WQ0008489_Monitoring - 11-2016_20161230

Permit No.: WQ0008489
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Facility Name:
NC Prison Facility at Piney Woods
County:
Hyde
Month: AIDEMBER
Year: 2016
PPI: 002
Flow Measuring Point: [AInnuent ❑EHlmnt ❑rm now generated
Parameter Monitoring Point: ❑Influent
I]Eflu nt ❑Groundwater Loxedng
❑Surface Water
Parameter Code ---►
5000
00310
0 U
31616 06
00625
Gs?�;
00400
j m
i # �c.
a,
d
a Eo
O
u_ E
y
O
24-hr hrs
GFd
mgll
" Y
„tng/,..
#/100 mLGL`
mg/L
m9GL
s
ni"gl4L
.,
4
7
0100
8
9
{W
10
0731DOd
11
-4:),T
13
WON
COM
14
115'
is
Obw
O&M-0
116
#12
INIUN
W=
- -
I
17
MAN
118
19
20
..
21 OfOO
..
' '
MEI
moi
1. %
MOM123
—
—
24
..
�, ....
25
OEM26
s,
27
W—OR—M
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6.8
RFK=
"
311
1
IF
BOOM
Average:
M{gs
Daily Maximum:SOON
Daily Minimum-
Sampling Type'
Grab
Ca
Grab rab
Grab
.. rabM
Grab
Monthly Avg. Limit.
_. _
Dally Limit:
""
R� _
A--, v+4vn,r d7. Nw a ...PP, IwPd3rYV?raWl WPPkIV rsW. Wevear=<°I M='!-bv„al I .�l WpvM?Wsa`il r

FORM: NDMR 03.12
Sampling Person(s)
Name: TOM BEASLEY 606BY FO
Name: To epiit F- SADI.ER
NON -DISCHARGE MONITORING REPORT (NDMR)
Certified Laboratories
Name:
Name: ENUIeotimENT = I NC .
Page I_ of
Does all monitoring data and sampling frequencies meet the requirements In Attachment A of your permit? Oc,Hnpoam O"o*c«^o eM
If the facility is non-compliant, please explain In the space below the reason(s) the facility was not in compliance. Provide In your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets If necessary.
oN NovemPER A.3,616 PRF6:801NZU WAS 1,63 FEET
oN NouEmf3ER f'1, Ullo FAr-E i90P o u) AS jzg.. FEET
op MovervtoM '>,qt xo16 1=RE6 eo►aRD WAS 2.f9 FEE"
5-r-ARTED DECErint3E12 If -2614 WITI+ 7.,12 FEIVi AND 8(;srj .A/3tk ?o rYtRIN'f141!✓ ovl;'& a FEET
So FNR/ PECameCC 210, X016 1Gf2�� 60AP-0 WAS aP,.3' FEET
Operator In Responsible Charge (ORC) Certification
ORC: To56 PN F SADLeR
Certification No.: W W I SSI'1
SZ IS1o5o
Grade: 0— Phone Number. Q -S-2) 9216- 222 N
Signature
By Ws slpndum.I tartly Owl NJ report Is acaarale and complete Wine best of my W.0.dge.
Permittee Certification
Permittee: COUNTY OF "De PINEY W000s W&j TP
Signing Official: TOSEPN F. SADL.ER
Signing Official's Title: AIANA3ER-- ORc
t1 Permit Expiration: O? Is( 19011
Date U Signature Date
I cw*. order penally of law, fhe1 Ws docunenl and all adsdunents were "Wed order my din a W or aupavklon In
W=dmcs we a "am dedgned to a e Nd all quaWled pemor" properly gatherad and evaluated Ihe Womratim
aftWed. Based on my kwitft of the person or persals who rrwrge Ne ryatem, or scse pemona directly MWomi fe for
gatlwrNg the Information, tta Infamallon submitted In, to the bed of my knowledge and belief, Ime, accurate, and complete. I am
swam dad them am aigriWcam perallas for submitdrp false kdonnaticn, k"Kfirg Ne poss6Wy of nes and knphaunenl for
bw ** vidattms.
Mall Original and Two Copies to:
Division of Water Quality
Information' Processing Unit
1617 Mall Service Center

NON DISCHARGE APPLICATION REPORT Page _I of I—
SPRAY IRRIGATION SITE(S)
PERMIT NUMBER: -
TOTAL NUMBER OF FIELDS: � I6
MONTH: allGftEk YEAR: 2D
FACILITY NAME: JVE)� UIonns i ICLASS: S COUNTY:
Formulas
D-HYLoading(incbes) =[Volume Applied (gallons) x 0.1336 (cubic feeNgallon)x12(inches/foaq)I[Am Sprayed (acres) x 43,560 (square feetlacre))
Maximum Rourly loading (Incbes) =Daily Loading (inches) I [lime Irrigated (minutes)/60 (minums/t w)I Monthly Loediog (loehes) = Sum of Daily Loadings (inches)
12 Mooth Fioaung TOmi (laches) =Sum of Na month's Monthly Loading (inches) and previous 11 momh's Monthly Loadings (inches)
Average Weekly Loading (Inches) =(Monthly Leading (inches/month)/Number of days in the month(days)oonth)) x i(days/week)
- Weather Codes: S -sunny, PC -party cloudy, CI -cloudy, R4ain, Sn-snow, SI -sleet
OPERATOR IN RESPONSIBLE CHARGE (ORC) �c-EpN F SADLER GRADE -N- PHONE - Z22-
CHECK BOX IF ORC HAS CHANGED .❑
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT. X_
DEHNR (SI TUR OFOPERATORINRESPONSIBLECHARGE)
P.O. BOX 29535 8 IS SIGNATURE,1 CERTIFY THAT THIS REPORT IS ACCURATE
RALEIGH, NC 27626.535 AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

