WQ0019665_Monitoring - 11-2016_20161228

Page 3 of 8
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00019665 MONTH: November YEAR: 2016
FACILITY NAME: Swan Quarter Sanitary District COUNTY: Hyde
Formulas:
Daily Loading (Inches) = [Vol- AWW (gaYrms) x 0.1336 (cubic teetrgaaon) x 12 {unc1KW oo1111(Am Sprayed (acres) x 43.560 (square reetlaae)] OR
= Volume Applied (gales) I [Area Sprayed (acres) x 27.152 Wdionslace4nc h)]
Maximum Hourly Loading (inches) = Daily Loading (inches) I [Tim krigeted (minutes) 160 (rninu r)) Monthly Loading (inches) = Sum or Daly Loadings (inches)
12 Month Floating Total (inches) =Sum of this month's MonNNy Loading (inches) and previous 11 ffwWs MoMhy Loadings Ondres)
n..�..m w�4i,, i „fl.tr.�., n��ti�1 = ruh,..�e,h„ n ,.x rr�hm r wrcnhwr iA d� h� ulwa m�mh raaem:7 rdayshweekl
Did Irrigation Occur At This Facilh
Yes: No: X
Did Irrigation Occur On This Field:
Yes: No:
X
Did Irrigation Occur On This Field:
Yes: No:
X
FIELD NUMBER: 1
AREA SPRAYED (acres): 2.98
COVER CROP:
PERMITTED HOURLY RATE (inches): 0.25
FIELD NUMBER: 2
AREA SPRAYED acres : 3.28
COVER CROP:
PERMITTED HOURLY RATE (Inches): 0.25
D
A
Trly
E
WEATHER CON MONS
Temper-
weathor atureat applicaft �
cow n tion Free boaN
PERMITTED YEARLY RATE (inches):
Volume Daily
led Time Irrigated Loading
32.5
Maximum
Hourly
Loading
PERMITTED YEARLY RATE (inches):
me Daily
Volume kan
Applied Irrigated Loading
32.5
Maximum
� I
dl ng
CF)
inches feet
gallons
minutes
Inches
Inchesga
ons
utes
Inches
nches
1
0
68
0 4.5
0
0
0.00
#DIV/O!
0
0-00
#DIV/0!
2-.
'PC
74
0
0
0
0.00
#DTV/0!
0
0:00
#DW/O!
3
C
80
0
OV
0
0.00
#DIV11
0
0
0.00
#DN/01
4
PC
67
0.21
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
6
C
65
0
0
0
0.00
#DIV/01
0
0
0.00
#W/O!
6
R
70
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
7
C
60
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/Ol
8
C
64
0 4.5
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/Ol
9
R
62
0.14
0
0
0.00
#DIV/0!
0
0
0.00
#DN/O!
10
C
58
0
0
0
0.00
#DIV/0!
0
0
0.00
#DiV/O!
11
C
67
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
12
C
56
0
0
0
0.00
#DN/0!
0
0
0.00
#DIV/O!
13
C
63
0
0
0
0.00
#DIV/O!
0
0
0.00
#DN/O!
14
R
68
0.79
0
0
0.00
#DIV/OI
0
0
0.00
#DIV/O!
i5
CL
63
0 4.4
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/O!
16.
C
65
0
0
0
.0.00
#DIV/0!
0
0
.0.00
#DN/0!
17
C
64
.0
.0
0
0.00
#DIV/0!
0
0
0.00
#DN/O!
18
C
69
0
0
0
0.00
#DIV/0!
0
0
0.00
#DN/0!
19
C
71
0 1
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0I
20
C
50
0
0
0.
0.00
#DN/0!
0
.0
0.00
#DIV/01
21
C
53
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/OI
22
C
54
0 4.3
0
0
0.00
#DN/01
0
0
0.00
#DIV/01
23
C
58
0
00
0.00
#DIV/0I
0
0
0.00
#DIV/0!
24
R
62
0.08.
0
0
0.00
#DIV/0!
0
0
0.00
#DN/0!
25
CL
70
0
0
0
0:00
#DIV/O!
