WQ0018992_Monitoring - 08-2016_20161007

FORM: NDAR-2 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page of
o Compliant ❑Non -Compliant
Did the application rates exceed the limits in Attachment B of your permit? ❑
2] Compliant ❑Non -Compliant
If not a basin, were the sites kept free of vegetation and raked?
If not a basin, were there any instances of effluent ponding in or runoff from the sites? El Compliant ❑ Non -Compliant
2] Compliant ❑ Non -Compliant
If a basin, were there any instances of breakout from the berms?
Was the onsite automatically activated standby power source tested and operational?
❑✓ Compliant E] 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 thfi corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Donald Omara Permittee:P1 fLACE PA -'Me $f&,P, AI-Agn(, C� 164 Sou+u+.f��o6 A6A
Certification No.: 22801 Signing Official: IC Qj*k-6o�
Grade: SI Phone Number: [phone] Signing Official's Title: PRoP� M t•.9-
Has the ORC changed since the previous NDAR-2? ❑Yes ❑
No Phone Number: 2 52 - 211 231 ? Permit Exp.: 6113 a (�o
q I3s I C
Date Signature
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

FORM: NDAR-2 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Page of
Pdrmit No.: WQ001 •..2
Facility Name: SouthwindsCarteret
` • 1 16
Did infiltration occur
Site Name:
this facility?_
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ee.
YES NO
Rate (GPD/ft):
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NON -DISCHARGE APPLICATION REPORT (NDAR-2)
FORM: NDAR-210-13 erlrllt?
e a lication rates exceed the limits in Attachment B of your p
Did th Pp
`were the sites kept free of vegetation and raked?
basin,
If nota onding in or runoff from the sites?
there any instances of effluent p
V -W-
-
0 Compliant
❑ Non-ComPliant
Compliant
❑ Non -Compliant
Compliant
❑ Non -Compliant
(] Compliant
❑ Non -Compliant
If not a basin, were
Compliant ❑ Non -Compliant
a basin, were there any instances of breakout from the berms erational?
If paler 50U1'Ce tested and Op of the non-com and describe the corrective_
the facility was not in compliance. Provide in your explanation the dates)
Was the onsite automatically activated standby
bedbow n reason(s) ken. Attach additional sheets if necessary.
If the facility is non-compliant, please explain in P actiort(s) to
ible Charge ORC) Certification
Operator in Respons
ORC: Donald Omara
Certification No.: 22801
Grade: SI
Phone Number: [phone]
Has the ORC changed since the previous NDAR-2?
❑ Yes ONO
Permittee Certification
Perrrtittee:a p�ac.t A� 7 Bir �irKlf:f cP d64 Souko6 Nb>f�
Signing Official:�R7 KQ PSoutL
Signing Official's Title: mei M l• R•
�
Permit Exp.:
Phone Number: 2,,52 - 2,J-1,11it
01136I11;
Date
R A� Signature
Date ared under my direction or supervision in accordance
r Signature I certify, under penalty of law, that this document and all attachments were prep
aired
property athered and evaluators bee f o gathering hemiation itted. Based on information, the y
late to the best of my imowiedge. with a system designed to assure that all quare the system, or those persons directly resp
that This report Is accurrate and comp inquiry of the person or persons who me In violations.
By this signature, I certify tru possibility of fines and imprisonment for knowing
infonrration submitted is, to the best of my imowledge and belief, true, accurate, and complete. t am aware that there are significant
penalties for submitting false information, induding the p
Mail Original and Two Copies to:
Division of Water ResourcesInformation Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 276994617