WQ0004910_Monitoring - 09-2016_20161017 (3)

1�
NON -DISCHARGE APPLICATION REPORT Page�ol�
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: • yq�� n ,�� MONTH: , YlYEAR!
FACILITY NAME: �� Q�a ��'^ [ COUNTY: �� f
Formulas;
Daily Loadlny (Inches) _ (Volume applied (g911ane) x 0.1336 (cubic tseUgallon) x 12 (incho �foet))![Ares Sprayed (acres) x 43,660 (;phare feauacre)) OR
- VolumcApplied (pallona)/ (Area Sprnycd (acs) x 27,152 (gallonwrocrc-in(:h)]
Maximum Hourly Loading (Inches) - Daily Loading (Inches) /ITime Irrigaled (minutes)/ 80 (minutes/hour)) Monthly Loading (inchos) = Sum of DaIIYLoadnga (inches)
12 Month Floating Total (inches) - Sum or this monin's Monthly Loading (ineht:) and pr9vlous 11 month's Monthly Loadings (Incnes)
AveragcWeekly Loading (inches)=IMorllhlyLoading ()nehcslmonlh)/Numbsrofda in[hemanth(days(m6nlh))x7(dayakeek)
Did Irrigation Occur tThis Facility:
Yes: No; ❑
Did Irrigation Oce On ThN'Field:
Yes: � No: ❑
Old irrigation Occ rOn This Field:
Yes: No: ❑
FIELD NUMBER: II
AREA SPRAYED acres : ,
COVER CROP:
PERMITTED HOURLY RATE (Inches). -I
FIELD -NUMBER:
AREA SPRAYED facrctIj 5_3
COVER CROP! (_14,49-
PERMITTED W40URLY RATE (inches):
D
WEATHER CONDITIONS
PERMITTED YEARLY RATE (inches):1
PERMITTED -YEARLY RATE (Inches);
Z -
A
T
E
TomCer ature Storage
Weather at procipita- Lagoon
gado^ ap pc,don tion Free -boa
VDlume
Applied
Time
Irrigated
Dally
Loadin
Maximum
Hourly
Loadinq
Volume
Apirilled
Tlme
krri ated
Daily
Loading
Maximum
Hourly
Loading
(°F) inches feet
gallons
minuteii
inches
Inches
gallons
minutes
inches
Incnes
2Z
2
,
3
4
5
, S
6
7
e
9
10
11
12
2 -1
30 1
A
13
2`
336
2oP
D
t'ti
,a
zle,0
3 v
U
Ot S
15
000
-P
5•:
1s
17
1B
2—,
1s
Z �Z
2a
z1
,,
zz
(� V�
2 zcr,
30
2190
- o
23
•
2Z OC'
. Z.l,L�
r
24
,
5�
25
2.2190
30
O
2-
2s
25
0
30
Df�r
7DO
3 17
/S
p
28 X 2 , 2-
v (S
2-; J t�a�
3
2s
' 0,.
30
s1
Tota) Gallons/Monthly Loading (inches)
12 Month Floating Total (inches)
t)
Average Weekly Loading (inches) •
�,
t
Weather Codes: C -clear, PC -partly cloudy, Cl -cloudy, R -rain, Sn-snow, SI -sleet
Spray irrigation operator in Responsible Charge (ORG): )�/�' Phon®:_252- 5527=7 f n I
a/)
OfZC r✓ertificatlon Number; " 6 )Check Box if ORC Has Changed: ❑
Mall ORIGINAL and TWO COPIES to:
DENIM
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Scrvica Center
RALEIGH, INC 27699-1617
-g.
,aegn
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURAYE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE,
DENR FORM NDAR-1 (11/2005)