0
0
0:00
#DiV/01
26
R
60
0.05
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
27
C
53
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/DI
26
PC
56
0
0
0
0.00
#DIV/Oi
0
0
0.00
#DiVrot
29
PC
70
0 4.3
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
30
PC
70
0.13
0
0
0.00 1
#DIV/0!
0
0
0.00
#DIV/0!
31
0
0
0
0
0.00
#DIV/0!
Total GagonsiMoathiy Loading (irtcir�)
.0.
0
0.00
12 Month Floating Tota[ (Inches)
-:
!0.00A#DN/0!
_.
0.00
Average Weekly Loading (inches)
.
0
- weather t:oass: c-ciear, m -parry cloudy, ct-ciouay, Kram, sn-snow, w-sieet
Spray Irrigation Operator in Responsible Charge (ORC): Allen Bliven Phone: [phone]
ORC Certification Number. 996725 Check Box if ORC Has Changed:
Mall ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
RALEIGH, NC 27699 4617 COMPLETE TO THE BEST -OF MY KNOWLEDGE.
NON -DISCHARGE APPLICATION REPORT DENR FORM NDAR-1 (11/2005)

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. iia taquirement does not apply to yourfacility put (NA) in the
compliant box. )
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 s(be(s).
3. A suitable vegetative cover was maintained on the sile(s) in accordance with the permit.
4. All buffer zones as specified in the permit were maintained during each application.
Page 3 of,6
Compliant N)
Y
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limits)
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 neoessary.
"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
forgathering the information, the informationsubmitted is, to.the best of my knowiedge.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."
by 9-yc
(signamw of Pefirifter Data
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
William G. Freed
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252-191-5277 9/30/2006
(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 26.0506 (b)(2)lD).
DENR FORM NDAR-1 (11/2005)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WON19665 MONTH: November
FACILITY NAME: Swan Quarter Sanitary District COUNTY:
Formulas:
Dally Load[ng (inches) = IVaume AWMd.(gaEons) x 0.1336 (ct9ge feettallon) x 12 f 0o9] r IArea Sprayed (acres) x 49.560 (square reat/acre)l OR
= Votuma Applied (gaW-) f [A -a s�(aero) x 27.152 (gaw+nch)1
Page 4 of 8
YEAR: 2016
Hyde
Maximum Hourly Loading (Inches) = Daly Loading (inches) I (Torre Irrigated (minutes) /60 (minutesftu*1 dy Loading (Inches) = sum of Davy Loadngs (nares)
12 Month Floating Total (Inches) = Surn of this morffs Momtdy Loafing (irrctres) end previous 11 ff=Ws Mm" Loadings Crrxfies)
Average Weakly Loading(Inches = Loading Cuxah
AenofM) I Number of days in fha rtwnth (deysiknorrm)1 x 7 (daysn eerq
a " a;1
Did Irrigation Occur At Th t
Yes: No: X
Did tfrigatlon Occur On This Field:
Yea: No:
X
Did Irrigation Occur On This Field:
Yes: No: X
FIELD NUMBER: 1 3
AREA SPRAYED cres : 3.43
COVER CROP:
PERMITTED HOURLY RATE (inches): 0.25
FIELD NUMBER: 4
SPRAYED acres : 3.73
COVER -CROP:
MITTED HOURLY RATE (inches): I0.25
D
Tmper
E
WEATHER CONDITIONS
Weather Te- Storage
code, ebaeat Precipaa- Lagoon
jappileatlon tion Free -board
PERMITTED YEARLY RATE (inches): 32.5
Maximum
Volume Daily Hourly
Applied Time 1 Wiwi Loading Loadin
WITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated Loadt
1 32.5
Maximum
Hourly
Loading
('F)
Inches feet
gallons
minutes
Inches
inches
gallons
minutes
Inches
Inches
1
aC
68
0 4.5
0
0
0.00
#D^J/0! .
0
0
0.00
#DIV/01
2'
PC
74
0
0
0
0.00
#DIVIO! 1
0
0
0.00
#DIV/01
3
C
80
0
0
0
0.00
#DIVIOI
0
0
0.00
#DIV/01
4
PC
67
0.21
0
0
0.00
#DIV/01
0
0
0.00
#DIVIO1
5
C
65
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
6
R
70
0
0
0
0.00
#DIVIO!
