WQ0004910_Monitoring - 10-2016_20161212 (3)

NON -DISCHARGE APPLICATION REPORT Pace_�_o(�
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMSER: • n �) MONTH: VtTr LC "t YEAR: "Zo, j&
FACILITY NAME:©(✓J %� C� t! U�J�� t �'I���" , y�'-1
GOUNTY:
Formulas: - i
Daily Loading (Inches) _ [Vohme applied (gallons) x D.1336 (euble (eellgsllon) x 12 (inche Jfoot)l 1 [Area Sprayed (ares) x 43.G00 (,qjwB (eeuacre)J OR
-'volumcApptlsd (Vagonsl ((Area Sprayed (act>�) x 21,152 (g511onu�acrc-inch!]
Nlaximum Hourly Loading (Inches) = Dally Loading (Inches) /[ilnte Irrigated (minulo.)1 a0 (minuleslhour)) Monthly Loading (inches) = Sum of DallyL=Vngs (inches)
12 Mon1h Floating Total (inches) = Sum of this nor? n's monthly Loading (inchC.) and priMous 11 month's Monthly Lazdings (Inches)
Average Weekly Loading (inches) = IMon(Ny Loading (inche*Jnonlh) I Number of da in the month (dav In) 7 (d —k
k
Did Irrigation occur t Tniu Facility:
Yes: No; ❑
u
mon )x sys tea )
Did Irrigation Occ r On Thls'Pieid: Did Irrigation Oc On This Field:
Yes: No:❑ Yes: No: ❑
FIELD NUMBER: FIELD -NUMBER:
AREA SRRAY@D at res : _ , •_ AREA SPRAY O aeres ; c
COVER CROP: '-0 0 OVER CROP: I Zp. C` tL
PERMITTED HOURLY RATE (Inches): PERMITTED HOURLY RATE (inches):
D
AMaximum
T
E
WEATHER CONDITIONS
Weather Tompehat�re Storage
at Pracrptta- Lagoon
code, appl,catlon Von Frea.boa
PERMITTED YEARLY RATE (inches):
Volume Time Dally
A liod Irrigated Loadin
,rte
Hourly
Loadin
PERMITTED YEARLY RATE finches)d 52-
Maximum
Volume Time Daily Hourly
A Ilei krrigeted Loadln Loadln
(°F) inches fest
gallons minutea
inches
Inches
gallons minutes
inches )neves
1
r
2200 O
2
y
�
c-
L1 1
Z
4
f-92
c
1.
5
2
T7
T �✓ 6r� — �/
�/c
ry2
li G/ 4
r
y!
e
c r.
9I
Fr 10
ZZ,Z120
7-7. `., -K�
1g
�;
J
�.(
t
71d
6I
Zri$✓
y
16
19
F
192a
I Z 12-
! "'3
as
z1
22
2s
24
25
27
28
29
�a
3j
_ 5
Total Ga{lonslMonthly Loading (inches)
,
r
12 Month Floating Total (inches)
•
tz`i'!
Average Weekly loading (inches)1
41 if7
p r
nor ours: c-, ear, rv.pai iq cwuuy, ,I-crouuy, R -ruin, an -snow, 51-nleet
Spray Irrigation Operator in Responsible Charge (ORC)yx�L- i' Phone:
ORC Cortificatlon Number: Check Box if ORO Has Changer!: 11
Mall ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN; Information Processing Unit
1617 flail Service Center
RALEIGH, INC 27699.1617
(SIGNATURE OF OPERATOR IN RESPONSIBLE GHARGE)
By TWS SIGNATURE. I CERTIFY THAT THIS REPORT IS ACCURAYE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
CENRFORMNDA.R (11/2005)

bialy -DISCHARGE APPLICATiON REPORT PsgeIW..J
SPRAY IRRIGATION SITE(S)
FeSLY Status.
Please indicate ( by insertina Y(es) or N(o) in the appropriate box ) whether the facility has beeEompllant
with the following permit requirements: (Vote, if s requirement does not apply to your facility put f4A) in the
cornplisnt box, )
1. The appl"tion rates) did not exceed the limits) specified in the permit. Com li nt Y,N)
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
3. A sultable vegetative cover was maintained on the slte(s) in accordance with the permit.
4. All buffer zones as specified in the permit were maintained during each application.
5, The freeboard in the treatment andfor storage lagoon(s) was not less than the limit(s)
specified in the pe&ni't.
