WQ0019665_Monitoring - 08-2016_20161004

Page 3 of 8
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S) '
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00019666 MONTH: August YEAR: 2016-
FACILITY
016-FACILITY NAME: Swan Quarter Sanitary District COUNTY: Hyde
Formulas:
Dally Loading (Inches) _ [volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 onchestfoot)] /[Area Sprayed (acres) x 43,560 (square feevacre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gailonslacre-Inch))
Maximum Hourly Loading (Inches) = Daily Loading Qnches) / [Time Irrigated (minutes) / 60 (minutes/houol Monthly Loading (Inches) =Sum of Daily Loadings Qnches)
12 Month Floating Total (Inches) = Sum of this month's Monthly Loading Qnches) and previous 11 month's Monthly Loadings Qnches)
Average Weekly Loading (inches) = rMordhiv Loadin (inchestmonth) / Number of days m me mann, rdawmanthtt , 7Ide�e-at
Did Irrigation Occur At This Facilit
Yes: No: x
Did Irrigation Occur On This Field:
Yes: No:
x
Did Irrigation Occur On This Field:
Yes: No:
x
'
FIELD NUMBER: 1
AREA SPRAYED acres : 2.98
COVER CROP:
PERMITTED HOURLY RATE (Inches): 0.25
FIELD NUMBER: 2
AREA SPRAYED acres : 3.28
COVER CROP:
PERMITTED HOURLY RATE (Inches): 0.25
D
A
T
E
WEATHER CONDITIONS
Temper-
store at Storage
weather applicago Preciplta- Lagoon
code
n tion Free -board
PERMITTED YEARLY RATE (inches): 32.5
Maximum
Volume Time Daily Hourly
Applied Irrigated LoadingLoadingApplied
PERMITTED YEARLY RATE (inches):
Volume Time Daily
irrigated Loadin
32.5
Maximum
Hourly
Loading
in
Inches feet
gallons
minutes
Inches
Inches
gallons
minutes
Inches
Inches
1
R
1 88
0.31
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
2
R
1 87
0.17
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
3
PC
84
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
4
PC
86
0 3.5
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
5
R
86
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
6PC
89
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
7
R
88
0.06
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
e
R
88
0.46
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
9
R
87
0.01
0
0 1
0.00
#DIV/0I
0
0
0.00
#DIV/01
10
R
89
0.1
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
11
PC
88
0 3.5
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
12
R
88
0.33
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
13
PC
91
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
14
C
93
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
15
R
93
0.02
0
0
0.00
1 #DIV/OC
0
0
0.00
#DIV/01
16
PC
90
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
17
PC
91
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
18
R
91
3.62 3.6
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
19
R
86
0.6
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
20
R
85
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
21
R
90
0.25
0
0
0.00
#DIV/O!
0
0
0.00
#DIWo!
22
PC
86
0.25
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
23
C
81
0.01
0
0 1
0.00
#DIV/01
0
0
0.00
#DIV/o!
24
PC
82
0 1
0
0
0.00
1 #DIV/01
0
0
0.00
#DIV/Ol
25
R
84
0.01 3.6
0
0
0.00
1 #DIV/01
0
0 1
0.00
#DIV/01
26
C
86
0
0
0
0.00
1 #DIV/0!
0
0
0.00
#DIV/0!
27
PC
90
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
28
R
86
0.03
0
0
0.00
#DIW01
0
0
0.00
#DIV/0!
29
R
86
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
30
R
86
0.2
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
31
R
87
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
Total Gallons/Monthly Loading (inches)
0
0.00
0
0.00
12 Month Floating Total (inches) ;•;•:•:•;•:•;•;•;•
•;•;•;•;•;•;•;•;•;.;•;•
0.00
0.00
Average Weekly Loading (Inches) •:•; ; ; : ; ::•;
;;; ; ; ; ; ; ; ; ; ;;;
0
0
Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator In Responsible Charge (ORC):
Allen Bliven
ORC Certification Number: 996725 Check Box If ORC Has Changed:
Phone: [phone]
Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
RALEIGH, NC 27699-1617 COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-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 been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
1. The application rate(s) did not exceed the limit(s) specified in the permit
C�o.,m Ifant .N)
I�
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
y�
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit
Y�
4. All buffer zones as specified in the permit were maintained during each application.
0
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
0
specified In the permit
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-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."