NON -DISCHARGE APPLICATION REPORT Page -L of y
SPRAY IRRIGATIM SITEM
Facility Status:
Please indicate ( by inserting Y(es) or N(c) in the appropriate box ) whether the facility has beeE2Mpliant
with the following permit requirements: (Vote. if a requirement does not apply to your facility put fdA) in the
compliant box. )
1. The application rate(s) did not exceed the lirnit(s) specifiedl in the permit. Compliant (Y,N)
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
3. A suitable vegetative cover was maintained on the slte(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)
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,
Over cr,p //t 3 ASS' /� e�� i` Irl 7,7
rr,)4)d whey) yg° ,)& Aj�e
"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 manrage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the be=st of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submittting false information, including the possibility of fines
and imprisonment for knowing violations-"
Z12 )VI )14
Aignature of ermittee)" Da e
&bo-- -�, &M
Permittee -Please print or type)
_P
o &w 12
(Permittee Address)
{Name of Signing Official-Plenj or type)
Lab-A,Ak& _7a e04I
(Position or Title)
252, 7/&
(Phone Plumber) (Permit Exp. Date)
' If signed by other than the permittee, delegation of signatory authority must be on file wit&i the stat¢ per 15A NCAC 28.0506 (b)(2)(1)).
DENR FORM NDAR-1 (11/200$)

NON-01SCH, RGE APPUCATION REPORT Paoe 2 -
SPRAY
SPRAY IRMATION SITE($)
THERE ARE TWO APPLICATION FIELDS PER PACE, US6 ADDITIONAL P GBS AS NEEMEED.
PERW NUTABER.• tA-)FR_oML191 ! MOWN; � ip YEAR!
FACILITY NAflnE;f L/voL (,, i COUNTY: � t�
Farmct[as: '
Deily I oading (Inches) _ [Valgmg Fppileo (gallons) x D.1326 W* teeUgelloni x 12 (indreo- foct)j / (gree 5pr2,yed (aces) x 43460 (,Quare reaVeore)1 OR
VolumC xpplled L aAons) / Ikt'es SprayRd (acres:) x 27,152 (galion�a4rc nch l)
tilaximum Hourly Lcpadln9 (Inches) = Daily Loading (Inches) /[flRle Ifni cried (ninures)1 eo (minulealhour)) Mvnthl ' Loadln
I MOMI1 Floating Total (Inchesj Sur11 of this montn';, N10nNIV L6adIAo Iirtchtnl and orAvlonc 11 —js'n RAn 4�1.. _ __ 5__, 9 ('rnclacs) _ $um of DallyLo3d nga (inches)
Spray Irrigation Operator in ResponsibIQ Charge (ORC):-91f � ,� ! Rhone: ?
QRc Co t€ficatfon plumber.-k� 1. 9 �% Check Box if ORG Has Changed: ED
Mall ORIGII AL and TWO COPIES to:
D E),,,l R
Division or Water Quality
AT'TN: Information Processing Unit
16117 1-0ail Service CGnter
RAI..EIGH, NC 27U54617
(SIGNATURE OF OPERATOR IN RESPOHZIBLE CHARGE)
BY THIS SIGNATURE, I CrzRT(FY THAT THIS REPpRT IS p,GGURRYC AND
CDMPLETE TO THE PEST OF r,4Y KNOWLEDGE,
DISH R FORT;/1 i`G!'.R-" M 1/200,9

NON -DISCHARGE APPLIIGATION REPORT Fsae —2 - of 5
SPRAY KRIGATON -SITE(S)
Facilitv Status;
Please indicate ( by inserting Y(es) or N(c) in the appropriate bog ) whether the facility has beeEOmpliant
with the following permit requirements: (dote, if s requiroment does not apply to your `aci/ity put (qA) in the
compliant bo)<, )
Corn liana Y,t�)
1. The application rate(s) did not exceed the limit(s) specified! in the permit.
2. adequate measures were taken to prevent wastewater rurofffrom the aite(s),
9. A sultakile vegetatives cover was maintained on the site(s) b*n accordance with the perm it.
4. A111 buffer?ones as specified in the permit were maintained during each applic-tion.
5, The freeboard in the treatment andlor storage lagoon(s) was not less than the Iirnitt(s) �
specified in the permit.
If the facility is non -comet 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,
OVle 47' I V r�3
"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 test or my knowledge and belief, true, accurate, and
complete, i am aware that there are significant penalties forsubmitting false information, including the possibility of fines
and imprisonment for knowing violations."
(ignature of Permittee)* Iga e
CPO rmlttee Please print or type)
13) r� 0- 91
. 'at`
(Permittee Address)
io ��r f � �
(Dame of Sighing Official -Please prin or type)
&Uk -e
(Position or Title)
2- t;7 Va
(Phone Number) (Permit Exp. Date)
If signed by other than the permittee, delegation of slgnatary authority must be ark file %vitih the stator per 15A NCAC 2B.a5oe (b)(2)(D)_
DEldp; [CORP, i IDAF:-1 (I i;