If the facility is non-com please explain in the space below the reasen(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compiiaince and describe the corrective action(s) taken. Attach
additional sheets if necessary,
kss
A
C ,,gq 0V4 L rel 74q, 1,1 A) 0i
"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
f rel/,
Permittee -Please print or type)
&0 2-9
fib '&/y) %) 2-09.7
(Permittee Address)
(Name of Signing Official -Please print or type)
(Position or Title)
(Phone Number) (Perrmlt EXP. bate)
' If signed by other thah the permittee, delegation of signatory authority must be on Fite with the Mata per 15A NCAA 28.0506 (b)(2)(D).
DENR FORM idDAR-1 0 1/20D$)

NON -DISCHARGE REPORT Pace
SPRAY IRRIGATION SITE($)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGE$ AS NEEDED,
PERMIT NUMBER., • /1� +L "[ar MONTH:cc4 I/_ oYEAR: .7-61,&J
f
FACILITY NAM@: loi,,on L-) � j DA I n�:
COUNTY:
Formulas: if
Daily Loading (Inches) _ [Volume Applied (gallons) x D.1338 IWO; feeVgallon) x 12 (incho -'foot)) r(Area Sprayed (sr, es) x 43,00 (;qualm (eeVacre)) OR
VGIumeApplle0(r0ailons)l(Area 5pmyo(acre )x 27,152(92110n2�1;xrc-inch))
Maximum Hourly Laadfng (inches) 'Daily Loading (Inches) /rrfnte Irrigaled (minulc6)180 Iminuleafhour)) Monthly Loading (incii s) = Sum of PahyLoadinga (inches)
12 Month Floating Total (inches) - Sum of this month'; MontIlly Loading (inch=) and pr9vlous 11 month's Monthly Ljzdingo (incnes)
,4verageWceklyLoeding(inehos)=1MonlhlyLoading(incnc nontA}/Num bar of days. in the month (dav;rmonthpx7(dayalweek)
woathcr Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, $n -snow, Si•sleet
Spray Irrigation Operator in Responsible Charge (ORC) .,;: xa�,� l.r� !� i i Phone: ,
OPC Certification Number; ,'j Check Box if ORC Has Changed: ❑
Mall ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN:Information ProOessing Unit
1617 Mail Service Center
RALEIGH, NC 27699.1617
(SIGNATURE OF OPERATOR IN RESPONSIELE CHARGE)
BY THIS SIGNA7URE. I CERTIFY THATTHIS REPORT IS ACCURATE Ar -AD
COMPLETE TO THE BEST OF FAY KNOWLEDGE,
DENRFORMNDAR-", (11/2005)
Yes: No:
rrigation Oce On This Fleld:
Yes: No• ❑
FIELD NUMBER:FIELD-NUMBER:
AREA SPRAYED [Acres);. .- a
COVER CROP: a scua_
PERMITTED HOURLY RATE (inches):
AREA SPRAYED acres : 5, _
COVER CROP: . C` Ite_
PERMITTEa R�OURLY RATE (inches).
-I
A
T
E
WEATHER
Waether
Godo'
CONDITIONS
Tamper ature Storage
at Praclprta_ Lagoon
appllcatlon tion Free.boar
PERMITTED YEARLY RATE (inches ). -I
VDlume Time Daily
-Applied Irri ated LoadingLoadin
�_
Maximum
Hourly
PERMITTEDYEARLY RATE (inchesid
Maximum
Volume Time Daily Hourly
A lied Irrigated Loading Loadin
l°F) inches fest
gallons minutea
inches
Inches
gallons anlnutes incnes incnes
1
r
22�c O
2
o
G
?
2 2 1
6
�t
`� ZIP
-011-57�
t
•i
1 gYPi%
?
,
a
w. �v�% }. S
12
(,
Z _
i i 5
it 1. 5
13
-a r ';�
a, " y
i r
21CA15) G
17%
1fl
a
_
19
a
r
Z0
z1
2z
`
23
24
25
.Z.. .
