WQ0019782_Monitoring - 09-2016_20161208

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) AjVj,
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FORM: 1 0
Permit No.: WQ0019782
Facility Name:
YMCA -CAMP WEAVER•
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Did irrigation occur
Field Name:
RPM
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Field Name:
Area (acresy 1
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1
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at this facility?
Cover Crop:
Cover Crop:
Natural Forest
Cover Crop:
Natural Forest
Hourly - (in):
Hourly Rate
1
Annual Rate (in)::
Annual Rate (iny
Annual Rate (in):
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Field Irrigated?
Field Irrigated?
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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? 2Compliant E] Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 2Compliant [:3Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 2Compliant El Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 2Compliant E] 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 correctiv,
action(s) taken. Attach additional sheets if necessary.
i
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Chip White
Permittee:
YMCA of Greensboro
Certification No.:
Signing Official: Greg Jones
Grade: Phone Number. 252-235-4900
------------- --------------------- _------------------ ----------- .......... ........... ........... .....................
Signing Official's Title: PresidentlCEC
Has the ORC changed since the previous NDAR-1? 2Yes ❑No
--------------------•----.................................--------------•--........................................---.--------
Phone Number: 3368548410 Permit Exp.: 9/30/20
...... - ............
.................
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El,� d
Signature Date
Signature w"L tp— 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 prepare7undder y�d ,Cisi n m a o ;
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based C
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, t
Information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are slgnific
penalties for submitting false Information, including the possibtiity of fines and imprisonment for knowing violations.
1
Mail Original and Two Copies to:
Division of Water Resources i
]Information Processing Unit
1617 Mail Service Center

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
Page 2 of 2
0 Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 0 Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? Ci Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? F�l Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance With the specified freeboard heights in your permit? ❑ 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.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Chip White
Permittee:
YMCA of Greensboro
Certification No.:
Signing Official: Greg Jones
Grade: Phone Number' 252-235-4900
Signing Official's Title: President/CEO
Has the ORC changed since the previous NDAR-1? 7 Yes ❑ No
Phone Number: 3368548410 Permit Exp.: 9/30/20
r t
Signature I 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
I
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources `
Information Processing Unit AI Ajjo_6 : 6
1617 Mail Service Center (�
Raleigh, North Carolina 27699-1617