requirements: (Vote: if a requirement does not apply to yrour facility put j4A) in the
compliant box. )
Compliant (Y,N)
1. The application rate(s) did not exceed the iimit(s) specified in the permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
3. A sultable 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 andfor storage lagoon(s) wa3s not less than Me limit(s)
specified in the permit,
Fsge-3— or
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 non-comp)iance 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 all qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiri of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the beast 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."
( ignature of permittee)* Date
(Permittee -Please print or type)
ermittee Addross`)
-A beiel
(Mame of Signing Official -Please print or '7
)
{Position or Title)
(Phone Plumber) (Permit Exp. Date)
' If signed by other than the permittee, delegation of signatory authority must be on file witfh the stato per 15A NCAC 26.0500 (b)(2)(D)_
DEWR FORM HD4.R-1 (11/2OU) -

NON -DISCHARGE APPLICATION REPORT Paaa of
SPRAT' IRRIGATION SITE($)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED,
PERMIT NUM6ER:• I CZI !v MONTH: AU 0 YEAR:201,
FACILITY NAME: n wy) (�� COUNTY:
Formulas:
Doily Loading (Inches) s (V'olum8 app ied (g911ons) x 0.1336 (cubic teeL'gallon) x 12 (incho Jfoot)] (,grey Sprayed (aces) x 43,G60 (,�r� (esVacl2)) OR
-VelumaApplied (0allon5)/ (Area Sprayod (acre;) x 27,152 (g5ltons'otrc inch)]
twfiximurrt Hourly Loading (Inches) - Daily Loading (Inches) / [Tine Irrigated (minulcs)! 80 Immuleolhour)] Monthly Loading (incBoes) = Sum of DallvLoad4ngz (inches)
12 Month Floating Total (inches) - Sum of thi: monln's Nlonthly U 55ding (inehc:) and pmvtous 11 month's Monthly Ljodings (lnortes)
,gyerogeWeakiyLoading(inehos)=IMonlhlYLoading(inchcg/monln)/Numberofdayainthe monchldaysrmontN)x?fdavaWeekl
Yes: Y No: ❑ I Yes:
ER:
No-
PERMITTED 1.1011PLY RATE /InnhacV•
yes.. ®' No:
FIELD NUMBER:
AREA SPRAYED (acre;
COVER CROP:
I . re eye --y L.vacuny tmrne'/I•A
( Ve/ I Iy
?( 0
1Naathsr Codes_ C-plear, PC -pertly cloudy, Cl -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC)_90b�"�f' )%7p� Phone:
ORC Certification Number: 14! J5• _9 Check Box if QRC Has Changed: ❑
Mall OP.IGINFkL and TWO COPIES fo:
DENR
Division or Water Quality
ATTN: Information Processing Unit
1617 rv(ail Service Center
RALEIGH, NC 27699-1617
-Q ���� �
(SIGNATURE. OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNA, URE, I CERTIFY TH,�LT THIS REPORT IS ACCURATE ANE]
CDIdPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORWIDAR 5 (11/2006)
•_
SWIM•
�^-�•'•�-alt: �:e'-1•111�\T�7•a111[NIC=i=•Y-
•Haurry
• _
Maximum
m���Gy��:�
I . re eye --y L.vacuny tmrne'/I•A
( Ve/ I Iy
?( 0
1Naathsr Codes_ C-plear, PC -pertly cloudy, Cl -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC)_90b�"�f' )%7p� Phone:
ORC Certification Number: 14! J5• _9 Check Box if QRC Has Changed: ❑
Mall OP.IGINFkL and TWO COPIES fo:
DENR
Division or Water Quality
ATTN: Information Processing Unit
1617 rv(ail Service Center
RALEIGH, NC 27699-1617
-Q ���� �
(SIGNATURE. OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNA, URE, I CERTIFY TH,�LT THIS REPORT IS ACCURATE ANE]
CDIdPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORWIDAR 5 (11/2006)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATI4'N SITE(S)
Facility Status;
Please indicate ( by inserting Y(es) or N(c) in the appropriate box ) whether the facility has beeEompliant
with the following permit requirements: (Mote,, if s requirement does not apple to your t"acility put (dA) in the
compliant box, )
compliant Y,N)
i
1. The application rate(s) did not exceed the lirnit(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 the permit.
4. All buffer zones as specified in the permit were maintained during each application.
5. The freeboard in the treatment andlor storage lagoon(s) was not less than the limit(s)
specified in the permit.
Psge E or J
If the facility is non-compliarot please expfain 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 non-comp)iance 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 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_"
( 1gnature of permittee)* Date
(P ermlttee-Please print or type)
Eb_&�z97
ermlttee Address
_)9, b64 z, j
{Name of Signing Offiaal-P ease print or typ )
{Position or Title)
(Phone plumber) (Permit Exp. Date)
'If signed by other than the permittee, delegation of signatory authority must be on file witfh the stato per 15A NCAA 26.05ou (b)(2)(D).
DENR FOPJO NDa.R-1 (11!200,)

