WQ0002056_Monitoring - 10-2016_20161116

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
mornmy Loaatng: 1os,000 0.21 0 0.00 0 0.00 0 0.00
12 Month Floating Total (in):
Permit No.: •111 1
Mobile Home
Onslow
Month:
October
•
• irrigation occur
at this facility?
Fj YES El N •
Area (acres):
Natural Pine
�91-11NzM
Cover Croly
Hourly Rate
. -.
Annual Rate (in):
Annual Rate (in):
WITMUFAR-Irw Mill
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Field g'
0
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mornmy Loaatng: 1os,000 0.21 0 0.00 0 0.00 0 0.00
12 Month Floating Total (in):

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
R] Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Compliant
❑ Non-compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Q Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
D Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
❑Q Compliant
❑ 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.
Signature
Operator in Responsible Charge (ORC) Certification
Certification
ORC: •� n \( C, (t� ii t S Z
�Permittee
Permittee: 3"'y� �) `2774 /J r
Certification No.: qj J
Signing Official: Johnnie A Gatlin
Grade: S Phone Number: T ®�
3 -3 $On —
Signing Official's Title: Owner
35_3 _333
Has the ORC changed since the previous NDAR-1?
❑ yes ❑ No
Phone Number: 910-353-3433 Permit Exp.: 2/28/20
Signature
Date
Signature Date
By this signature, I certify that this report is accurrate 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 Mail Service Center
Raleigh, North Carolina 27699-1617