0
0
0.00
#DIV/Ol
7
C
60
0 1
0
0
0.00
#DIVIO!
0
0
0.00
#DIV/0!
s
C
64
0 4.5
0
0
0.00
#DIVIO!
0
0
0.00
#DIVIO!
9 "
R
62
0A4
0
0
0.00
#DIV/01
:0
0
-0:00
4DIVI01
10
C
58
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
11
C
67
0
0
0
0.00
#DIV/01
0
0
0.00
#DIVIO!
12
C
56
0 1
0
0
0.00
#DIVIO!
0
0
0.00
#DIV/Ol
13
C
63
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
14
R
68
0.79
0
0
0.00
#DIVIO!
0
0
0.00
#DIVIO!
15
CL
63
0 4.4
0
0
0.00
#DN/01
0
0
0.00
#DIV/01
16
C
65
0
0
0
0.00
#DIVIO!
0
0
0.00
#D!V/01
17
C
64
0
0
0
0.00
#DIV/OI
0
0
0.00
#DIV/O!
1s
C
69
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
19
C
71
0
0
0
0.00
#DIV/0I
0
0
0.00
#DIV/01
20
C
50
0
0
0
0.04
#DIV/01
0
0
0.00
#DIVIO!
21
C
53
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
22
C
54
0 4.3
0
0
0.00
#DIVIO!
0
0
0.00
#DIV/01
23:
C
58
0
0
0
0.00
#DIVIO!
0
0
0:00
#DIVl01
24
R
62
0.08
0
0
0.00
#DIV/01
0
0
0.00
#DIV/Ol
25
CL
70
0
0
0
0.00
#DIVIO!
0
0
0.00
#DIV/0!
26
R
60
0.05
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
27
C
53
0
U
0
0-00
#DIVIO!
0
0
0.00
#DIVIO!
28
PC
58
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIVIO!
29
PC
70
0 4.3
0
0
0.00
#DIVIO!
0
0
0.00
#DIV/01
30
PC
70
0.13
0
0
0.00
#DIVIO!
0
0
0.00
#DIV/01
31.
0
0
O:oo
#DIV/O!
0
0
0.00
-#DIVIO!
Total Gallons/Monthly Loading (inches)
00.00
0
0.00
12 Month Floating Total (inches)
;
0.00
0.00
Average Weekly Loading (inches) �,'-
�_ -
0
;"�.
0
* Weather Codes: C -clear, PC -partly cloudy, Cl -cloudy, R -rain, Sn-enowr, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Allen Bliven Phone:
ORC Certification Number: 996725 Check Box if ORC :Has Changed:
Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Service Center
RALEIGH, NC 276994617
491-5277
(SIGNATURE OF OPERATOR N RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE 8EST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (1112005)

Page 4 of 8
NON-DISCHARGE.APPUCATION REPORT
SPRAY IRRIGATION SITES)
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 your facility put (NA) in the
compliant box )
'Y 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
z - 2- /c
(SIgnat6Ve of ermittee)* Date
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
Wiliam G. Freed
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252-491-5277 9/30/2006
(Phone Number) (Permit Exp. Date)
* H signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 26.0506 (b)(2)(D).
DENR FORM NDAR-1 (1112005)
Com liant N)
1. The application rate(s) did not exceed the limits) specified in the permit
ly
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
0
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.
0
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.
'Y 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
z - 2- /c
(SIgnat6Ve of ermittee)* Date
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
Wiliam G. Freed
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252-491-5277 9/30/2006
(Phone Number) (Permit Exp. Date)
* H signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 26.0506 (b)(2)(D).