26
27
2e
29
3q
Total Gallans,Monthly .Gad)ng (inthas)
f
r
12 Month Floating Total (Inches)
Average Weekly loading (inchos) •
[
woathcr Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, $n -snow, Si•sleet
Spray Irrigation Operator in Responsible Charge (ORC) .,;: xa�,� l.r� !� i i Phone: ,
OPC Certification Number; ,'j Check Box if ORC Has Changed: ❑
Mall ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN:Information ProOessing Unit
1617 Mail Service Center
RALEIGH, NC 27699.1617
(SIGNATURE OF OPERATOR IN RESPONSIELE CHARGE)
BY THIS SIGNA7URE. I CERTIFY THATTHIS REPORT IS ACCURATE Ar -AD
COMPLETE TO THE BEST OF FAY KNOWLEDGE,
DENRFORMNDAR-", (11/2005)

NON -DISCHARGE APPLiCATION REPORT Page Z711 i"
SPRAY iRRiGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has bee¢omplfant
with the following permit requirements: (Vote,; if a requirement does not apply to your facility put f4A) in the
compliant box. )
1. The application rate(s) did not exceed the limit(s) specified; in the permit.
Com li of(Y,N)
2, Adequate measures were taken to prevent wastewater runoff from the site(s),
� x Do�`
3. A suitable vegetative coyer was maintained on the slte(s) in accordance with the permit.
4. All buffer zones as specified in the permit were maintained; during each application.
5, The freeboard in the treatment andfor storage lagoon(s) was not less than the limit(s)
specified in the permit.
If the facility is non-com plian 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 gat hared and evaluated the information
submitted_ Based on my inquiry of the person or persons who marmge the system, or those persons directly responsible
for gathering the information, the informatlon submitted is, to the best of my knowledge and belief, true, accurate, and
complete, 1 am aware that there aree significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations-"
9)/
(Signature of permittee)* Date
Permittee -Please print or type)
91
(Permittee Address)
(Name of Sighing Official -Please print or type)
{Position or Title)
(Phone Number) (Permit Exp. nate)
` If signed by other than the permlttee, delegation of signatory authority must be on file wMh the stat¢ per 15A NCAC 26.050E (b)(2)(D)_
DENP FORM NDAP.-9 ('1112005)
� x Do�`
"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 gat hared and evaluated the information
submitted_ Based on my inquiry of the person or persons who marmge the system, or those persons directly responsible
for gathering the information, the informatlon submitted is, to the best of my knowledge and belief, true, accurate, and
complete, 1 am aware that there aree significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations-"
9)/
(Signature of permittee)* Date
Permittee -Please print or type)
91
(Permittee Address)
(Name of Sighing Official -Please print or type)
{Position or Title)
(Phone Number) (Permit Exp. nate)
` If signed by other than the permlttee, delegation of signatory authority must be on file wMh the stat¢ per 15A NCAC 26.050E (b)(2)(D)_
DENP FORM NDAP.-9 ('1112005)

NON -DISCHARGE APPLICATION REPORT Page- of
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PA ES AS NEEDED.
PERMIT NUMBER:. � "[c'�1� MONTH: oc4f iejl YEAR: �Cjf&j
FACILITY NAME: •�o6,n O E IJ l L Ciel
COUNTY:
Formulas: �-
Dolly Loading (Inches) s (b'olyme Applied (gslldns) x 0.1336 (cu01c tesUgsllon) x 12 (inchorloot)) �[4rea Sprayed (saes) x 43,660 (aQuara feel/acre)) OR
-vrilumc Applied (Jr allone) / (Area Sprayed (acres) x 27,152 (gallon�Ucre-inch))
Maximum Hourly Loading (Inches) _ Daily Loading (Inches) /ITlme Irrigaled (minutes)160 (minutes/hour)( Monthly Loading (incfws) =Sum of Dally Loadinga (inches.)