�� e-,- 'r, William G. Freed
(Slgnatur f P (ttee)* Date (Name of Signing Official -Please print or type)
Wayne Hodges, Chairman By Authority, President Enviro-Tech
(Permittee -Please print or type) (Position or Title)
252-491-5277 9/30/2006
(Phone Number) (Permit Exp. Date)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
* If signed by other than the permittee, delegation of signatory authority must be on fife with the state per 15A NCAC 28.0506 (b)(2)(1)).
Page 3 of 8
DENR FORM NDAR-1 (11/2005)

Page 4 of 8
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00019666 MONTH: August YEAR: 2016
FACILITY NAME: Swan Quarter Sanitary District COUNTY: Hyde
Formulas:
Dally Loading (Inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inchesHoot)] /[Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acrednch)]
Maximum Hourly Loading (Inches) =Daily Loading (inches) /[me Irrigated (minutes) /60 (minutes/hour)] ily Loading (Inches) =Sum of Daily Loadings (inches)
12 Month Floating Total (Inches) =Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (Inches) = [Monthly Loading (inches/month) / Number of days in the month (days/month)] x 7 (daysAveek)
Did Irrigation Occur At This Facilit;
Yes: No: x
Did Irrigation Occur On This Field:
Yes: No:
x
Did Irrigation Occur On This Field:
Yes: No: x
....................................
FIELD NUMBER: 3
AREA SPRAYED (acres): 3.43
COVER CROP:
PERMITTED HOURLY RATE (inches): 0.25
FIELD NUMBER: 4
EA SPRAYED acres : 3.73
COVER CROP:
MITTED HOURLY RATE (inches):l 0.25
D
A
T
E
WEATHER CONDITIONS
Temper- Storage
weather atureat Preciplta- Lagoon
Code* application tion Free -board
PERMITTED YEARLY RATE (inches): 32.5
Maximum
Volume Daily Hourly
Applied Time Irrigated Loadina Loading
ZMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigate Loading
32.5
Maximum
Hourly
y
Loading
(°F)
Inches feet
gallons
minutes
Inches
Inches
gallons
minutes
Inches
inches
1
R
88
0.31
1 0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
2
R
87
0.17
0
0
0.00
#DIV/0!
0
0
0.00 1
#DIV/01
3
PC
84
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/O!
4
PC
86
0 3.5
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
5
R
86
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
6
PC
89
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
7
R
88
0.06
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
8
R
88
0.46
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
9
R
87
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/O!
10
R
89
0.1
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/O!
11
PC
88
0 3.5
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
12
R
88
0.33
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
13
PC
91
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
14
C
93
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
15
R
93
0.02
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
16
PC
90
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/0!
17
PC
91
0 1
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
1a
R
91
3.62 3.6
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
19
R
86
0.6
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
20
R
85
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
21
R
90
0.25
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
22
PC
86
0.25
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
23
C
81
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
24
PC
82
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/O!
25
R
84
0.01 3.6
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
26
C
86
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
27
PC
90
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
28
R
86
0.03 1
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
29
R
86
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
30
R
86
0.2
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
31
R
87
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
Total Gallons/Monthly Loading (inches)
0
0.00
0
0.00
12 Month Floating Total (inches)
:::::*-'..-'-'-'-*-'-'-'-'-'-'-'-'-'-'-*-'-::::::::::::::I
0.00
0.00
Average Weekly Loading (Inches),:::::::::
0
0
' Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Snsnow, SI -sleet
Spray Irrigation Operator In Responsible Charge (ORC):
ORC Certification Number: C)_/ ( -7;2')"-
Mail
;2')r
Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1617
Alien Bliven
Phone: [phone]
Check Box if ORC Has Changed:
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (11/2005)

Page 4 of 8
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 been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
1. The application rate(s) did not exceed the limit(s) specified in the permit.
Compliant N)
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
0
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
0
4. All buffer zones as specified in the permit were maintained during each application.
0
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
specified in the permit.