DENR FORM NDAR-1 (1112005)

Page 5 of 8
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WOOO19665 MONTH: November YEAR: 2016
FACILITY NAME: Swan Quarter Sanitary District COUNTY: Hyde
Formulas:
Delhi loading ((lichee)=[Vohntre APPW (gallons) x 0-1336 (chic eevgaton) x 12 Csnrsses)faogl l [A- SPWM (-) x -03,560 [square 1eeVaae)I OR
= Volume Applied (gdilons) / [Area Sprayed (ewes) x 27,152 (gaftWam4nch)I
Maximum Hourly Loading (inches) = Dms7y Loaamg Cmdres) / Creme Irrigated (minutes) / 66 (minutesmwrr)I sty Loading (Inches) = Sum a D3q Loadvsgs Whes)
12 Month Floating Total (inches) =Sum of this months Monthy Loading (inches) and previous 11 month's Monthly Loadings Cmdses)
Average Weekly Loading (inches) = pAonthy Loading Com) / Number of days in the month (dayshnoith)l x 7 (daysM eek)
Did Irrigation
Yes:
OccurAt
11118 Facilit; Did irrigation Occur On This Field:
No: X Yes: No:
X
Did Irrigation Occur On This Field:
Yes: No: x
FIELD NUMBER: 5
AREA SPRAYED (acres): 4.03
COVER CROP:
PERMITTED HOURLY RATE (inches): 0.25
FIELD NUMBER: 6
SPRAYED acres : 4.18
COVER CROP:
D HOURLY RATE (inches): 025
D
ATemper-
T
E
WEATHER CONDITIONS
Storage
�+ft' awm at jPrecipits.Lagoon
Cody application tion Fre"aard
P) Inchee tett
PERMITTED YEARLY RATE (inches):
Volume Dal
Daily
lied Time Irrigated! Loading
gatkxw mir%umsInch"
32.5
Maximum
Hourly
Loading
hrhars
WITTED YEARLY RATE (inches):
Volume Time Daily
A lied Irrigated Loading
gallons minutes Inalses
32.5
Maximum
HOU rly
Loading
Inc has
1
C
68
0 4.5
.0
0
0.00
#D)V/0!
0
0
0.00
#DIV/01
2
PC
74
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/Ol
3
C
80
0 1
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
4
PC
67
0.21
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
s
C
65
1 0
0
0
0.00 .
#DIV/O!
0
0
0.00
#DIV/01
6
R
70
0
0
0
0.00
#DIV/01
0
0
0.00
#DIWO!
7
C
60
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
s
C
64
0 4.5
0
0
0.00
#D)V/O!
0
0
0.00
#DIV/0!
9
' A
62
0.14 :
0
0
0.00
#DIV/0! .
0
0
0.00
#DIV/0!
10
C
58
0
0
0
0.00
#DN/01
0
0
0.00
#DIV/01
11
C
67
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/Ol
12
C
56
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
13
C
63
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
14
R
68
0.79
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
15
CL
63
0 4.4
0
0
0,00
#DIV/0!
0
0
0.00 1
#DIV/01
16
C
65
0
0
0
0.00
#DIV/01
0
0
0:00
#DN/01
17
C
64
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/O!
is
C
69
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
19
C
71,
0
0
0.
0.00
#DIV/01
0
.0 ..
0.00
#DIT//O!
20
C
50
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
21
C
53
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
22
C
54
0 4.3
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
23.
C
68
0
0
0
.0.00
#DIV/O!
0
0
0.00
#DIV/01
24
R
'62
0:08
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
2s
CL
70
0
0
0
0.00
#DIV/01
0
0
0.00
V/0!
26
R
60
0.05
0
0
0.00
#DIV/01
0
0
0.00
#DIWO!
27
C
53
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
28
PC
58
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
29
PC
70
0 4.3
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
30
PC
70
0.13.
0
0
0.00
#DIV/01
40
0
0.00
#DIV/0!
311
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
Total Gallons/Monthly Loading (Inchas)l
0
0.00
0.
0.00
,
12 Month Floating Total (inches) `
,
1
0.00
; :.
0.00
Average Weel y Loading (Inches)j-, ;
0
Q
Weather Codes: C -clear, PC -partly cloudy, Ci -cloudy, R -rain, Sn-snow, Sl -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Allen Bliven Phone: [phone]
ORC Certification Number 996725 Check Box if ORC Has Changed:
Mail ORIGINAL and TWO COPIES to.
