WQ0024756_Monitoring - 08-2016_20161017 (2)

FbRM: NDAR-2 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page _ of
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The Grove
—DWd infiltration occur at
this facility?
Area(acres):
Area (acres):'
Area (acres):
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Rate (GPD1ft2):�
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Site Infiltrated?
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FORM: NDAR-210-13 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page _ of
Did the application rates exceed the limits in Attachment B of your permit?
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?
If a basin, were there any instances of breakout from the berms?
Was the onsite automatically activated standby power source tested and operational?
❑+ Compliant ❑ Non -Compliant
0 Compliant ❑ Non -Compliant
❑a Compliant ❑ Non-compiont
0 Compliant ❑ Non -Compliant
❑+ Compliant ❑ Non -Compliant
If the facility is non-compliant, please explain in the space below the reasons) the facility was not in compliance. Provide in your explanation the dale(s) of the non-compliance and describe the corrective
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Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Donald Omara
Permittee:
Certification No.: 22801
Signing Official:
Grade: SI Phone Number: [phone]
Signing Official's Title:
Has the ORC changed since the previous NDAR-2? ❑ yes I7 No
Phone Number: Permit Exp.:
Signature Date
Signature Date
By this signature, I certify that this report is acwrale and complete to are best of my knowledge.
I cenily, under penalty of law, that Iris 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 parsons who manage the system, or those persons directly responsible for gathering the information, the
Information submitted is, to the best of my knovdedge and belief. hue• accurate, and complete. I am aware that there are significant
penalties for submitting false Information, wK*AN the poss0aly of fins and Impdsonmem for knmw g violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617