WQ0009098_Monitoring - 09-2016_20161101

NON -DISCHARGE APPLICATION REPORT Page&-of�
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: MONTH: YEAR
FACILITY NAME vy
COUNTY:
Formulas:
Dally Loading (inches) = Nolume Applied (gallons) x 0:1339 (cubic feetigallon) x 12 (inchesltoot)) I [Area Sprayed (acres) x 43,580 (square feet/acregR
= Volume Applied (gallons)/ [Area Sprayed (acres)x 27,152 (gallons/acre4nch))
Maximum Hourly Loading (inches) - Dalry Loading (inches) I (Time Irrigated (minutes) 160 (minutesmour)) ; 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)
AVeraga rveenry "oaumg IIOGOY51 = lm muy wauiny �n m��e����w�uq,..���..-....�..-,....:.........-• --,
Occur At This Facility: Did Irrigation Oeeur On This Field:
Yes• ❑ No: Yes• ❑ No•Yea•
_.....- •- -
IrriIrciga'ag
Irrigation Occur On Thia Field:
❑. No: ❑
FIELD NUMBER:
AREA SPRAYED acres :
COVER CROP:
PERMITTED HOURLY RATE (Inches):1
2DId
'']J_
FIELD NUMBER:
AREA SPRAYED (acres :
COVER CROP:
PERMITTED HOURLY RATE (inches):
D
A
T
E
WEATHER CONDITIONS
T.mP.r+wn storage
Weather at Preclplb- Lagoon
Code* application tion Frea-boar
(•Fl Inches feat
PERMITTED YEARLY RATE (Inches):1
Volume Time Dally
A lied IrHooted Loadln
gallons minutes Inches
Maximum
Hourly
Loadin
inches
PERMITTED YEARLY RATE finches):
Volume Time Daily
Applied irrigated Loading
gallons minutes Inches
Maximum
Hourly
Loading
Inches
1
2
3
4
S
8
7
`
8
9
101
1
12
13
14
15
18
171
19
19
20
21
22
23
r26
30
31
Total GallonslMonthly Loading (Inches)
12 Month Floating Total (inches)
Average Weekly Loading (inches)
Weather codes: t; -clear, YG-parry clouGly, W-Glouoy, R -ram, anenuw, a1o,
4T
Spray Irrigation Operator in Responsible Charge (ORC): 11Phone
ORC Certification Number: F 9.0's Check Box if ORC Has Changed: ❑
Mail ORIGINAL and TWO COPIES to: N
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality (ilGANATURE OF ERATOR IN RESPO IBLE CHARGE]
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (512003)

NON -DISCHARGE APPLICATION REPORT Page of
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has beenompliant
with the following permit requirements: (Vote: if a requirement does not apply to your facility put MA) in the
compliant box. )
1. The application rate(s) did not exceed the limits) specified in the permit.
Com II t Vf N)
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
F
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
E�
4. All buffer zones as specified in the permit were maintained during each application.
LTJ
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 actions) 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 a information, including the possibility of fines
and i fprisonment for knowingviol�a^tinons�(%
��7 v
C {
N y ,
(Sign t re of Petnittee)` Date - (Name o Sig ing CO
cial-Please ri or e
�F A
v V It 01 111991.14111"K
( ermi e -Please print or type) Po tion or Title
6 lgg�m I
IN l3
e um er) (P it Ext. Date)
(Permittee dyes
• If signed by other than the permittee,.delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(2)(D).
DENR FORM NDAR-1 (5/2003)