DENR
Division of Water Qualify _
ATTN: Information Processing Unit (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
RALEIGH, NC 27699-1617 COMPLETE TO THE BEST OF PAY KNOWLEDGE.
DENR FORM NDAR-1 (11/2005)

Page 5 of 8
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 your facility put (NA) in the
compliant box. )
Com !'rant ,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit Y
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. 0
5. The freeboard In the treatment and/or storage lagoon(s) was not less than the limit(s) Y�]
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 property 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."
/ 2 -22-
(Signature of Obrmitteer Data
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
William G. Freed
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252-491-5277 9/30/2006
(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 26.0506 (b)(2)(D).
DENR FORM NDAR-1 (11/2005)

Page 6 of 8
NON -DISCHARGE APPUCATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WOOO19665 MONTH: November YEAR: 2016
FACILITY NAME: Swan Quarter Sanitary District COUNTY: Hyde
Formulas:
Daffy Loading ((ndus) =.lVok me APWIed tga9ons) xo.133s (aibic:iea(9auon)x 72,Cutches►ood)1(4Ar&a Splayed (acres) x 4s.SW (square teetl=e)I OR
= Volunm AppM (gallons) /[Area Sprayed (saes) x 27.152 (gar-sraae4Kh)I
Maximum Hourly Loading (Inches) = Daly Loading (lis) / ire Irrigated (minutes) 16D (minutes(tmurp dy Loading (inches) = Shun of Daay Loadvhgs (mches)
12 Month Floating Total (Inches) = Sum of Otic month's Montdy LoacrM (Inches) and previous 11 month's MorMy loadings Cmdtes)
Avaraao Weekiv Loadina lincheal = rMorhtthhr Losdma (trxhesfmonlh) / Number of days in the month (dars/mordh)1 x 7 (daysNreeld
Did Qallon
Yes:
=r AtTh edi$
No: X
Did Irrigation Occur On This Field:
Yes: No:
x
Did Irrigation Occur On This Field:
Yes: No: x
r _
FIELD NUMBER: 7
AREA SPRAYED (acres): 4.48
COVER CROP:
PERMITTED HOURLY RATE (inches): 0.25
FIELD NUMBER: 8
SPRAYS acres): 4.18
COVER CROP:
MITTED HOURLY RATE (inches): 0.25
D
A
E
WEATHER NDITIONS
weather Tat meat Predpita Lagoon
Cod®� applkxtlor► tion Froe�board
PERMITTED YEARLY RATE (inches): 32.5
Maximum
Volume Dally Hourly
Applied Time Irrigated LoadingLoadingtied
TTED YEARLY RATE finches):
Volume Time Daily
Irrigated LoadingLoadin
32.5
Maximum
LoadinHourly
9
g
IT)
Inches feet
gallons
minutes
inches
inches
gallons
minutes
Inches
Inches
1
C
as
o 4.5
0
0
0.00
#DIV/O!
0
0
0.00
#DIVroI
a
PC
74
0
0
0
0:00
#DIV/01
0
0
0.00
#DIV/01
3
C
80
0
0
0
0.00
#DIV/01
0
0
0.00 1
#DIV/O!
4
PC
67
0.21
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
5
C
65
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
6
R
70
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
7
C
60
0
0
0
0.00
#DIV/O!
1 0
0
0.00
#DIV/O!
8
C
64
0 4.5
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
9
R
62
0.14
0
0
0.00
#DIV/01
0
0
0.00
4DIV/01
10
C
58
0
0
0
0.00
#DIV/Ol
0
0
0.00
#DIV/Ol
11
C
67
0
0
0
0.00
#DIV/Ol
0
0
0.00
#DIV/01
12
C
56
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
13
C
63
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
14
R
68
0.79
0
0
0.00
#DIV/Ol
0
0
0.00
#DIV/O!
15
CL
63
0 4.4
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
16 :
C
65
0
0
0
0:00
#DIVI01
0
0
0.00
#DIV/O!
