HomeMy WebLinkAboutWQ0014046_Monitoring - 11-2016_20161208FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _/ Of L
Permit NNo.7A:d1
Facility Name
Month: Aj0 Year: 0
Did irrigation occur
Field Name:
`Fie7tlName n
Field Name: .
alt this facility?
Cover Crop:
Cover Crop:.
YES NO
Hourly Rate (in):
Hourly Rate
"M
Annual Rate (in):
Field Irrigated? ES NO
""A
g,
Field Irrigated? ❑ YES
Weather
Freeboard
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UU-1 I�IVIN-IJI3l., l`IAIKIst Art! LIUAI IUGR IKCI'UKI (NUAK-1) PageQ,—of
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Did the application rates exceed the limits in Attachment B of your permit? �ompliant ❑ 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? - p,Kompliant ❑ Non -Compliant
Dere all setbacks listed in your permit maintained for every application to each permitted site? compliant EJ Non -Compliant
Were all freeboards Maintained in accordance With the specified freeboard heights in your permit? ®�eompliant ❑ 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.
p Operator in Responsible Charge (ORC) Certification
Permittee Certification
p3 pA �.-'�""
OP.C: a �' 7'-,
t( 1 lam_ .' �l reA,' `"=r" �"='�'_'.2_ .0.�
Permittee: �d CJ a�F
Certification No.: `�8 ;)
Signing Official: +� u7 -C d P
Grade: Phone Number: " 3 _ 6+ m , yZ,'P
Signing Official's Title:ln'llfog
Has the ORC changed since the previous NDAR-1? ❑ Yes 5�lo
Phone ilumber:q/ qs A4 Permit Exp.: /Q 3
L / y ti 0X /
ft�- 11
l�
Signatur 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
=7
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Perma �No- W(9,0 /AI -)4L
Facility NameL<Slbtb ,Q I
County: Month:
Year -S
®ad irrigation occur
�1440-1'
Field Name:
Field Name:
3 Area (acres)
Area (acres
Area (acres):
alt this facility?
Cover Crop -
Cover Crop:
tit
YES ❑ NO
A gQU.1.1w
V
Hourly Rat e (inIT
our y a
Rate In
U
Annual Rate (in):
--RKNEW
Annual Rate (in):
Weather
Freeboard
i, r�:2
Field Irrigated? YESJ❑ NO
&Z".g. Q
Field Irrigated? ❑ YES
2
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FORM: NDAP,-1 02-1.1 NON -DISCHARGE APPLICATION REPORT (NDAR-3) Page _—A.of- Af
Did the app9ication rates exceed the limits in Attachment S of your permit?
Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
zCompliant
❑ Non-compliant
Was a -suitable vegetative cover maintained on all sites as .specified in your permit?
12 Compliant
❑ Non-compliant
Wena all setbacks gisted in your permit maintained for every application to each permitted site?
121111C.mpriant
❑Non -Compliant
Were ail freeboards maintained in accordance with the specified freeboard heights in your permit?
U,4.mpliant
❑ 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 dates) of
the non-compliance and
describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification I
II I �i
I
I; .l
Certii:!catio!'t ivE,,.i�} Signing Official: - y
'r f K 6
Grade:' PhonE IVumber: 91,, a 6fc- e- ,c,°2 � � I C -�� Signing Official's Title:
16? 0
Has the ORC changed since the previous NDARA? ❑ Yes Vo Phone Number: 9/ Permit Exp.: �r I
r
Signature Date Date
By [his 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 pp
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submilted. 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 [hat 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