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-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."
(Signature of Permittee)* Date
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
William G. Freed
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252-491-5277 9/30/2006
(Phone Number) (Permit Exp. Date)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).
DENR FORM NDAR-1 (11/2005)

Page 5 of 8
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00019665 MONTH: August YEAR: 2016
FACILITY NAME: Swan Quarter Sanitary District COUNTY: Hyde
Formulas:
Dally Loading (Inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (incheslfoot)] /[Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (Inches) =Daily Loading (inches) /Mme Irrigated (minutes) /60 (minuteslhour)] ily Loading (Inches) =Sum of Daily Loadings (inches)
12 Month Floating Total (Inches) =Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (Inches) = [Monthly Loadin (inches/month) / Number of days In the month (days/monthll x 7 (daysAveakl
Did Irrigation Occur At This Facllir
Yes: No:
x
Did Irrigation Occur On This Field:
Yes: No:
x
Did Irrigation Occur On This Field:
Yes: No: x
....................................
FIELD NUMBER: 5
AREA SPRAYED (acres): 4.03
COVER CROP:
PERMITTED HOURLY RATE (inches): 0.25
FIELD NUMBER: 6
ZEA SPRAYED acres): 1 4.18
COVER CROP:
MITTED HOURLY RATE (inches): 0.25
D
A
T
E
WEATHER CONDITIONS
Temper-
weather atureat Precipita-
code• application Non
l`FI Inches
Storage
Lagoon
Free -board
feet
PERMITTED YEARLY RATE (inches):
Volume Daily
Applied Time Irriciated Loading
gallons minutes Inches
32.5
Maximum
Hourly
Loading
Inches
RMITTED YEARLY RATE (inches):l
Volume Time Daily
Applied Irri ated Loadin
gallons minutes Inches
32.5
Maximum
Hourly
Loading
Inches
1
R
88
0.31
1
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
2
R
87
0.17
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
3
PC
84
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
4
PC
86
0
3.5
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
5
R
86
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
6
PC
89
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
7
R
88
0.06
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
8
R
88
0.46
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
9
R
87
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
10
R
89
0.1
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
11
PC
88
0
3.5
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
12
R
88
0.33
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
13
PC
91
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
14
C
93
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
15
R
93
0.02
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
16
PC
90
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
17
PC
91
0
0
1 0
0.00
#DIV/01
0
0
0.00
#DIV/01
18
R
91
3.62
3.6
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
19
R
86
0.6
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
20
R
85
0.01
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
21
R
90
0.25
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
22,
PC
86
0.25
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
23
C
81
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
24
PC
82
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
25
R
84
0.01
3.6
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/0!
26
C
86
0
0
0
0.00
#DIV/01
0
0
0.00 1
#DIV/0!
27
PC
90
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
28
R
86
0.03
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
29
R
86
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
30
R
86
0.2
0
0
0.00
#DIV/0!
0 1
0
0.00
#DIV/01
31
R
87
0.01
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
Total Gallons/Monthly Loading (inches)
0
0.00
0
0.00
12 Month Floating Total (Inches)j:::::::::::
: : :::::::::::::::
0.00
0.00
Average Weekly Loading (inches) ; ;
0
0
Weather Codes: C -clear, Pc -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC):
ORC Certification Number: 996725
Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1617
Allen Bliven
Phone: [phone]
Check Box if ORC Has Changed:
(S TURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (11/2005)

Page 5 of 8
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 been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
1. The application rate(s) did not exceed the limit(s) specified in the permit.
Com Iiant N)
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
0
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
u
4. All buffer zones as specified in the permit were maintained during each application.
0
S. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
0
specified in the permit.
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-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."
(S`fgnatureo6TPermittee)* Date ,---
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
William G. Freed
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252-491-5277 9/30/2006
(Phone Number) (Permit Exp. Date)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(2)(D).