NON -DISCHARGE APPLICATION REPORT Page
SPRAY IRRIGATION SITE(,9)
THERE ARE TWO ,APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAW. S AS NEEMED,
PERMIT NU1A8ER: • ��� MONTH; W_�r, t�� p�,, `�}�/ �o YEAR: OvIb
FACILITY NAMi?, , I oion i f _V E— �s��� r
� COUNTY. nr� Ui� 1 li't'l n 7� 11,
Formulas:
Doily I oading (Inches) _ (`,•'olvms ApplleC (gallons) x 0.1326 (cubic feetgallon) x 12 (inches feet)) I (Ama Sprayed (ams) x 43,660 (,quam ll edl8cre)1 OR
-'Juiumcapplled (nallOnsl((.grea sprayed (acres) x 27,152 (gellOnw�a; rc-inch!)
Maximum Hourly Lpoding (Inches) = Daily Loading (Inches) /!Time Irtigaled (ninu1o4;)l60 Iminulesthour)) Monthly Loading (inctwq) = Sum of Dallyloadings j aches)
12 Month Floating Total (inches) Sum of [his menm's naonNiy La5di0g (inchc.) and prgvlous 11 nonlhs Monthly Laodings (Inchsst
AversoDWeAlyt,oaging(inahes)=IMonihlyLOading(ineha0morAWNumbar Ofdays ir,themanth+dwA(mwhI7W7rnavAI•, L,I
010 rigation ccur ot This Facility! bid Irrigation Occ On This -Field; Did Irrigation Occur•On Thls Field:
Yes' No: © 1 Yes: No: ❑ Yes:.. 0� No: i-1
NUM
AREA
P€RCUIITTED HOURLY PATF tlnnhaat-I i� neenarwre _,;:
©
WEATHER CONDITIONS
PERMITTED YEARLY BATE (inches):
7
-V1111 may. trIV4K67 mm r.(mcnes):
PERMITTEDYEARLY
8
K,?L_
9
-—
A
Tomper store
Weather
Storage
Maximum
11 (00 ,
Maximum
T
at Pr®es rca-
Coda* p
t a oon
9
Volume Time Dail Y
Hourly
Volume
c,��
'3 C1
Hourly
g
appllcvtlon tion
Free -boar
A lied Irri ated Loadin
Loadln
A lied
Loadln
(°F) inches
is®t
gollons minutes inches
Inchas
galton9
Inches
19 7_
20
2
2
21
22 C% tJ ..,2. zoo
23 • Z2 cQ
50
2d 2.1"'
M,_7
1
t}r
2 2Lci7
c
4
s f, a
5`
22 7 OF
_�4�
43300Dods,
ISS' `
5
29
30
6
7
8
K,?L_
9
90
11 (00 ,
12 1 2, 2.
30 1 6, 122 1c t�
2L�
0,
,s 2
c,��
'3 C1
15 0e.0
7 i3 'f / '' UJ
C
/
1s
17
1fl 2,
19 7_
20
21
22 C% tJ ..,2. zoo
23 • Z2 cQ
50
2d 2.1"'
.30 G, 4
1
t}r
2 2Lci7
c
s f, a
5`
22 7 OF
_�4�
43300Dods,
ISS' `
. )j1
29
30
3j
Tota! GallonslMor,tltly Lnaeiing (inctYas)
12 Month Floating Tota! (Inches) i)
Average Weekly Loading
" tretathcr Codes: C -clear, PG -partly cloudy, Ci -cloudy, R-raih, Sn-snow, Si -sleet P
Spray Irrigation Operator in Responsible Charge (ORC) � Phrrne: ,2_5 r (--.�,f� / t
Of?C Gertif(catlon Number: S-)q,,(� 169_9 (15' Check Box if ORG Has Changed: ❑
Mall ORIGIWrL. 3ndTWO COPIES to=
DENIR
Uvisicn of Water Clu�litV ty
ATTN: Informatie,h processing Unit (SIGMA! URE OF OPERATOR IN RE8FONSI6LE CHARGE)
1617 1✓lai! Service center 13Y THIS SIGNATURE• 1 CERTIFY THAT THIS REPORT IS ACCURAYE AIh,iD
RAIUCH, NC 2769S.1 C,1 7 CD14PLETE TO THE BCST OF C<<Y KNC!'dLEGGE,
DELI=;FORIANDA.R-, 01/2005;

