WQ0004972_Monitoring - 09-2016_20161101

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NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDIDTIONAL PAGES AS NEEDED
PERMIT NUMBER:_ W0004972 MONTH: September YEAR: 2016
FACILITY NAME: Forest Lakes Preserve ELS. COUNTY: Davie
Formulas:
Daily Loading (inches) _ [Volume Applied (gallons) x 0.1336 (cubic feettgallon) x 12 (inches/fool)] / [Area Sprayed (acres) x 43,560 (square feetlacre) or
_ [Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch).
Maximum Hourly Loading (inches) = Daily Loading (inches) / [Time Irrigated (minutes) / 60 (minutes/hour)] Monthly Loading (inches) =Sum of Daily Loading (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 (inches) = [Monthly Loading (inches/month) / Number of days in the month (days/month )] x 7 (days/week)
Did Irrigation Occur At This Facility:
Yes: M No: ❑
aid Irrigation Occur On This Field:
Yes: © No:❑
Field Number:
Area Sprayed (acres): 7.0
Cover Crop:
Permitted Hourly Rate (inch)
Irrigation Occur On This Field:
Yes: ❑ No: ❑
Field Number:
i Sprayed (acres):
Cover Crop:
Permitted Hourly Rate (inches):
Permitted Yearly Rate (inches):
Maximum
Volume Time Daily Hourly
Applied Irrigated Loading Loading
gallons minutes inches inches
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WEATHER CONDITIONS
Permitted Year Rate (inches):
146.8
D
A
Weather Temperature
Storage
Maximum
T
Code' at Predpita-
Lagoon
Volume Time Daily
Hourly
L
application lion
Free -board
Applied Irrigated Loading
Loading
(°F) inches
feet
gallons minutes inches
inches
Irrigation Occur On This Field:
Yes: ❑ No: ❑
Field Number:
i Sprayed (acres):
Cover Crop:
Permitted Hourly Rate (inches):
Permitted Yearly Rate (inches):
Maximum
Volume Time Daily Hourly
Applied Irrigated Loading Loading
gallons minutes inches inches
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*Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Glenn Price Phone: [phone]
ORC Certification Number: 987931/20771 Check Box if ORC Has Chaned: F1Mail ORIGINAL and Two COPIES to:
ATTN: Non -Discharge Compliance Unit X
DENR (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
Division of Water Quality By this signature, I certify that this report is accurate and
1617 Mail Service Center complete to the best of my knowledge.
RALEIGH, NC 27699-1617
DENR Form NDAR-1 (5/2003)
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1
1
t'• • 1 I
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Total Gallons/Monthly Loading (inches)
12 Month Flo,fing Total (inches)
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*Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Glenn Price Phone: [phone]
ORC Certification Number: 987931/20771 Check Box if ORC Has Chaned: F1Mail ORIGINAL and Two COPIES to:
ATTN: Non -Discharge Compliance Unit X
DENR (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
Division of Water Quality By this signature, I certify that this report is accurate and
1617 Mail Service Center complete to the best of my knowledge.
RALEIGH, NC 27699-1617
DENR Form NDAR-1 (5/2003)

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 your facility put (NA) in the
compliant box.)
Compliant (Y,N)
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).
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3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
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4. All buffer zones as specified in the permit were maintained during each application.
S. 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.
"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 a qualified personnel properly gather and evaluate 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
inform on bmitted is, to th best of my knowledge and belief true, accurate, and complete. I am aware that there are significant
peva res fors bmitting falfq�nation, including the possibility of fines and imprisonment for knowing violations."
of
(Permittee -Please print or type)
2N. Riverside Plaza, Suite 800
Chicago, Il 60606
(Permittee Address)
James M. Cheshire
(Name of Signing Official -Please print or type)
President R & A Laboratories
(Position or Title)
(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 213.0506 (b) (2) (D).