IVOh DISCIHARGE APPLICATION REPORT Paae S o(_
SPRAY IRRIGATION SITE($)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMITNUM6ER:.ti�j lA�� qol MONTH; D YEAR--
FACILITY
EARFACILITY NAME;67
,2f I/L aN!1„� n COUNTY:
Formulas:
Daily Loading (Inches) � (Volume Apptleo (gsllone) x 0.1336 (ouDle (Get/gallon) x 12 (inche:Jfeot)) i(,gfea 5pFeyed (aces) x 43,00 (;phare (eaveerep OR
- Vulumcappged (0allonsl/(Area SprayAd (acres:) x 21,152 (gallonw�atro-inch))
MmimumHoutlyLpading(Inches) =D.3i[yLoadfng(Inches)/[T(meirrigaled(minulc5)/80(minutes/hour)I Monthly Loading(inchosi =Sum af1)allyt.oad4nge.(inches)
12 Month Floating Total (inches) - Sum of this months marimly Losding (incho:) and prgvlous 1 i month's Monthly Ljadings (Inches)
AveragcWeeklyLoadlnalinehesl=IMonUlui_naeinnlinehccmon,ntrtumno �reowt \tip ti a,,., ,:—,,,,-,
Did irrigation octurp This Facility:
Yes: No: ❑
Did Irrigation Occur On Thls Field; Dld Irrigation Occur On This Field,
Yes: 19— No: ❑ Yes: ( No: ❑
FIELD NUMBER:
AREA SPRAYED acres :
COVER CROP: V
PERMITTED HOURLY RATE (Inches):
..C1_1
FIELDNUMBER; L
AREA SPRAYED fieres
COVER CROP:
PERMITTED R40URLY RATE (inches):
D
WEATHER CONDITIONS
PERMITTED YEARLY RATE finches)d
PERMITTED 'EARLY RPtTE inch®
A
E
vVeathture Storage
er jTo-p,�,,,-
t 1 r®ciprca- Lagoon Volume Time
Codo oppllcatlon tion IlFree.bmiaApplied Irrigated
Dally
Loadin
Maximum
Hourly
Loadin
Volume Time
A lied Rrrigated
:
MaximumT�
Daily Hourly
Loadin Loadln
1'F) inches feet
gallons minutes
inches
Inrhas
gallons anlnutes
inenes Inches
7
2
4
2 ,1
5
,
6
7
8
9
1 Q
10
11
12
13
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15
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,
17
77
19
20
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2z
23
Z.
24
25
26
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,15
27
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29
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2s
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15
si
Total Gallons/Manthly Loading (inches)
7
12 Month Floating Total (Inches)
Average Weekly Loading (inches)
y
;
Hik;i uues. v,eN,rv'Vui eiy �tv�uy, vim wuuy, tc ram, on -snow, 51'51@@1
Spray Irrigation Operator in Responsible Charge (CRC),pr� %� J Phone:
ORC Certification Number: �?S..g Check Box if QRG Has Changed: ❑
Mall ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN; Information Processing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1617
_YA')
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
By THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
CDMPLETE TO THE BEST OF MY KNOWLEDGE.
DENRFORMNDAR-1 (11/2005)

NON -DISCHARGE APIaLiC;.ATiON REPORT Psge-5— or J
SPRAY IRRiGATIO'N SITE(S)
Facility Status;
Please indicate (by inserting Y(es) or N(o) in the appropriate box) whether the facility has beeEompllant
with the following permit requirements: (Vote, - If a requirement does not apply to your facility put f4A) in the
compliant box, )
1. The application rate(s) did not exceed the limit(s) specifiers in the permit. Compliant MN)
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 andlor storage lagoon(s) was not less than the limit(s)
specified in the permit.
If the facility is non-com 121ion 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 non-compliance 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 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_"
4wdl�� - /1Z) 4 1 ))
( ignature of permittee)* r Date
42
1/
(Permittee -Please print or type)
ermittee Addross`)'
- OL�4 Z_-, j
(Dame of Signing Official -P lease print or t7&<<!
hcC 1j0j_ CS ��i --�Z��
{Position or Title)
(Phone Plumber) (Permit Exp. Date)
'If signed by other than the permittee, delegation of signatoryauthority must be on file with, the stater per 15A NCAC 26.0500 (b)(2)(D).
DEUR FORD NDAR-1 (11/200$)