WQ0034386_Monitoring - 10-2016_20161208

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0034386 MONTH: OCTOBER YEAR:
FACILITY NAME: Town of LaGrange WWTP COUNTY: Lenoir
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] /(Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Monthly Hourly Loading (inches) = maximum inches applied over a one hour period for that day
Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
..,. weew., I ..mal.... r..�t.ect - rnnnnft,l�� I nariinn linnhaclmnnlhl / Ni imhar ni days in the month ldayslmonthll x 7 ldays/weekl
Did Irrigation Occur At This Facility:
Yes: No: X
Did Irrigation Occur On This Field:
Yes: No:
X
Did Irrigation Occur On This Field:
Yes: No:
FIELD NUMBER:
AREA SPRAYED (acres):
COVER CROP:
PERMITTED HOURLY RATE (inches):
FIELD NUMBER:
AREA SPRAYED (acres):
COVER CROP:
PERMITTED HOURLY RATE (inches):
D
T
E
WEATHER CONDITIONS
Storage
weather Temper-ature Precipita- Lagoon
code' at application tion Free -board
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated Loading
Maximum
Hourly
Loading
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated Loading
Maximum
Hourly
Loading
inches feet
gallons mtnu es inches
Inc Fes
gallons minutes inches
inches
1
2
3
4
5
6
7
8
9_?.
10Q`�`1�•''
1213
14
16
17
>1.
18
tl'
19
20
21
22
23
24
25
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
0 0.00
0 0.00
12 Month Floating Total (inches)
Average Weekly Loading (inches)
0
0
Weather Godes: G -clear, Pu -partly clouay, cl-ctouay, m -ram, -on-snow, of -steer
Spray Irrigation Operator in Responsible Charge (ORC): James W Sutton
ORC Certification Number: 25209 Check Box if ORC Has Changed:
Phone: [phone]

Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit (SIGNAV013t OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY TH6-SIGNATURE, 1 CERTIFY THAT THIS REPORT IS ACCURATE_AND
RALEIGH, NC 27699-1617 COMPLETE TO THE BEST OF MY KNOWLEDGE.
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 yourfacility put (NA) in the
compliant box. )
Compliant (Y,N)
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).
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit. 0
4. All buffer zones as specified in the permit were maintained during each application.
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the 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 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."
(Signature of Permittee)* Date
Town of LaGrange .
(Permittee -Please print or type)
PO Box 368
LaGrange. NC 28551
(Permittee Address)
John P. Craft
(Name of Signing Official -Please print or type)
Town Manager
(Position or Title)
December 31, 2015
(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).