WQ0000948_Monitoring - 08-2016_20161004

MON -DISCHARGE APPLICATION REPORT (NDAR4)Pago,-L of 4.
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Facility Maine:
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Area (aGr60-
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TOWN OF JACKSON
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1
11'.'22 "': " '
Fescue
Pleld Name•
Area (acres);
Cover crop:
2
12.40
Fescue
Count T� iVorFhsm
y:
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; Area (aftds):
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etd Name:
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(acres): )
Cover Crop:
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4
12.26
Fescue
i lotirhr.l@ato' In .
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`'Ahnual l Wd (In):
-
Hourly Rate (in);
Annual Rate (In):
I iourly Ivatc�,(ln):
Hourly Rate (in):
Annual Rate (in)'
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of--/ -
Did the application rates exceed the limits in Attachment B of your permit? U Compliant ❑ Won -Com pliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? L7Compllant 0 Non -Com pliant
Was a suitable vegetative cover maintained on.all sites as specified In your permit? . 0 c mplfant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application. to each permitted site?, -C1 Compliant❑ Nan•Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? L" 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 datels1 of the non-comoiianca and dascrihe lhp nnrraofhm
Operator In -Responsible Charge (ORC) Certification
Permittee Certification
ORC: Johnny G. Young
Permittee: Town of Jackson
Certification No.: 2 312 9
Signing Official: Jason S. Morris .
Grade:1 collection Phone Number: 252-534-3811
Signing Official's Title: Mayor
Has the ORC changed since the previous NDAR-1 ? y� ®No
Phone Number: 2 5 2 — 5 3 4 — 3 8' 1 1 permit Exp.: 12-31-16
i? lE
QZZ %lv
4under
USi ature Date
Signature Date
By this signature, I c ify that This report is accurrate and complete to the best of my knowledge.
Iertiry, penally of law, that this document and all attachments were prepared under my direction or supervision In accordance
wiIli 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 Die 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, l am aware that there are significant
penalties for submitting false information, including the possibility of lines 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

MUI%4-UIZ5Ut-IAKUE APPLICATION REPOI;T (NDAR.'i )
Page '4 of.:Z.
ern,itIdo.: W000009iji
Facility Mame ,,,.TOWN
O JACKSONJACKSO
.a..�,
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ou
county: Northampton
Illl)i011 Monti,•
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.
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C
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[Did �U'6'�c�ja�; on occur
... , 5
field Name:
l_
.><�....Ye'ir•
d Nam .
ol� L�111s �I'�1�0�0�°„°
A't'ea (arrOt3):;
;fl,i
Area (acres):
( )
Area (Ocreq):
Area (acres):
CovUr Cron:
H'ot.trl j R7ie
'Fescue
Cover Crop:
Cover C I'op:
'� '
I _
Cover Crop:
IdYEs ❑ No
(In):..
_
Hourly Rate (in):
I lotirlj I'ate,(tn):
Hourly Rate (in):
Weather
/lfiiiu l !?ate (In):
r
Annual Rate (In):
Annual P:ata (tn)
Annual Rate (III):
Hold 1t'rIF� ;teci;'
r. n m•. a
-�u, S"c»
j...�`
field Irrigated?
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o E
❑YES ❑ No
c :,
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C lolci irridatod?
b•
w. a
0 YES.
u;
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-
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t'�" rii
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field Irrigated?
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u .0 freeboard
c - :L
w
ro U i�9 o fl
CD o o. o �?�
f1 YES ❑ idi]
T,. f� �,
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❑ YES No
rn E
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c �
F in ft ft
w
:: .. gal
_� minim
s,.�..... -_.,
In it,
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gal w, min
in c_ in
u
gal min
in in
(OO 100
7
12
'
13
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20
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-
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-
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22
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_
23
24
66 10025
"-O
26
27
_
28
'-
29
30
Monthly Loading:
•12 Monti, Floating Total 111): JE-
_-......
._

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-'I) Page L_ of /
Did the a0plication rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Efcompllant ❑ Non -Compliant
Compllant E.] Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 0 c mpliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? dCompliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? Ej ompliant O 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 arlditinnal ahoatc If naeoecanr V
Operator In Responsible Charge (ORC) Certification
Permittee Certification
ORC: Johnny G. Young
Permittee: Town of Jackson
Certification No.: 23129
Signing Official: Jason S. Morris
Grade:l collection Phone Number: 252-534-3811
Signing Official's Title: Mayor
Has the ORC changed since the previous NDAR-1? 0 ye ® No
Phone Number: 252-534-3811 Permit Exp.: 12-31-16
L) Sig ature Date
Signature Date
By this signature, I c (fy that this report Is accurrale and complete to the best of my knowledge,
I ertlfy, 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617