WQ0014046_Monitoring - 09-2016_20161025 (3)

7
FORM: NDAR-1 08-11
40MR.-
NON-DISCHARGE APPLICATION REPORT (NDAR-1)
VZ Page / Ofq-
PermilNo.:'601)j,,.g4
Facility NameiS .,�jj
County:�7XO
Months" Year
Did irrigation occur
MOM,
Field Name:
N
Field Name:
Area (acres):
Area (acres
(acres):
alt this facility?
Cover Crop; r Lte
,r: P_
C
Cover Crop:
r.
e -'YES ❑ NO
Hourly Rate (in):
a ask i
Hourly Rate n
-M
Annual Rate (in):
eAnnria 'a
Annual Rate (in):
Weather Freeboard
Field Irrigated? El YES 0
M".
Field Irrigated? ❑ YES
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Monthly Loading:
12 Month Floating Total (in) -
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"'•". ""^•-�"-DJUIV-UlZ)1.611AK,I"C Al"-t-Ut„AI1UN KLNVKI (NUAK-1)
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a'suitalble vegetative cover maintained on all sites as specified in your permit?
Page --,2,of__4�
Compliant ❑ Non -Compliant
a-em1 pliant ❑ Non -Compliant
91"n pliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 9�eompliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ompliant ❑ 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 the corrective
action(s) taken. Attach additional sheets if necessary.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Bail Service Center
Raleigh, North Carolina 27699-1617
Operator in Responsible Charge (ORC) Certification
Permittee Certification
R
ORO:
y�
�.�-� �' �✓ _r� �j ®® e�
Perry itLee: ° �? l 5�3 t S f� r` %a a"� �` ✓ i°2 s �' �,�
ef�
.c- y
Certification No.: shy �:
'16
Signing Official -.'� SF's / C t-2C,c✓Ala7f it
Grader
t3
Phone Number: c 9— 3 - '444 � m ex; r`-4
91 q- /�,- 9 ? S22 4 , ez e
Signing Official's Title:
Has the
ORC changed since the previous NDAR-1? ❑
❑ Yes No
Permit Ex / I
Phone Number:�� �- � 9� _ �� � p.; � � � - �i
O' 2C' L�-J•l
4&
kature Gate
Signature Date0
By this signature, I certify that this report is accurrale 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 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.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Bail Service Center
Raleigh, North Carolina 27699-1617

NUIV-U1JLMAKht.A6✓1 U!-A11UN KtVUKI (NUAK-1) Hage —.3 of t%
Permit No�Vg7Q® e)
Facility Names d
. / �,
Coun tY Month
Year• I
,
�,
®ad irrigation
g��A®9l �CC999'
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Field Name:
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i
Field Name•
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. )�i} F=i 6v �L 4t�! L';1i..'F'
Area (acres):
ilY .3. '.'c
raALea�(rs�_
�
Area acres
Cover Crop:.." -
oYopF 's z =
Cover Crop.
YES ❑ NO
n
H©�fl l I )#tzJ
Hourly Rate (in):
Rate
Hourly (in):
57A
Annual Rate in :
( )
Field Irrigated? YES �pNo�Ft
9 ❑ {c
ual ale �n 'r
fietiilr tl?y
q�F
` a 7-
prn uaa� U j3e x
Annual Rate (in): 6
Weather
Freeboard
n
x 1� gafedEs� (10
Field Irrigated. [t4ES
��7Fs
[I NO
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FORNI: NDAR-1 03-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page Aj .of
Did the application rates exceed the limits in Attachment S of your permit? pliant 0 Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?ompliant
Lt ❑ Non -Compliant
Was a -suitable vegetative cover maintained on all sites as specified in your permit? _ Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?ompliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?ompliant ❑ 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 the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
tL �rJ`5,u�>�� T�
Permittee: i���+' e,s/��,rm�� Lc.�e,• O�.imr'6�
f
�UF.C:
Certification No.:f
Signing Official: R'
GraderPhone Number: 6-�5� C-
Signing Official's Title:
Has the ORC changed since the previous NDAR-1? ❑ YeS Leo
Phone Number: 9j . �,��--I�•� �&� Permit Exp.: 0
Signature Date
SI nature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penally 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.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 mail Service Center
Raleigh, North Carolina 27699-1617