12 Month Floating Total (inches) = Sum or this: mpmn's Montoly Loading (imh6.) and prgvlous i 1 monlhq M.=Wy Laodtngs (Incnes)
,QVerapcWeeklyLOBdlntllinehcsl=lMonlhlvin.adinnrinencrJmnnlnt/tJumnornfno,ro.nrhn.,,,,..rt,ram„�r,�w�.r,,,,,�rw.............r.r
Did IrrIUat1070ccur t This Facility:
'les: `� No: ❑
Bid Irrigation Occ r On This'Plela. ce Did Irrigation OOn This Field:
Yes: No: ❑ Yes: No: ❑
FIELD NUMBER:
AREA SPRAYED acres : _ r -3Y
COVER CROP: Ui iQ
PERMITTED HOURLY RATE (Inches):
FIELD.NUMBER:
AREA SPRAYED
COVER CROP: CFS—
PERMITTEa FHOURLY RATE (inches):
D
A
T
E
Wr=ATF!@R CONDITIONS
Weether Tomyer slurs Storage
at Pr®cipita- Lagoon
Code" aPpllcatlon tfon Free -boa
PERMITTED YEARLY RATE inches :
Volume Time! Dally
Applied Irri abed Loodiriq I
5
Maximum
Hourly
Loading
PERMITTEDYEARLY RATE (inches : 52-
Maximum
Volume Time Daily Hourfy
Apelled Hrri ated Loadin Loadin
f°F) inches feet
gallons minucea
inches
Inches
gallons aninutes
inches Inches
7
ArL,
Z 2 ac.,
'
2J
Z �
1
s
2
�
s
2,
7
Zig
- f 15
Z-
.5
205
s
Z
_
1, i _�'
'5--
1 t)5
.—
rs
11
'" �Q
2v�
is
d
Q
16
17
y
18
a
18
,
C"ZZ
L2r
Z0
21
_
zz
`
23
2d
25
26
27
2a
29
30
31
Total GallonsfMorrthly Loading (inches)
c
r
12 Month Floating TDUI (Inches)
a
Average Weekly Loading (inchos)
aurdr vDuaa:-c,;rcarr�,-Pdrvy etouay, ut-cwuey, Karam, 5n -snort', a1•sieeelt
Spray Irrigation Operator in Responsible Charge (ORC),`~1fi�
ORC certifica4lon hlumber;�� ,1� , 1 )), Check Box if ORG Has Changed: ❑
Mall ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Service Center
RALEIGH, NG 27695-1617
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
EY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORtA NDAR-" (11/2005)

NON -DISCHARGE APPLICATION REPORT Ease oP;
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has beeE2Meliant
with the following permit requirements: (Vote, if a requirement does not apply to your facility put f4A) in the
compliant box, )
1. The app!ication rate(s) did not exceed the limits) specified in the permit.
Cornli nt Y,N)
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.
4. All buffer zones as specified in the permit were maintained during each application.
5. The freeboard in the treatment andfor storage lagoons) was not less than the limit(s)
specified in the permit:.
If the facility is non-comnlianb 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 Df 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 maraage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the gest 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
Permittee -Please print or type)
PC); 17-91
,Y) A1 C/ �
(Permittee Address)
% r `
E r 'VW';L_r_
(Name of Signing Official -Please print or type)
(Position or Title) 1;_7�'
(Phone Humb®r) (Permit Exp. Date)
' If signed by other than the permlttee, delegation of signatory authority must be an file witfi the Mata per 15A NCAA 2B.0500 (b)(2)(D)_
DEWR FORM ND4.R-1 (11/2007)

NON -DISCHARGE APPLICATION REPORT Page o(�
SPRAY IRRIGATION SITE(S)
THERE- ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: • 1/,)UCC0 MONTH: 0c),&I� YEAR: ` f_3
FACIL)TY NAMQ:_ 'JjOLu� ul (� VWDA � COUNTY. yt �
Daily Loading (Inches) _ (v'olvme aDWled (gallons) x 0.1336 (cable fset/g311on) x 12 (inchc Jfoot)) r(grea Sprayetl (aces) x d3,G60 (,Quare feel/acre)) OR
Vulumcapplied (gallons)/ (Area Sprayed (acrac) x 27,152 (gallomaIncrc-inch))
Maximum Hourly Loading (Inches) = Daily Loading (inches)/ ITlme Irrigated (ninutc.)l60 (mMulea/hour)) Monthly Loading (inetoesl = Sum of DaIIYLoactinga (inches)
12 Month Floating Totcl (inches) = Sum of this mpnm's monthly Loading (inches) and prgvlous 11 months Monthly Loodings (Inclles)
,AversgcWeeklyLoading (inchot)=ImonihlyLoad'ng(incharJmornh)/NUmDerOfdays inthemonth ldays(month))x7(daysareek)
wtt trrlganon aceur At This Facility!
