WQ0004972_Monitoring - 10-2016_20161202

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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: October 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 feet/acre) 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: ❑
Did Irrigation Occur On This Field:
Yes: © No:❑
Field Number:
Area Sprayed (acres): 7.0
Cover Crop:
Permitted Hourly Rale (incl
Did Irrigation Occur On This Field:
Yes: ❑ No: ❑
Field Number:
Area Sprayed (acres):
Cover Crop:
11 Permitted Hourly Rate (inche:
i.8 Permitted Yearly Rate (inches
Maximum
Hourly Volume Time Daily
Loading Applied Inigmed Loodim
inches gallons minutes inches
Maximum
Hourly
WEATHER CONDITIONS
Permitted Yearly Rate (Inc[
D
A
Weather Temperature
Storage
T
Code' at Precipita-
Lagoon Volume
Time Daily
Ni
application tion
Frcc-board Applicvl
Irrigated Loadin
(°F) inches
f t gallons
minmesI inche
Did Irrigation Occur On This Field:
Yes: ❑ No: ❑
Field Number:
Area Sprayed (acres):
Cover Crop:
11 Permitted Hourly Rate (inche:
i.8 Permitted Yearly Rate (inches
Maximum
Hourly Volume Time Daily
Loading Applied Inigmed Loodim
inches gallons minutes inches
Maximum
Hourly
*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 Changed:
Mail ORIGINAL and Two COPIES to: /K
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)
Total Gallons/Monthly Loading (inches)
12 Month Floating Tmt,] (inches)
A,cr.gc Weekly Loading (lnchc�)
+ urb o.r
*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 Changed:
Mail ORIGINAL and Two COPIES to: /K
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)

M
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. EV
2. Adequate measures were taken to prevent wastewater runoff from the site(s). 4
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
4. All buffer zones as specified in the permit were maintained during each application. ETI
S. The freeboard in the treatment and/or storage lagoon(s) was not less than the V
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 'ons bmitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant
penalt es for s bmitting fa e rmation, including the possibility of fines and imprisonment for knowing violations."
-1L / James M. Cheshire
(SiF'atur of Permit )* Dat (Name of Signing Official -Please print or type)
(Permittee -Please print or type)
2N. Riverside Plaza, Suite 800
Chicago, Il 60606
(Permittee Address)
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).