17
C
64
0
0
0
0.00
#DIV/Ol
0
0
0.00
#DN/Ol
18
C
69
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
19
C
71
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
20
C
5o
0 1
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
21
c 1
53
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
22
C
54
0 4.3
0
0
0.00
#DIV/Ol
0
0
0.00
#DIV/01
:23
c
58
0
0
0
.0.00
MV/01
0
0
.0.00
#DIV/01
24
R
62
0.08
0
0
'0.00
#DIV/O!
0
0
0.00
#DIV/0
25
Ci_
70
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/O!
26
R
6o
0.05
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
27
C.
53
0
0
0
0.00
#DN/0!
0
0
0.00
#DIV/01
28
PC
58
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
29
PC
70
0 4.3
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
30
PC
70
0.13
0
0
0.00
#DIVI01
0
0
0.00
#DIV/O!
31
0
0
OZO
#D1V/01
0
0
0.00
#DIV/01
Total GallonslMonthly Loading (inches)
p
- -:<;
0.00
" :'
0
_
0.00
= "
12 Month Floating Total (inches)
-
0.00
=
0.00
Average Weekly Loading.(inches)
-
0
0
-
' Weather Codes: Clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow; Sl -sleet
Spray Irrigation Operator In Responsible Charge (ORC): Allen Bliven Phone:
ORC Certification Number: 996725 Check Box V ORC Has:Changed:
Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: information Processing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1617
491-5277
GNATURE OF OPERATO N RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST Of MY KNOWLEDGE.
DENR FORM NDAR-1 (11/2005)

Page 6 of 8
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 comoliant
with the following permit requirements: (Note. if a requirement does not apply to your facility put (NA) in the
compliant box. )
1. The application rate(s) did not exceed the limit(s) specified in the permit.
Com iant N)
Y
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
0
3. A suitable vegetative cover was maintained on the site(s) In accordance with the permit.
u
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.
"1 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. l am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
�Z 12- -,z2 - C�
ignature oPrermitteer Date
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
William G. Fred
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252-491-5277 9/30/2006
(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 2B.0506 (b)(2)(1)).
DENR FORM NDAR-1 (11/2005)

Page 7 of 8
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0019665 MONTH: November YEAR: 2016
FACILITY NAME:. Swan Quarter Sanitary District COUNTY: Hyde
Formulas:
Dally LAading (Inches) a [VOWMe Applied (gaQons) x 0.1338 (aubic feeHg®Bor) x 12 (tnchesifoot)1( [Area Sprayed (acres) x 43,580 (square f-vacre)] OR
= Volume Applied (gallons)! [Area Sprayed (acres) x 27.152 (gallons/acre4nch)]
Maximum Hourly Loading (inches) = OwV Loading (suehes) / [rum Imgamd (minutes) / a0 (n*wwsfiour)1 hly Loading (inches) = Sum of Daily Loadinp (ouches)
12 Month Floating Total flitches) =sum of this mows Mnnedy Loadmg (mcim) and previous 11 morws Mone* Loadings Oxhes)
Average Weekly Loading (inches) = !Monthly Loading (inchesJmordh) /!dumber of days in the mordh (days/mo NI x 7 (daysAveek)
Did Irrigation occur At This Ficilifty
Yes: No: X
Did Irrigation Occur On This Field:
Yes: No:
X
Did Irrigation Occur On This Field:
Yes: No: X
re
FIELD NUMBER. 9
AREA SPRAYED acres . 4.93
COVER CROP:
PERMITTED HOURLY RATE (inches): 0.25
FIELD NUMBER. 10
tEA SPRAYED acres : 5.08
COVER CROP:
MITTED HOURLY RATE (inches): 025
D
A
T
E
WEATHER CONDITIONS
Temper. sWrege
wwuw atneeat F%rc gm. L g=
Corw application can FMO -boort!
CFF) Inches rest
PERMITTED. YEARLY RATE (inches): 32.5
Maximum
Volume Osily Hourly
A Iad Thi -a Itelgated Loading Loading
gaff -43 minutes ht :Les Inches
IMITTED YEARLY RATE (Inches),
Vo:umo mine Daily
[ed Irrigated Loading
•.gallons minutes Inches
32.5
Maximum
Hourly
Los2leg
inches
1
C
68
0 4.5 1
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
2
PC
74
0 1
0
0
0.00
#DIV/0!