DENR FORM NDAR-1 (11/2005)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WOOO19665 MONTH: August YEAR.
FACILITY NAME: Swan Quarter Sanitary District COUNTY:
Formulas:
Dally Loading (Inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] /[Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) /[Area Sprayed (acres) x27,152 (gallons/acre-Inch)]
Maximum Hourly Loading (Inches) =Daily Loading (inches) /[Time Inigated (minutes) / 60 (minutes/hour)] tly Loading (Inches) =Sum of Dairy Loadings (inches)
12 Month Floating Total (Inches) =Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (Inches) = [Monthly Loading (incheslmonth) /Number of days in the month (dayshnonth)] x 7 (days/week)
Did Irrigation Occur At This Facillt;
Yes: No: x
Did Irrigation Occur On This Field:
Yes: No:
x
Did Irrigation Occur On This Field:
Yes: No: x
....................................
FIELD NUMBER: 7
AREA SPRAYED (acres): 4.48
COVER CROP:
PERMITTED HOURLY RATE (inches): 0.25
FIELD NUMBER: 8
ZEA SPRAYED (acres): 1 4.18
COVER CROP:
MITTED HOURLY RATE (inches): 0.25
D
A
T
E
WEATHER CONDITIONS
Temper- Storage
weather ature at Precipita- Lagoon
Code* applicatlon tion Free -board
PERMITTED YEARLY RATE (inches): 32.5
Maximum
Volume Daily Hourly
Applied Time Irrigated Loading Loading
tMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated Loading
32.5
Maximum
Hourly
Loading
(°F)
Inches feet
gallons
minutes
Inches
Inches
gallons
minutes
Inches
Inches
1
R
88
0.31 1
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
2
R
1 87
0.17
0
0
0.00
#DIV/0!
0
1 0
0.00
#DIV/0!
3
PC
84
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
4
PC
86
0 3.5
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/0!
5
R
8,6
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
6
PC
89
0.01
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/O!
7
R
88
0.0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
8
R
88
0.46
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
9
R
87
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/O!
10
R
89
0.1
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
11
PC
88
0 3.5
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
12
R
88
0.33
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/O!
13
PC
91
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
14
C
93
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
15
R
93
0.02
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
1s
PC
90
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
17
PC
91
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/0!
1s
R
91
3.62 3.6
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
19
R
86
0.6
0
0
0.00
#DIV/0!
0
0
0.00 1
#DIV/O!
20
R
85
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
21
R
90
0.25
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
22
PC
86
0.25
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
23
C
81
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
24
PC
82
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
25
R
84
0.01 3.6
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
26
C
86
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
27
PC
90
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/0!
28
R
86
0.03
0
1 0
0.00
#DIV/0!
0
0
0.00
#DIV/01
29
R
86
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
30
R
86
0.2
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
31
R
87
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
Total Gallons/Monthly Loading (inches)
0
0.00
0
0.00
12 Month Floating Total (inches)
::::::::::::::::::::::::::::::::::::::::::::::::::::::
0.00
0.00
Average Weekly Loading (inches)
::::::::::::::::::::::::::::::::::::::::::
0
0
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, Slsleet
Spray Irrigation Operator in Responsible Charge (ORC):
ORC Certification Number: 996725
Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1617
Allen Bliven Phone: [phone]
Check Box if ORC Has Changed:
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
Page 6 of 8
2016
DENR FORM NDAR-1 (11/2005)

Page 6 of 8
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 been compliant
with the following permit requirements: (Note: /f a requirement does not apply to your facilityput (NA) in the
compliant box. )
1. The application rate(s) did not exceed the limit(i) specified in the permit.
Com liantY N)
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 and/or storage lagoon(s) was not less than the limit(s)
0
specified in the permit.
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-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."
(Slgnat rejPermittee)* Date
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
William G. Freed
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252-491-5277 9/30/2006
(Phone Number) (Permit Exp. Date)
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).
