WQ0000948_Monitoring - 10-2016_20161130

NON-DISCHARGEAPPLICA-iInIA R)PPf)PT IRMA IPA I ; 9
Permit No,: WQ0000940
Facillty�Name: "
TOWN OF JACKSON
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county: Northampton
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Year: p��~
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Field Maine:
2 a
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, 11:.'22
Area (acres):
12.40
Area r.ciz� .
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.3
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Fleid Maine:
Area (acres):
IN
' covar'croj :
'r, l'ourli� l,7to !n
Fescue
COvel' ero p
Fescue
, Cciv4r (crap::
Fescue :..:
cover crop:
12.26
Fescue
YES ONO
( )?
_
Hourly Rate in ;
y ( )
Iq.ourll hma(c tltl):
Hourly Rate (in):
�TWeather :� �_N
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page____L of `1
Did the application rates exceed the limits in Attachment B of your permit? I6mpllant ❑Non -Compliant
Were adequate measures taken to prevent: effluent ponding in or runoff from -the sites? [J &mpilant ❑ Non -Compliant
Was a suitable vegetative. cover maintained on all sites as specified in your permit? C -f compliant ❑Non Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? Clcompllant ❑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 necessarv.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORc:. Johnny : G. Young
Permittee: Town of Jackson
Certification No.: 23129
Signing Official: Jason S. Morris
Grade:l C o 11 a It t i o n Phone Number: 252-534-3811
Signing Official's Title: Mayor
Has the ORC changed since the previous NDAR-1? . yes El No
Phone Number: 252-534-3811 permit Exp,: 12-31-16
Sign t Date
Signature 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 or 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
16.17 Mail Service Center
Raleigh, North Carolina 27699-1617

+ l%3Ul11••IJISI;i-I11KUL—; APPLICATION REPORT (NDAR-'i) Page 4 of
Permit No.: WQO0009118
Facility Name:
TOWN OF JACKSON
^
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County: Idotthatnpton Month:
�Ctp
Yoar
Md �G�l �l�: oo, occur
7—
77 loid' hlaliie;
,� . 5 '
Field dName: ;
- _
i=1oId.W. tr�c
Fiold Name:
.y
at UNG faduty?(actor)::.
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. Ti -,39 ..
Area (acres):
area (dare's);
Area (acres):
Coyer Crap:
FeSCue
Cover Crop;
Cover.Gl'ap;
'' ' `
Cover Crop:
® YES ❑ No
Elourly iRpt ,(iri):.
Hourly Rate (in):
110 qrly rate (i11):
; ' -
I Hourly Rate (in):
Annual Rate (in):
;..AnnualP.atQ (in):�
Annual Rete (in):
.av
Weather
� I"rooboard
rlerici h ripatecl+
r] Yrs 1� tdt]
Field Irrigateil7
❑ YES Elmo
�lol,d lrrijatedi'
. CJ YES. " [
Field Irrigated?
❑ YES ❑ No
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Monthly Loading
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iMonth Floatm Total inE.
;.- r.

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?" B6mpllant ❑Non•Compliant
Were adequate measures taken to prevent effluent ponding in or runoff -from the sites?CTi�mpuant 0Non-Compliant
Was -a suitable vegetative cover maintained on all sites as specified in your permit? Ci compliant 0 Non Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ffCompllant ❑ Non.compl,ant
Were all freeboards maintained in accordance with the specified freeboard heights in„ your permit? [Ytampllant ❑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 necessarv.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Johnny G. Young
Permittee: Town of Jackson.
Certification No.: 2 312 9
Signing Official: Jason S. Morris
Grade:1 collection Phone Number: 252-534-381.1
Signing Official's Title: Mayor
Has the ORC changed since the previous NDAR-11 yes Cl No
Phone Number: 252-534-381112-31-16
Permit Exp.:.
Sign t Date
Signature Date
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 or the person or persons who manage Ilia 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 (duality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617