WQ0021204_Monitoring - 09-2016_20161024 (3)

NON -DISCHARGE APPLICATION REPORT Page 3 of
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00021204
MONTH: September YEAR: 2016
FACILITY NAME: North Chatham Vol. Fire Department COUNTY: Chatham
Formulas:
Daily 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) x 27,152 (gallons/acre-inch)]
Monthly Hourly Loading (inches) = maximum inches applied over a one hour period for that day
Monthly 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 (inchesl = [Monthly Loadino (inches/month) / Number of days in the month (days/month)) x 7 (days/week)
Did Irrigation Occur At This Facility:
Yes: 121 No: ❑
Did Irrigation Occur On This Field:
Yes: I7 No: ❑
Did Irrigation Occur On Th[a Field:
Yes: ❑ No: 2
FIELD NUMBER: 1 1
AREA SPRAYED (acres): 0.15
COVER CROP: Grass
PERMITTED HOURLY RATE (inches): 0.3
FIELD NUMBER:
AREA SPRAYED (acres):
COVER CROP:
PERMITTED HOURLY RATE (inches):
WEATHER CONDITIONS
PERMITTED YEARLY RATE (inches):
25.4
PERMITTED YEARLY RATE (inches):
D
A
T
E
Storage
Temper- Lagoon
Weather
� ature at Preclpita- Free-
code application tion board
Volume Time
Applied Irrigated
Dail Y
Loading
Maximum
Hourly
Y
Loading
Volume Time Dail Y
Applied Irrigated Loading
Maximum
Hourly
Y
Loading
('F) inches feet
gallons minutes
inches
inches
gallons minutes inches
inches
1
2
3
4
5
6
C 88 1.59
305 24
0.07
0.19
7
8
9
10
11
12
PC 82 0
305 24
0.07
0.19
13
14
15
16
17
18
19
R 79 0.53
20
21
22
23
24
25
26
R 67 1.14
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
610
0.15
0 0.00
12 Month Floating Total (inches)l
1
3.58
Average Weekly Loading (inches)l
1 1
0.0349233
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:
Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1617
Randall Jarrell Phone: [phone]
7937 Check Box if ORC Has Changed: ❑
(SIGNATURE OF O ERATOR/ RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (1112005)

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) specified in the permit.
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)
specified in the permit.
Page �� of S—
Com liant (Y,N)
Y
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."
12ju ['0
(Signature of P rmittee)* Date
Randall Jarrell
(Permittee -Please print or type)
45 Morris Road
Pittsboro, N.C. 27312
(Permittee Address)
Randall Jarrell
(Name of Signing Official -Please print or type)
ORC
(Position or Title)
919-548-3099 1/31/2012
(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)