DENR FORM NDAR-1 (11/2005)

Page 7 of 8
° NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00019665 MONTH: August YEAR: 2016
FACILITY NAME: Swan Quarter Sanitary District COUNTY: Hyde
Formulas:
Daily Loading (Inches) = [Volume Applied (gallons) x 0.1336 (cubic feettgallon) x 12 (inches/foot)] /[Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / [Time Irrigated (minutes) / 60 (minutes/hour)] fly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (Inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (Inches)
Avuann Wunlrly I n�°finn /innhn�\ = IAAnnthh° l n,,iinn /inrhuc/mnnfh\ / Numhnr of rine in fhu mnnfh /rine/mnnfhll v 7 /davahunnkl
Did Irrigation, Occur At This Facilit)
Yes: No: x
Did Irrigation Occur On This Field:
Yes: No:
x
Did Irrigation Occur On This Field:
Yes: No: x
FIELD NUMBER: 1 9
AREA SPRAYED (acres): 1 4.93
COVER CROP:
PERMITTED HOURLY RATE (inches): 0.25
FIELD NUMBER: 1 10
tEA SPRAYED (acres): 1 5.08
COVER CROP:
MITTED HOURLY RATE (inches): 0.25
D
A
T
E
WEATHER CONDITIONS
Temper- Storage
weather ature at Precipita- Lagoon
Code` application tion Free -board
PERMITTED YEARLY RATE (inches):
Volume Daily
Applied Time Irri ated Loading
32.5
Maximum
Hourly
Loading
ZMITTED YEARLY RATE inches :
Volume Time Daily
Applied Irrigated Loadin
32.5
Maximum
Hourl y
Loading
(°F)
Inches feet
gallons
minutes
Inches
Inches
gallons
minutes
Inches
inches
1
R
88
0.31
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
2
R
87
0.17
0
0
0.00
#DIV/0!
'0
0
0.00
#DIV/01
3
PC
84
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
4
PC
86
0 3.5
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
5
R
86
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
6
PC
89
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
7
R
88
0.06
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
8
R
88
0.46
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
9
R
87
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
10
R
89
0.1
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
11
PC
88
0 3.5
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
12
R
88
0.33
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
13
PC
91
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
14
C
93
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
15
R
93
0.02
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0! '
16
PC
90
0
0
0
0.00
#DIV/0!
0
0
0.00.
#DIV/0!
17
PC
91
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
18
R
91 -
3.62 3.6
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
19
R
86
0.6
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
20
R
85
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
21
R
90
0.25
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
22
PC
86
0.25
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
23
C
81
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
24
PC
82
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
25
R
84
0.01 3.6
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
26
C
86
0
0
1 0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
27
PC
90
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
28
R
86
0.03
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
29
R
86
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
30
R
86
0.2
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
31 1
R 1
87
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
Total Gallons/Monthly Loading (inches)
0
0.00
0
0.00
12 Month Floating Total (inches)::::::::::::::::::::::::::::::::::::::::::::::.........
0.00
0.00
Average Weekly Loading (inches) :::::::::::::::::::::::::::::::::::::::::
0
0
- fiveatner uooeS: G -clear, rG-partly c101.10y, lit -cloudy, R -ram, on -snow, .71-51eet
Spray Irrigation Operator in Responsible Charge (ORC):
Allen Bliven
Phone: [phone]
ORC Certification Number: 996725 Check Box if ORC Has Changed:
DENR FORM NDAR-1 (11/2005)

IIA&iI ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1617
Page 7 of 8
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
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 been compliant
with the following permit requirements: (Note: if a requirement does not apply to yourfacility put (NA) in the
compliant box. )
1. The application rate(s) did not exceed the limit(s) in the
Compliant —liant �,N)
specified permit.
LT1
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
0
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
0
4. All buffer zones as specified in the permit were maintained during each application.
0
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
0
specified in the permit.
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-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."
21=��Lz �Z- - .7 4, -- 7
(Signatur erm)ttee)* Date
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
William G. Freed
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252-491-5277
(Phone Number)
9/30/2006
(Permit Exp. Date)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b)(2)(D).
