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FOkM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page /_ of
Permit No.A `�D;(%
Facility Name�S7b—,)C I
County:
Month: Year:
I( � ! o�
Did irrigation
F1�elcirNarne�
Field Name:
Y , fi F�el�d"Name �� '
Field Name:
occur
l�rea(acres)
Area (acres):
Area"(acnes)
Area (acres):
,,
at this �aCl�l$y
_
�'�
4 .Cou(erCro x ?F-
Cover Crop:
r 'Cover Crrop _
Cover Crop:, C
Kourly Ra ek(m) ` ?�
Rate (m):
Hourly Rate
❑ YES o
_, _ 5:Hourly
a
(in):
g1�nualRafee) ��
2Faed3lrf)gated?zIJrYEs ,i yq
Annual Rate (in):
Field Irrigated? E] YES 1940Fieldlrr
A4nualpRate (m)
gate?QiEs y No
Annual Rate (in):
Field Irrigated? ❑ YES o
Weather Freeboard
v
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gal min in in
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i
t
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Monthly Loading
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CT
p1, CJs
12 Month Floating Total (in)
—\Ivi. ivuni \- I uu- I I AYYLIt-AI IUN Kt_.NUKI (NUAK-1) Page A of_�Il
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? 2<0mpliant ❑ 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 additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
x
&'l�z 6
Permittee:
LJAJ —STC)d�
Certification No.: 008-
70��®
Signing Official:
Grade: JC:z- Phone Number: 9/ ?",6 7,3 — ;4646
9a q -z 9 /4 Ce
Signing Official's Title: h1,41L R
Has
Has the ORC changed since the previous NDAR-1? ❑ Yes [-r o�
Phone iVumber:q/ lqtl, �4 Permit Exp.: % •e , � ��
Signature Date
Signatur Date
By this signature, I certify that this report Is accurrate and complete to the best of my knowledge.
I certify, under pen�1'yf 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 Quality
Information Processing Unit
1617 Mail Service Center /
Raleigh, North Carolina 27699-1617
, 1\1 . "--,\-I VU -I I
IdVISI-UlZA,r1AKUt,Ark''U(IAIIVIVKti-'VKI (NUAK-1) / ','®'1 I -age —? of
Permit No ��`}®�
a�
Facility Name
Q
County Month:
tY �(� Year:
®ad irrigation
FreJc1 Nainee; r
Field Name:
sr die d NaPje
�� < r `fit
Field Name'
occur
8Area
(acres):
alt this facility?
��
..
Cover G or p
Cover Crop: � �
Co�r�Go , "`
p,�
Cover Crop:
7 y; -I�L'i �� 3
- ..
_
❑ YES [eNo
v } .liTa�' t ate.•
Hourly Ra eY+in)F. rte( �a r
HourlyRate in :
(• ) �
9�
'� �
k�Houf'I�+�Ratey(�n�)�3 y ��,��,� �' �
Hourly Rate (in);
d
ual�Rate 9i
Annual Rate (in):
Annual Rate
�An
(in):
Weather
Freeboardie
d Ir��jated?CYEslNQ ,
Field Irrigated? ❑ YESy�FelBlrrigafedI�`
0
�^/
Field Irrigated. ❑ YES U
•e=•: oSr
3,.�`aye
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by ars Z
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U
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om
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Monthly
Loading
aT
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12 Month Floating
Total (in):
FORIVI: NDAR-'I 02-1'I NON -DISCHARGE APPLICAMW REPORT (NDAR-1) Page 14 -of 1�
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? [Kompliant ❑ Non-compliant
Was a -suitable vegetative cover maintained on all saes as specified in your permit? f,J ompliant ❑ Non-compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? compliant ❑ Non -Compliant
Were app 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 additional sheets if necessary.
j Operator in Responsible Charge (ORC) Cetaification
Permittee Certification
OR'C. rF( -: '. - a ` fr 6L+t
'eriniitee: ` dA�' %G4� er' , r e ly ' '
1..
�
Garb:kation iv_,.: ''lar
C
Signing Official: y�z� os? ✓ N u
GradF: t Phone Number: � e �; ®i CAX
Signing Official's Title:
Has the ORC changed since the previous NDAR-1? ❑ Yes No
Phone Number: i 9 �4,4,Permit Exp.:91
17 lb
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 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. i
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617