Yes: No: ©
Did Irrigation Occ r On Thls'Field:
Yes: No! i]
Did Irrigation t7cc On This Field
Yes: W No• ❑
FIELD NUMBER: FIELD NUMBER:
AREA SPRAYED acres : -51 AREA SPRAYED (acre: r
COVER CROP: 5 `-tib COVERCROP: .'C. te_
PERMITTED HOURLY RATE (Inches):j PERMITTED HOURLY RATE (inches):
WEATHER CONDITIONS
PERMITTED YEARLY RATE (inches):
� � PERMITTEDrYEARLY
RA'P'E inches 5,7
LA
Storage
at hrsalplta- Lagoon
Codo° apppcsdon tion Free•boer
Volume Time
Applied Irrigated
Dally
Loadin
axmumWeather
Hourly Volume
Loading A 11ed
Time
Hrrigated
:
Maximum
Daily Hourly
Loading Losdln
(°F) inches feet
gallons minutes
inchos
Inches gallons
minutes
inches inches
1TO
1
2 2 C,
V,X
296
1
2
4
�r
s
2,
-
7
z Z Lc
i I
t .a
9
7�
200
3z,
I
10
rt ✓
-�_
) ,G
YPC-
I L
0
167
s-/ -
"
1622,
7rev _
y
17
ZO
21
_
22
2n
24
25
Z.
26
27
H211
Total Gallons/Monthly Loading (inches)
XI
r
12 Month Floating Total (Inches)
�
tC`5
Average Weekly Loading (inches)
, i,-.,
" Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, Si -sleet
Spray irrigation Operator in Responsible Charge (ORC) Phone;�j��`-TA
p'�j
OPC Certification Number � -^ Check Lox if ORC Has Changer!: ❑
Mail OP.IGINr"iL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
11317 Mail Service Center
RAL.EICrH, NC 27699-1617
rr�
ILI��'� L
(SIGNATURE OF OPERATOR IN RESPONSIELE CHARGE)
HY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
t7ENR FORt✓7 NDAR-1 (11/2005)

NON -DISCHARGE APPLICATION REPORT Page off ,J
SPRAY IRRIGATIO:I1 SITE(S)
Faeility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has beeE2Mpllant
with the following permit requirements: (Voter if a requirement does not apply to your facility put f1A) in the
compliant box, )
1. The application rate(s) did not exceed the timit(s) specified in the permit.
Com li nt Y,N)
2. Adequate measures were taken to prevent wastewater runoff from the site(s),
N-11
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
i
4. All buffer zones as specified in the permit were maintained during each application.
5, The freeboard in the treatment andlor storage lagoon(s) was not less than the limit(s)
specified in the permit.
If the facility is non-com12flan 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,
E / t ;j
�d,/T
N-11
i
"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 ell 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 informatlon submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submititing false information, including the possibility of fines
and imprisonment for knowing violations_"
(signature of Permittee)" ®ate
F_
Permittee -Please print or type)
-,Pu "?_91
(Permittee Address)
04ame of Signing Off icial=Please print or type)
(Position or Title)
G M��
(Phone Number) (Permit Exp, pate)
` If signed by other than the permittee, delegation of signatory authority must be on file with the st itm par 159, NCAA 28.0506 (b)(2)(D)_
DENR FORM NDP.P-1 (111 006)

NON -DISCHARGE APPLICATION REPORT Page
SPRAY IRRIt��4T1O�1 S1TE(�)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL P.AGI;S AS NEEDED.
PERMIT NUMBER:'` eyc . ,� `-[� jl� V[s � ( YEAR: 0j&
MONTH:
FACILITY NAME: ��I„yr1 0 /L-VL)M a"1 COUNTY!