0
0 1
0.00
#DIV/01
3
C
80
0 1
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
4
PC .
67
0.21 1
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
5
C
65
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
6
R
70
0
0
0
0.00
#DIV/0!
.0
0
0.00
#DIV/0!
7
C
60
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
8
C
64
0 4.5
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
9
R
62 ,
0.14
0
0
0.00
#DIV/01
0''
0
.0.00
#DIV/01
10
C
58
0
0
0
0.00
#DIV/0!
0
0
0.00 1
#DIV/0!
11
C
67
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
12
C
56
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
13
C
63
0
O
0
0.00
#DIV/O!
0
0
0:00
#DIV/01
14
R
68
6.79
0
0
0.00
#DN/0!
0
0
0.00
#DIV/0!
15
CL
63
0 4.4
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
16
C .
65.,
0
0
0
0.00
#DIV/01
0
0
0.00 .
#DIV/0!
17
C
64
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
18
C
69
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
19
C
71
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
20
C
,so
0
0
0
.00
#D)V/0!
0
0
0.00
#DIV/0!
21
C
53
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
22
C
54
0 4.3
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
23
C
58
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
24
R
62
0.08
0
0
0.00
#DIV/0!
0
0
0.00
#DIV101
25
CL
70
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
.26
R
60
0.05
0
0
0.00
#DIV/0!
0
0
0.00
#.DIV/0!
27
C
53
6
:0
0
.0.00
#DiV/O!
0
0
0.00
#DIV/0!
28
PC
58
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
29
PC
70
0 4.3
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
30
1 PC
70 1
0.13
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
31
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
Total Gallons/Monthly Loading (inches)
0
0.00
0
0.00
12 Month Floating Total (inches) `,._
,_
0.00
-,
0.00
Aveirage Weekly Loading (inches) ,._
0
.,;..
0
Weather codes: C -clear, PC -partly cloudy, CI -cloudy, R-raln, Sn-snow, SI -sheet
Spray Irrigation Operator in Responsible Charge (ORCY Allen Biiven Phone: [phone]
ORC Certification Number. 996725 Check Elox if ORC Has Changed:
Mail ORIGINAL and TWO COPIES to:
DENR FORM NDAR-1 (11/2005)

DENR
Division of Water Quality
ATTN: Information Processing Unit
117 Mail Service Center
RALEIGH, NC 27699-1617
Page 7 of 8
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
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 your facility put (NA) in the
compliant box. )
Compliant ,N)
Y
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.
4. All buffer zones as specified in the permit were maintained during each application.
5. The freehoard'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.
1 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."
=::Z 7 �Z r z '-'2.2— /c
(Sig tuan(Sig re Permittee)* Data
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
William G. Freed
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252-491-5277 9/30/2006
(Phone Number) (Permit Exp. Date)
* If signed by otherthan tlhe permitte% delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).
DENR FORM NDAR-1 (1112005)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00019665 MONTH: November
FACILITY NAME: Swan Quarter Sanitary District COUNTY:
Formulas:
Daily Loading (Inch-) = N Applied (gaooas) x 0.133& (a+tiic faevgalion) x 12 0r4heSfi0Ml / (Nee Sprayed (aces) x 43.5 (squans feWeare)) OR
= Vokir- Applied (gd-s) / (Nee Sprayed (aces) x 27152 (gWWWam*ich)1
Page 8 of 8
YEAR: 2016
Hyde
Maximum Hourly Loading (inches) = Dally Loading (f hes) / Ulme irrigated (mirxrtea) / 60 (mini esMour)) dy Loading (inches) =Sun of Dally Loadings (mares)
12 Month Floating Total pnches) =Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (flares)
Average Weeldy Loading (Inches) = wznMy Loading rMaresfmonth) / NWrber of days in the month (days/morth)I x 7 (dayshveelr)
Did iMgation OW" At This Facey:
Yes: No: X
Did Irrigation Occur On This Field:
Yea: No:
X
Did Irrigation Occur On This Field:.
