WQ0005173_Monitoring - 10-2016_20161219

NON DISCHARGE APPLICATION REPORT
HIGH RATE INFILTRATION SITE(S)
THERE ARE THREE SITES PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER W00005173 COUNTY:
FACILITY NAME: Cape Royall Dolphin CLASS: II MONTH:
Formulas:
naily 1_oadinn (aallnns/sauare feet/=Volume Annlied(aallonsl/Site Area (sauare feet)
Page 2 of 2
Carteret
OCT YEAR 2016
* Weather Codes: S - sunny, PC - partly cloudy, Cl - cloudy, R - rain, Sn - snow, SI - sleet
OPERATOR IN RESPONSIBLE CHARGE (OF Daniel E. Fortin GRADE: II
ORC Certification Number: 7180
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
PHONE: [phone]
CHECK BOX IF ORC HAS CHANGED
X l� 6
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE,
DENR FORM NOAR-2(5/2003)
SITE NUMBE Zone 1
SITE NUMBE Zone 2
SITE NUMBE
SITE AREA (sq. ft.):
5,024
SITE AREA (sq. ft.):
5,024
SITE AREA (sq. ft.):
WEATHER CONDTIONS PERMITTED RATE (gpd/sp.
5
PERMITTED RATE (gpd/sp
5
PERMITTED RATE (gpd/sp.ft.):
A
T
E
Weather Temp. Precip Volume Time
Code` Applied Irrigated
(`F)tation
Daily Loading
Volume Time
Applied Irrigated
Daily Loading
Volume Time Daily
Applied Irrigated Loading
low inches gallons minutes
gallons/sq. ft.
gallons minutes
gallons/sq. ft.
gallons minutes gallons/sq. ft.
1
4000
0.796f7=84
000
0.79617834
2
4000
0.79617834
4000
0.79617834
3
5000
0.99522293
5000
0.99522293
4
3500.
0.69665605
3500
0.69665605
5
3000
0.59713376
3000
0.59713376
6
4500
0.89570064
4500
0.89570064
7
4000
0.79617834
4000
0.79617834
8
4000
0.79617834
4000
0.79617834
9
5500
1.09474522
5500
1.09474522
10
4500
0.89570064
4500
0.89570064
11
5000
0.99522293
5000
0.99522293
12
4500
0.89570064
4500
0.89570064
13
6000
1.19426752
6000
1.19426752
14
3500
0.69665605
3500
0.69665605
15
500
0.09952229
500
0.09952229
16
7000
1.3933121
7000
1.3933121
17
4500
0.89570064
4500
0.89570064
18
3000
0.59713376
3000
0.59713376
19
3000
0.59713376
3000
0.59713376
20
4000
0.79617834
4000
0.79617834
21
3000
0.59713376
3000
0.59713376
22
500
0.09952229
500
0.09952229
23
5500
1.09474522
5500
1.09474522
24
4500
0.89570064
4500
0.89570064
25
500
0.09952229
500
0.09952229
26
3000
0.59713376
1 3000
0.59713376
27
4000
0.79617834
4000
0.79617834
28
4500
0.89570064
4500
0.89570064
29
4000
0.79617834
4000
0.79617834
30
3000
0.59713376
3000
0.59713376
31
5500
1.09474522
5500
1.09474522
Loading ga ons sq.
Z4.Ub4J94
24.0643949
FMonthly
ear-To-Date'Loading ga ons sq. .
3 7
Z39.1 7
* Weather Codes: S - sunny, PC - partly cloudy, Cl - cloudy, R - rain, Sn - snow, SI - sleet
OPERATOR IN RESPONSIBLE CHARGE (OF Daniel E. Fortin GRADE: II
ORC Certification Number: 7180
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
PHONE: [phone]
CHECK BOX IF ORC HAS CHANGED
X l� 6
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE,
DENR FORM NOAR-2(5/2003)

NON -DISCHARGE APPLICATION REPORT
HIGH RATE INFILTRATION SITE(S)
FACILITY STATUS:
the following permit requirements:' (Note: If a requirement does not apply to your facility put "Win the compliant
box.
Compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. LTJ
2.. The site was kept free of vegetation and raked at intervals specified
in the permit.
3. The Automatically Activated Standby power -source is on site and
operational.
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 noncompliance 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 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
imprisonmentfor,kno olations."
Daniel E. Fortin
Signature of Permittee * Date (Name of Signing Official -Please print or type)
innnial F Fnrfin Operator Responsible in Charge
Permittee - Please print or type
P.O. Box 4188
Emerald Isle, NC._28594
Permittee Address
(Position or Title)
252-393-8720 02/28/2019
(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).