NON -DISCHARGE APPLICATION REPORT Psge
SPRAY IRRIGATi0f4 5FE(S)
Facility Status;
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has beeEom liant
with the following permit requirements_ (Voter if a requirement does not apply to yrour `acilrty put f!A) ht the
compliant box, )
Iorn liars( Y,PI)
1. The application rate(s) did not exceed the limit(s) specified in the permit.
2. Adequate measures were taken to prevent wasteawater runoff from the site(s}.
3. A Meltable vegetativo cover was maintained on the site(s) in accordance with the perm it.
4. All buffer zones as specified in the permit were maintained during each application.
5, The freeboard in the treatment andfor storage lagoon(s) wes not less than the limit(s)
specified in the pernlit.
If the facility is non-compliant please sxplain 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."
i ? ��1 }
( ignature of perrnitteW Iia e
Permittee -Please print or type)
PL) -, z q
(Permittee Address)
(Name of Signing Official -Please prim o� hype)
(Position or Title)
2- 5 ; 7/ � 0 t �
(Phone Number) (Permlt Exp. Date)
` If signed by other than tho permittee, delegation of signatory authority mu .t !ze on fife witch the scam per 15A NCAA ZB.05off (b)(2)(D)_
DEWR FORE. 1 ICAP-1 (1111-004:)

SON -DISCHARGE APPLICATION REPORT Facie
SPRAY IRRIGATION SITE(,9)
THERE ARE TWO APPLICATION FIELDS PER PAOFA, USE ADDITIONAL FAGES .AS NEEDED,
PERMIT NUhi&ER.• l_�C1 "1 y q �- CAQNTFI: 'Yi YEAR!
FACILITY NAME;___ f I %�t��} �� t�v Ll I ' [) COUNTY.
FPrmulas:
Daily loading (Inches) _ [ti'olvma Applied (gallons) x D.1336 (,.u* WUgsllon) x 12 (inchc.€oet)) i (Area Sprayed (ares) x 43.00 (,qui (QaUacre)) OR
= V01umc Apptled (nallons) C {.Area Sprayed (acs) x 27, 75Z {galln7up rc_inch )J
rylax[mUM Hourly Lcmding (Inches) = Daily Loading (Inches) /[Time Inig8led (minulcs)100 (minuleamour)J Monthly Loading ([ncfws) = Sum of DallyLoadinge (inohes)
92 Month Floating Total (inches) =sum of this momh'c �70hNly L6adi0a {inehCs) and prq does 1 i month's Morlhly Laodlnos llneno i
pray Irrigation Operator in Responsible Charge (C)RC)-. - Phone:
OpC Certiffcaflon thlumber: q,A 1&2221!,5,0gjr_-heck Box if QRG Hes Changed., 11
&"kall OP.I(3INAL and TWO COPIES ta_
DENR
Division of Water Quality
.ATTN: Information Processing Unit
1617 Mail Service Center
RALUCH, NC 2789 -1617
(SIGNATURE OF OPERATOR Ih RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS r�Er TORT IS AGCURaTE AND
GDIAPLETE TO THE BCST OF N,Y KNOIVLEDGE,

NON -DISCHARGE APPLICATiON REPORT
SPRAY KRIGAT)Ofd SFE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate bog ) whether the facility has beeEomplfant
with the following permit requirements: (Voter if a requirement does not apply to your ,`scility put f4A) in the
compliant box, )
Psge O( -.5
Gem lia�lt Y,N)
1. The npplication rates) did not exceed the Iirnit(s) specifiecl in the permit.
2. ,adequate measures were taken to prevent wastewater runoff from the site(s),
8. A :suitaNe vegetative cover was rnafntained on the site(s) in accordance with the permit.
4. All buffer zones as speoified in the permit were maintained during each application,
5, The freeboard in the treatment andfor storage lagoon(s) was not less than the limit(s)
specified in the pernjft.
If the facility is coon -cora liarot 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 quali led 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, tam aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
J i F} ,1
LE
(Signature of permittee)* Qa e
Permittee -Please print or type)
Y, 0 9
A) A) �� 7
(Permittee Address)
�r / b / � P g,
{Mame of Signing Official -Please prin ortype)
(Position or Title)
2-52-, 9 L7��� � _ � u t,.
(Phone Number) (Permit Exp. Date)
If signed by afher than the permittee, delegation of slgnwoly aathority must be on rile with the std& per 15A NCAC 2B.05o6 (b)(2)(D)_
DEWR FORIA I IDARA ('111200$)

