WQ0005173_Monitoring - 08-2016_20161010

NON DISCHARGE APPLICATION REPORT Pa-ge 2 of 2
HIGH RATE INFILTRATION SITE(S)
THERE ARE THREE SITES PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER WQ0005173 COUNTY: Carteret
FACILITY NAME: Cape Royall Dolphin CLASS: II MONTH: AUGUST YEAR 2016
Formulas:
naiiv I nadinn (nallnns/snuare feet)=Vnlume Annlied(aallons)/Site Area (sauare feet)
*. Weather Codes: S - sunnyi PC - partly cloudy, CI - cloudy, R - rain, Sn - snow, SI - sleet
OPERATOR IN RESPONSIBLE CHARGE (OF Daniel E. Fortin
ORC Certification Number: 7180
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
co
v
GRADE: II PHONE: [phone]
CHECK BOX IF ORC HAS CHANGED
X
(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-2(5/2003)
SITE NUMBE Zone 1
SITE NUMBE Zone 2
SITE NUMBE
SITE AREA (sq. ft.):
5,024
SITE AREA (sq. ft.):
5,024
SITE AREA (sq. ft.):
WEATHER CONDTIONS PERMITTED RATE (gpd/sp.
5
PERMITTED RATE (gpd/sp
5
PERMITTED RATE (gpd/sp.ft.):
A
T
E
WeatherTemp. Precip Volume Time
Code ` Applied Irrigated
('F) tation
Daily Loading
Volume Time
Applied Irrigated
Daily Loading
Volume Time Daily
Applied Irrigated Loading
Iinches gallons minutes
gallonslsq. ft.
gallons minutes
gallons/sq. ft.
gallons minutes gallons/sq. ft.
1
4000
0.7 78 4
4055
10.79617934
2
4000
0.79617834
4000
0.79617834
3
4000
0.79617834
4000
0.79617834
4
3000
0.59713376
3000
0.59713376
5
2500
0.49761146
2500
0.49761146
6
3000
0.59713376
3000
0.59713376
7
3000
0.59713376
3000
0.59713376
8
3000
0.59713376
3000
0.59713376
9
1 3000
0.59713376
3000
0.59713376
10
2000
0.39808917
2000
0.39808917
11
2500
0.49761146
2500
0.49761146
12
2500
0.49761146
2500
0.49761146
13
2500
0.49761146
2500
0.49761146
14
3000
0.59713376
3000
0.59713376
15
3.000
0.59713376
3000
0.59713376
16
2000
0.39808917
2000
0.39808917
17
2000
0.39808917
2000
0.39808917
18
2500
0.49761146
2500
0.49761146
19
3000
0.59713376
3000
0:59713376
20
2000
0.39808917
2000
0.39808917
21
2.500
0.49761146
2500
0.49761146
22
3000
0.59713376
3000
0.59713376
23
2000
0.39808917
2000
0.39808917
24
1500
0.29856688
1500
0.29856688
25
2500
0.49761146
2500
0.49761146
26
2000
0.39808917
2000
0.39808917
27
2000
0.39808917
2000
0.39808917
28
3000
0.59713376
3000
0.59713376
29
2500
0.49761146
2500
0.49761146
30
1500
0.29856688
1500
0.29856688
31
1500
0.29856688
1500
0.29856688
on y oa Ing ga ons sq. .
6.
6. 3
ear- o- ate Loading(gaIIons/sqJQllllllllllllllllll�
231.71
*. Weather Codes: S - sunnyi PC - partly cloudy, CI - cloudy, R - rain, Sn - snow, SI - sleet
OPERATOR IN RESPONSIBLE CHARGE (OF Daniel E. Fortin
ORC Certification Number: 7180
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
co
v
GRADE: II PHONE: [phone]
CHECK BOX IF ORC HAS CHANGED
X
(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-2(5/2003)

NON -DISCHARGE APPLICATION REPORT
HIGH RATE INFILTRATION SITE(S)
FACILITY STATUS:
the following permit requirements: (Note: If a requirement does not apply to your facility put "Win the compliant
box.
Compliant (Y,N)
1'., The application rate(s) did not exceed the limit(s) specified in the permit.
2. The site was kept free of vegetation and raked at intervals specified
in the permit.
3. The Automatically Activated Standby power source is on site and
operational.
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 noncompliance 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 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 viol tions."
Daniel E: Fortin
Signature of Permittee * Date (Name of Signing Official -Please print or type)
Daniel E. Fortin
Permittee - Please print or type
P:O. Box 4188
Operator Responsible in Charge
(Position or Title)
Emerald Isle; NC 28594 252-393-8720 02/28/2019
Permittee Address .(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 NDAAR-2(5/2003)
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