WQ0005173_Monitoring - 09-2016_20161115

NON DISCHARGE APPLICATION REPORT
HIGH RATE INFILTRATION SITE(S)
THERE ARE THREE SITES PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER W00005173 COUNTY: Carteret
FACILITY NAME: Cape Royall Dolphin CLASS: II MONTH: SEPT
Formulas:
Dailv Loadina (aallons/square feet)=Volume Annlied(oallons)/Site Area (square feet)
Page 2 of 2
P
YEAR 2016
* Weather Codes: S - sunny, PC - partly cloudy, Cl - cloudy, R - rain, Sn - snow, SI - sleet
OPERATOR IN RESPONSIBLE CHARGE (Of Daniel E. Fortin
ORC Certification Number: 7180
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
GRADE: II PHONE: [phone]
CHECK BOX IF ORC HAS CHANGED
X Oet� (E. jE4�'L
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-2(5/2003)
SITE NUMBE Zone 1
SITE NUMBE Zone 2
SITE NUMBE
SITE AREA (sq. ft.):
5,024
SITE AREA (sq. ft.):
. 5,024
SITE AREA (sq. ft.):
WEATHER CONDTIONS PERMITTED RATE (gpd/sp.
5
PERMITTED RATE (gpd/sp
5
PERMITTED RATE (gpd/sp.ft.):
A
T
E
Weather Temp.
Code'
(*F)
Precip Volume Time
tation Applied Irrigated
Daily Loading
Volume Time
Applied Irrigated
Daily Loading
Volume Time Daily
Applied Irrigated Loading
low
inches gallons minutes
gallons/sq. ft.
gallons minutes
gallons/sq. ft.
gallons minutes gallons/sq. ft.
1
2 0 0 0
77TOW7
0.39808917'
2
2000
0.39808917
2000
0.39808917
3
5000
0.99522293
5000
0.99522293
4
4500
0.89570064
4500
0.89570064
5
3000
0.59713376
3000
0.59713376
6
3500
0.69665605
3500
0.69665605
7
2500
0.49761146
2500
0.49761146
8
2500
0.49761146
2500
0.49761146
9
3000
0.59713376
3000
0.59713376
10
2000
0.39808917
2000
0.39808917
11
3000
0.59713376
3000
0.59713376
12
3000
0.59713376
3000
0.59713376
13
4500
0.89570064
4500
0.89570064
14
3500
0.69665605
3500
0.69665605
15
4500
0.89570064
4500
0.89570064
16
4500
0.89570064
4500
0.89570064
17
1 2000
0.39808917
2000
0.39808917
18
4500
0.89570064
4500
0.89570064
19
6500
1.29378981
6500
1.29378981
20
5500
1.09474522
5500
1.09474522
21
4000
0.79617834
4000
0.79617834
22
3000
0.59713376
3000
0.59713376
23
5000
0.99522293
5000
0.99522293
24
3500
0.69665605
3500
0.69665605
25
3500
0.69665605
3500
0.69665605
26
4000
0.79617834
4000
0.79617834
27
4000
0.79617834
4000
0.79617834
28
5500
1.09474522
5500
1.09474522
29
3000
0.59713376
3000
0.59713376
30
4000
0.79617834
4000
0.79617834
311
0
0
Monthly
oa Ing
ga ons sq.
22.095949
2. 9 9
Year- I o- ate Loading ga ons sq.
.58
237.58
* Weather Codes: S - sunny, PC - partly cloudy, Cl - cloudy, R - rain, Sn - snow, SI - sleet
OPERATOR IN RESPONSIBLE CHARGE (Of Daniel E. Fortin
ORC Certification Number: 7180
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
GRADE: II PHONE: [phone]
CHECK BOX IF ORC HAS CHANGED
X Oet� (E. jE4�'L
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-2(5/2003)

NON -DISCHARGE APPLICATION REPORT
HIGH RATE INFILTRATION SITE(S)
FACILITY STATUS:
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. The site was kept free of vegetation and raked at intervals specified
in the permit.
3. The Automatically Activated Standby power source is on site and
operational.
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 noncompliance 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 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
im risonment for knowing violations."
0 / / -,F-16 Daniel E. Fortin
Signature of Permittee * Date (Name of Signing Official -Please print or type)
Daniel E. Fortin
Permittee - Please print or type
P.O. Box 4188
Emerald Isle, NC 28594
Permittee Address
Operator Responsible in Charge
(Position or Title)
252-393-8720 02/28/2019
(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 26.0506 (b) (2) (D).
DENR FORM NDAAR-2(5/2003)