DENR FORM NDAR-1 (11/2005)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00019666 MONTH: August
FACILITY NAME: Swan Quarter Sanitary District COUNTY:
Formulas:
Dally Loading (Inches) = [Volume Applied (gallons) x 0.1336 (cubic feettgallon) x 12 (incheslfoot)] /[Area Sprayed (ages) x 43,560 (square feettacre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre4nch)]
Page 8 of 8
YEAR: 2016
Hyde
Maximum Hourly Loading (Inches) =Daily Loading (inches) /[Time Irrigated (minutes) /60 (minutesfnour)] fly Loading (Inches) =Sum of Daily Loadings (inches)
12 Month Floating Total (Inches) =Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loadlno (inches) = [Monthly Loading finrhes/month) /Number of days in the month (days/month)l x 7 (daysAveek)
Did Irrigation occur At This Facility:
Yes: No: X
Did Irrigation Occur On This Field:
Yes: No: X
Did Irrigation Occur On This Field:
Yes: No: X
.....................
FIELD NUMBER: 1 11
AREA SPRAYED (acres): 4.78
COVER CROP:
PERMITTED HOURLY RATE (inches): 0.25
FIELD NUMBER: 12
EA SPRAYED acres : 3.43
COVER CROP:
MITTED HOURLY RATE (inches): 0.25
DMaximum
A
T
E
WEATHER CONDITIONS
Temper- Storage
weathr atureat Precipita• Lagoon
Code'eapplication tion Free -board
PERMITTED YEARLY RATE (inches): 32.5
Maximum
Volume Daily Hourly
Applied Time Irri ated LoadingLoadingA
ZMITTED YEARLY RATE (inches):
Volume Time Daily
lied Irrigated Loading
32.5
Hourly
Loading
F
(°)
Inches feet
gallons
9
minutes
Inches
Inches
gallons
minutes
Inches
Inches
1
R
88
0.31
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
2
R
87
0.17
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
3
PC
84
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
4
PC
86
0 3.5
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
5
R
86
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/O[
6
PC
89
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
7
R
88
0.06 1
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
a
R
88
0.46
0
0
0.00
#DIV/0!
1 0
0
0.00
#DIV/O!
9
R
87
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
10
R
89
0.1
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
11
PC
88
0 3.5
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
12
R
88
0.33
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
13
PC
91
0
0
0'
0.00
#DIV/0!
0
0
0.00
#DIV/01
14
C
93
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
15
R
93
0.02
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/O!
16
PC
90
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/O!
17
PC
91
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
18
R
91
3.62 3.6
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
19
R
86
0.6
0
0
0.00
#DIV/0!
1 0
0
0.00
#DIV/01
20
R
85
0.01
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
21
R
90
0.25
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
22
PC
86
0.25
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
23
C
81
0.01
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
24
PC
82
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
25
R
84
0.01 3.6
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/0!
26
c 1
86
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/O!
27
PC
90
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
28
R
86
0.03
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
29
R
86
0.01
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/O!
30
R
86
0.2
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
31
R
87 1
0.01
0
0
0.00
#DIV/01
0
0.00
#DIV/O!
Total Gallons/Monthly Loading (inches)
0
0.00
0
0.00
12 Month Floating Total (inches)
::::::::::::::::::::::::::::::::::::::::::::::::::::::
0.00
0.00
Average Weekly Loading (inches)::.:�:::::>:::::*:::::::::::::::::::
0
0
• Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC):
Allen Bliven Phone: [phone]
ORC Certification Number: 996725 Check Box if.ORC Has Changed:
Mail 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)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (11/2005)

Page 8 of 8
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 been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
1. The application rate(s) did not exceed the limit(s) specified in the permit.
Com liant N)
Y
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
0
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
0
4. All buffer zones as specified in the permit were maintained during each application.
0
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
0
specified in the permit.
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-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."
(Signature of Pe ee)* Date
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
William G. Freed
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252-491-5277 9/30/2006
(Phone Number) (Permit Exp. Date)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).
DENR FORM NDAR-1 (11/2005)