WQ0036327_Monitoring - 09-2016_20161219

FORM: NDAR-208-11 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Pape 1 of?
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Facility Name: Mystic Meadows WVVTF
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11
FORM: NOAR-208-11
NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Did the application rates exceed the limits in Attachment B of your permit?
If not a basin, were the altos kept free of vegetation and raked?
If not a basin, were there any Instances of effluent ponding in or runoff from the sites?
If a basin, were there any Instances of breakout from the berms?
Was the onsite automatically activated standby power source tested and operational?
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If the facility Is non-oanplient, please explain In the apace below the reason(s) the fdAry was not In compliance. Provide In your explanation 8v date(s) of the nawornp8vla and describe the coneaM
action(s) taken. Attach addabnal sheau If necessary.
Operator In Responsible Chu" (ORC) Certification
PemdWe Certification
ORC: Michael Bolt
Pwmitfw: Meadow Partners
Cerdficatton No.: 22966
Signing Ofiblel: Hugh Shannon
Grade: N Phone Number: 828.421.7229
Signing Ofiiclars Title: Manager
Has the ORC changed since the previous NDAR-27 ❑yr m No
Phone Number: (828) 42/1-31`49 Pamir Pte.: 0 513112 01 8
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10/1/16
Signature Dale
Signawre Date
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Mall Original and Two Copies to:
Division of Water CuaWy
Information Proca aing unit
1817 Mall Service Center
Raleigh, North Carolina 27699.1017