NON -DISCHARGE APPLICAVON REPORT Pace 5 of
SPRAY IRRIGATION SITE($)
THERE ARE TWO APPLICATION FIELDS PER PACE, USE ADr)ITIONAL PAGI_s.As NEEDED,
Pl5iR1VIiT NUfdSEla: •1,JS LI cL��`7 f ^ MON 4 H;,. YEAR!
FACILITY NAM4: _ - ,t (,%�Wn V ( i � �A I ap� COUf rY!
Farmutas: '
Daily I,oadfng (hlches) _ (L'olvrne �pptleQ (gsllone) x D.1336 (cuDlc tseUgsllon) x i2 (ind;cc�'foet)) r(Area Spr2yetl (acres) x 43,Gtio (;��, (esUacre)) OR
= Vblumcapp44 (gallons) I (.Ares SprayFd (ad x cr27,1,52 (g511on�r�cre-inch))
%aximum Hourly Laadins (Inches] = Daily Loading (Inches) /[7fine Irrigated (ninwcb)/E+0 (minuleamour)) Monthly Loading (inrfwsj =Sum of DallvLoaalinga (inches)
1Z Momh Floating Total (inches) ❑ Sum of this mmm', fl9pfi NIY L6&dinA (h'C11t) and omVtous 11 monlh'4 Mmnn hlv I .,-,A11­­
Spray Irrigation Operator in Responsible Charge (ORC) _4 � _ Phone.:
ORC Certification dumber; ��. % , Check Box if ORC Has Changed: ❑
Mull OF -101 AL, and TWO COPIES to:
DEUR.
Uvision of Water duality
A7`fN: Informatinn Processing Unit
1617 h4ail Service Center
RALE18H, NC 276991.1617
� � 1
(SIGNATURE OF OPEIRATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNIA-1 URE, I Cr=PTIF'(THstT PHIS REPORT IS ACCURATE At -,'D
CDrAPLETE TO TH1= BCST OF C4Y KhOV1LEDGE.
DEh!R.FCFI>rtJG'f�.i1--" (?7/2005)

NON-DISGHARGE APPLICATION REPORT
SPRAY IRMGATOW WE(S)
Faei�us,
Please indicate ( by inserting Y(es) or N(o) in the appmpri2te box ) Whether the facility has becE2WEIIant
with the following permit requirements: (Vote; if a requiremenP does not apply to your facility put t4A) in the
coMp(iant box, )
F;-ae Lor
liartf Y,H)
1. The application rate(s) did not exceed the Frni;(s) specified in the permit. Goat
2. ,adequate measures were taken to prevent Wastewater runoff from the 4ite(s).
3. A suitable vegetative cover was maintained on the site(s) in accordance with the perm ft.
4. All buffer zones as specified in tite permit were maintained during each application.
5, The freeboard in the treatment andfor storage lagoon(s) wzDs not loss than the limit(s) r
specified in the perm[t.
If the facility is non-com 2 please explain in the space below the reasan(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compiiance and describe the corrective action(s) taken. attach
additional sheets if necessary,
417 //1 . r7 P2 L3 �7
"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 quali led personnel properly gathared and evaluated the information
submitted. Based on my inquiry of the person or persons who man2ge the system, or ftQ-e persons directly responsible
for gathering the information, the informatlon 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_"
( bgnature of Csermit#ee)*
Permittee -Please print or type)
PoF
(Permittee Address)
(flame of Sighing Official -Please prin or type)
2C-1
(Position or Title)
(Phone Number) (Permit toxo. Date)
` If slq_ned by ofher than the permittee, delegation of signatory authority must ! a! on file %vit ih the stat¢ per 15A WC AC 26.0500 (b)(2)(D)_
GEf�� FORI,4 i ID4.i=: •i (11;�;cp,�)