Formulas: d
Daily Loading (Inches) _ (v'Qlume Applied (gsllane) x 0.1336 (euple teet/gallon) x 12 (inchcc'foo1 / IAM2 Sprayed (ares) x 43,00 (srnrare reel/ecre)) OR
- VolumcApplled (Dalloris) I (Area SprayRz (acra;) x 27,152 (�31IDn acrc inch))
Maximurn Hourly LQading (Inches) 'Daily Loading (Inches) / [rime Irrigated (minulcs)J 60 (minutes/hour)) Monthly Loading (inciiws) =SUM of DallvtoWinge. (inches)
12 Month Floating Total )inches) Suln er this moron's naantnly LD&ding (inches) and prgvlous i 1 month s hlanthly La❑dings (Inenesl
0.yersgrWeaklyLoa ding(inches)=IMonIhlYLoading(inchcsJnonln)/NumDerofdayainthemonthldaysmomn))x7(asysa+�ek)
IUltl lrgnArnon r Sr Tat c , r-�
” 1Noather Codes: C Blear, PC -Partly cloudy, Cl -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (DRC) d_�` Phone:
01?C certiFicatlon l�umber:c� `}� } - Check Box if ORO Has Changed: ❑
rrlall ORIGINAL and TWO COPIES (D:
DENR
Division or Water Quality
ATTN: Information Praressing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1 61 7
e
t'4
(SIGNATURE OF OPERATOR IN RESPONSIBLE C-HARGE)
BYTHIS SIGNATURE, I CEI2TIPY THAT THIS REPORT IS ACCURATE AND
CDMPLETE TO THE BEST Or MY KNOWLEDGE,
DEIRFORtANDAR-1 (11/2905)
-- c: ---- �� • •s•
Yew No; ❑
a,rp ungauan vcc r vn r ms aero;
Yes: No: ❑
Did lyrigation Dc. On Thls Field:
Yes: No: ❑
FIELD NUMBER:
AREA SRRAYED sires : _ a-
COVER CRO!':
PERMITTED HOURLY RATE (Inches):
FIELD -NUMBER:
AREA SPRAYED facres ; c
COVER CROP:—
PERMITTECt HOURLY RATE (inches):
D
T
H
WEATHER
Coda*
Coda*
CONDITIONS
Tomger atura storage
at prw1plta_ Lagoon
appllc�tlon tion Free boar
PERMITTED YEARLY RATE (Inches),
Volume Time DaPly
b lied Irri abed Loadin
Maximum
Hourly
LoadingA
PERMITTED YEARLY RATE inches): 5',7
Maximum
Volume Tlme Daily Haurry
lied firri ated Loadln Loading
(°F) inches toet
gallons minutes
inches
Inches
gallons minutes inches inches
1
r
722 GC O
v
157
6
A 12
J7_I
�P
7
f 1
10M2r
9
0'may
10
aE
�;Oi
15B•
) �J,
11
Y�
F,•ZP-
,r}
12
<<
ti10 a jo
13
2
% 15
14
16
-20
G
2
d!2,
e
76
} if -
L7
F
/
.
-7
20
z1
_
2z
23
24
26
27
26
29
30
_
To Ga{)onsfPfrnnthly Loading (inthas)
x
12 Month Floating Total (Inc]
tC`Y
Average Weekly Loading (inchos)
)
/
” 1Noather Codes: C Blear, PC -Partly cloudy, Cl -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (DRC) d_�` Phone:
01?C certiFicatlon l�umber:c� `}� } - Check Box if ORO Has Changed: ❑
rrlall ORIGINAL and TWO COPIES (D:
DENR
Division or Water Quality
ATTN: Information Praressing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1 61 7
e
t'4
(SIGNATURE OF OPERATOR IN RESPONSIBLE C-HARGE)
BYTHIS SIGNATURE, I CEI2TIPY THAT THIS REPORT IS ACCURATE AND
CDMPLETE TO THE BEST Or MY KNOWLEDGE,
DEIRFORtANDAR-1 (11/2905)

NON-I)ISCHARGE APPLICATION REPORT
SPRAY (RRIGATIO N 9ITE(S)
Fae)lite Status:
Please indicate (key inserting Y(es) or N(o) in the appropriate box ) whether the facility has beeERMpliant
with the following permit requirements: (Vote, if a requirement does not apply to your facility put f4A) in the
ccmpliant box. )
1. The application rate(s) did not exceed the limit(s) specifieo9 in the permit.
Com li ofY,N)
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
3. A suitable vegetative coyer was maintained on the slte(s) in accordance with the permit.
4. All buffer zones as specified in the permit were maintained during each application.
5. The freeboard in the treatment andfor storage lagoon(s) was not less than the limit(s)
F_Jt7
specified in the permit.
If the facility is non-comoliant 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 ell qualified personnel properly gathered and evaluated the information
submitted_ Based on my inquiry of the person or persons who marnage the system, or those persons directly responsible
for gathering the information, the informatlon submitted is, to the test 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
Rermlttee-Please print or type)
— /Z 91
6 0-W91
(Permittee Address)
04ame of Signi11ng ®fficial-b=lazes print or type)
(Position or Title)
, "^" I �/;_7
(Phone Number) (Permit Exp. Date)
' If slgned by other than the permittee, delegation of signatory authority must be on file willb the stato per 15A NCAC 28.0506 (b)(2)(D)_
DENR FORM NDA.R-'I (1 VZOO$)