WQ0009098_Monitoring - 10-2016_20161207

NON -DISCHARGE APPLICATION REPORT : Page _C;& of n,
SPRAY IRRIGATION SITE($)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: 11 PIS MONTH: YEAR:
FACILITY NAMEAL®` COUNTY: � k
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic faeugallon) x-12 (inches/foot)) l [Area Sprayed (acres) x 43,560 (square feetlacreQR
- Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre4nch)i
Maximum Hourly Loading (inches) - Dairy Loading (Inches) I fnmeinigated (minutes) 160 (minutes(hour)) Monthly Loading (Inches). -Sum of.Daiy Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
-...__....-. __�.__..__�__._...__.�....__�:__n_-�_-.__...r�.a..-.�.....r.�.....i..x•am....,h M�wlmnn/hllxTlrlavefwafah). --
nvrragr xxrrn,r waumr„....-w..,...,-... ............ :. ��_... _._...-'--- •------
Did Irrigatlon Occur At, Facluty: Did Irrigation Occur On This Field:
Yes: ❑ No Yes: ❑ - No:
- -
-
Dld Irrigation occur On This Field:
Yes: C3. No: ❑
FIELD NUMBOER-1 I
AREA SPRAYED acres :
COVER CROP: I
PERMITTED HOURLY RATE (Inches):
FIELD NUMBER:
AREA SPRAYED acres
COVER CROP:
PERMITTED HOURLY RATE (Inches):
D
A
T
E
WEATHER CONDITIONS
TemP.r.tun Storage
Weather
Code' at Preciplte. Lagoon
appllcallan tion Free -boar
l'FI Inches feet
(Inches:
PERMITTED YEARLY RATE (Inchissij
Volume Timis Dally
Applied Irrl ated LoadingLoading
gallons minutes Inches
hL a
Maximum
Hourly
Inches
PERMITTED YEARLY RATE (inches),
I
Volume Time Daily
Applied Irri ated Loading
gallons minutes Inches
Maximum
Hourly
Loading
Inches
1
2
3
4
5
6
7
e
9
a
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
28
27
28
29
30
1
31
Total Gailons/Monthly Loading (Inches)
12 Month Floating Total (inches)
Average Weekly Loading (Inches)
weather Codes: c -clear, rl.:-paruy ciouay, W—ciouay, R -ram, Ornsnaw, Or-srrra
Spray Irrigation Operator in Responsible Charge (ORC): ` Phon I�
ORC Certification Number: qqnCheck Box if ORC Has Changed: ❑
Mall ORIGINAL and TWO COPIES to:
4
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality (SI ATURE OF PERATOR RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, i CERTIFY THAT THIS REPORTS
ACCURATE AND COMPLETE
RALEIGH, NC 27 699-1 61 7 TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (5/2003)

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 beecomDliant
with the following permit requirements: (Vote: if a requirement does not apply to your facility put (dA) in the
compliant box. )
1. The application rate(s) did not exceed the limit(s) specified in the permit
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
Page of
Compliant N)
3. A suitable vegetative cover was maintained on the site(s) In accordance with the permit. 1�
4. All buffer zones as specified in the permit were maintained during each application
5. The freeboard in the treatment and/or storage lagoons) was not less than the limit(s) .
specified In the permit.
If the facility is non-compliant please explain in the space below the reasons) 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 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
51 MI;
TI 1to
(Position or Title) `
M1
(one Number)
MA.1W:�
or
` 1�1 13
(P it Ex . Date)
• If signed by other than the permittee, Aelegation of signatory authority must be on file with the state per 15A NCAC 2a.0500 (b)(2)(D).
DENR FORM NDAR-1 (5/2003)