Yes: No: X
-
FIELD NUMBER: 11
AREA SPRAYED (acres): 1 4.78
COVERCROP.1
PERMITTED HOURLY RATE (inches): 025
FIELD NUMBER: 12
tEA SPRAYED (acres): 3.43
COVER CROP:
MITTED HOURLY RATE (inches): 0.25
D
AStorage
T
E
WEATHER CONDITIONS
weather T�mperp,vgpila
�8 application tion Freeboard
('F) Inches fe®t
PERMITTED YEARLY RATE (inches): 32.5
Maximum
Volume Daily Hourly
ted Time Irri ated Loadin Hourly
gallons minutes inches Inches
WITTED YEARLY RATE (inches):
Volume Time Daily
lied Irri ated Loadin
gallons minutes Inches
32.5
Maximum
Hourly
Loading
Inches
I
C
68
0 •x..5
.0
O
'0.00
#€SIV/O!
0
0
0:00
#D,'V/O!
2
PC
74
0
0
0
'0.00
#DIV/Ol
0
0
0:00
#DIV/0!
3
C
80
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
4
PC
67
0.21
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/01
s
C
65
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
6
R
70
0
0
0
0.00
#DIV/Ol
1 0
0
0.00
#DIV/01
7
C
60
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/O!
8
C
64
0 4.5
0
0
0.00
#DIV/O!
0
0
0:00
#DIV/0!
9
R
62
0.14
0
0
0.00
#DIV/01
0
0
0:00
#DN/O!
10
C
56
0
0
0
0.00
#DIV/Ol
0
0
0.00
#DIV/O!
11
C
67
0
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/O!
12
C
56
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
13
C
63
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
14
R
68
0.79
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/O!
15
CL
63
0 4.4
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/O!
16
C
65.
0
0
0
0:00
#DMO!
0
.0
.0.00
#DIV/O!
17
C
64
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
18
C
69
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
19
C
71
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/Ol
20
C
so
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
21
C
53
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/O!
22
C
54
0 4.3
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
23
C
56
0
0
0
0.00
#DIV/Ol
0
0
0.00
#DIV/O!
24
R
62
0:011
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
25
CL
70
0
0
0
0.00
#DIV/01
0
0
0.00
#DIV/O!
26
R
60
0.05
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/O!
27
C
53
0
0
0
0.00
#DIV/O!
0
0
0.00
#DIV/O!
za
PC
58
0
0
0 "
0.00
#DIV/01
0
0
0.00
#DIV/0!
29
PC
70
0 4.3
0
0
0.00
#DIV/01
0
0
0.00
#DIV/01
30
PC
70
0.13
0
0
0:00
#DIV/0!
0
0
0.00
#DIV/0!
31
0
:0
0.00
#DIV/0!
0
0.00
#DIV/01
Total Gallons Monthly Loading (inches)
0
0.00
0
:': `
0.00
12 Month Floating Total (inches)
0.00
0.00
Average Weekly Loading (inches)
;.:. ,. ,:. _-
0
0
weather codes: C -clear, PC -partly cloudy, c14cloudy, R -fain, Sn-snow, Sl -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Allen Bliven Phone:
ORC.Certification Number: 996725 Check Box 9ORC Has;Changed:
Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Service Center
RALEIGH, NC 276994617
491-5277
r
( IGNATURE 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 NDAR-1 (11/2005)

Page 8 of 8 , .. .
e 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 your facility put (NA) in the
compliant box. )
1. The application rate(s) did not exceed the limits) specified in the permit.
'Com iartt N)
ly
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
L�
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.
S. 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
-7� :;Z= 12- 122 - A=
(Signatufs of Peoffitteer Date
Wayne Hodges, Chairman
(Permittee -Please print or type)
PO Box 21, Swan Quarter, NC 27885
(Permittee Address)
William G. Freed
(Name of Signing Official -Please print or type)
By Authority, President Enviro-Tech
(Position or Title)
252491-5277 9/30/2005
(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 28.0506 (b)(2)(D).
DENR FORM NDAR-1 (11/2005)