FACILITY WATUS:
Please indicate (by checking the appropriate box) whether the facility has been compliant or non-compliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.) non-
comRliant compliant
1. 1 he application rate(s) did not exceed the limit(s) specified in the permit.
❑
IN
I 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 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 noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
IFO•. , ► �.e • ► ,. r
W,3
-S-rAg(EA AIDUCMeEQ W rN A 1 os FEET fyNo ENDING W 1 i 9 A,19 FEET
"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 imprisonment for knowing violations."
print or type)
(Sig turA of Permittee); (Date)
(Permittee Address) (Phone Number) (Permit p. Date)
•
it signed by other than the pemdttee, delegation of signatory authority must be on rile with the state per 15A NCAC 2B.0506 (b) (2) (D).

NON DISCHARGE APPLICATION REPORT Page °l —
SPRAY IRRIGATION SITE(S)
PERMIT NUMBER: k—O& QQQ2Z%S 9 TOTAL NUMBER OF FIELDS: �: MONTH:.AJOUL nA YEAR: 3olb
FACILITY NAME: _f?INE�tpS �LQT_____ CLASS: _^�_ COUNTY:
Formulas -
DailyLoadiog(ioches) =(Volume Applied gallons) x03336(cubic reel/gallon) x 12(inohesttool)l/[Arta Sprayed lacteal x 43,560 (square feet/ave)]
Maximum Rourly Loadiog(loches) =Daily Loading (inches)/[Tm- Irrigated (minutes)/60(minuka/houp) Monthly Londing(inche)=Sumo(Daily Loadings(inches)
12 Mouth Floating Total (Iacbes) =sum or this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loadlog(inches) =[Monthly Loading (inches/month)/ Number of days in themondt(dayslmomb)] x 7(daystwed0
Weather Codes: S -sunny, PC -partly cloudy, CFcloudy, R -rain, SSn--s-now, 51 -sleet �y�— �� 2-224
OPERATOR IN RESPONSIBLE CHARGE (ORC) , ICAS 36nLeP, TRADE _JJJ—_ PHONE 1
CHECK BOX IF ORC HAS CHANGED ❑ .
ATTN: COMPLIANCE GROUP
DIY. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29F35
RALEIGH, NC 27626-535
X— ——---------
(SI TURF OPERATOR IN RESPONSIBLE CHARGE]
BY IS SIGNATURE, I CERTIFY THAT IriIS REPORT IS ACCURATE
AND COMPLETE TO DIE BEST OF PAY KNOWLEDGE.

)EA C.11ITY STATUS:
Please indicate (by checking the appropriate box) whether the facility has been co li or non-compliant
:r,iih the following permit requirements: (Note: /fa requirement does liotapply to ynurfacility put (NA) in the
Compliant box.) non-
compliant compliant
I. The application rate(s) did not exceed the limit(s) specified in the permit. ❑
z. Adequate measures were taken to prevent wastewater runoff from the site(s). ® ❑
I 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 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
pernut. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
:additional sheets if necessary.
_=V&S oatt oa3 ARE OV E9 THt 12-
7
2 pbZ IS /5 856 IIUeKES
71�NG 003 15 /(0 OW IIt/C,EG
"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 imprisonment for knowing violations."
COUAM E)F 1+yhE
(Permittee- Please print or type)
(SlOturl of Permittee)' (nate)
PC)dpX JoL SWAN QUAeFER N,C• 8216-f4196IYOUbO17
(Ptrinittee Address) (Iloite Number) (Permit Exp. Date)
It signed by other than the permIltee, delegation of signatory authority must be on the with the state per 15A NCAC 2B.0506 (b) (2) (D),

NON DISCHARGE APPLICATION REPORT Page of in
SPRAY IRRIGATION SITE(S)
PERMIT NUMBER: 11) Q C)CD'&49q TOTAL NUMBER OF FIELDS: 12 MONTH: IVDAC IAM YEAR: R016
FACILITY NAME: _PJM_LW[012S__U)_WTP CLASS: ' COUNTY: J4 i D45 -
Formulas
Daily Loading (iuches) = [Volume Applied (gallons) x 0.1336 (cubic feeUgallon) x 12 (k¢tlWfooq) / (Area Sprayed (acres) x 43,560 (square feelfarse))
Maximum Hourly Loading(laclaw) =Daily Loading(inches)/[Tune Irrigated (minutes)/ 60(minurea/hougl Monthly Loadmg(locbes) = Sum of Daily Loadings (inches)
12 Month Floating Towi (Inebes) =Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (inches) = [Moodily Loading (inches/mmnth) / Number of days in the month (days/month)) x 7 (days/week)
• Weather Codes: S -sunny, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, 51 -sleet
OPERATOR IN RESPONSIBLE CHARGE (ORC) neEaN E SR DL-Eg
CHECK BOX IF ORC HAS CHANGED ❑
M
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
GRADE J1 - PHONE %�6 -.q
(S ATU E OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
FIELD NUMBER: 00S
FIELD NUMBER:
AREA SPRAYED aces: c)
AREA SPRAYED aces: O
COVER CROP:
COVER CROP:
Permitted HOURLY Rae (inches): Q,
Permitted HOURLY Rate (inches):
'
D
A
T
E
WEATHER CONDITIONS
Storage
Lagoon
Freeboard
Permitted WEEKLY Rate inches : Q
Permitted WEEKLY Rate inches : in. 2.
Weather
Code •
Temp.
al Precipi.
a lication talion
Maximum
Volume Tune Hourly
Apviicd Im ated Loading
Daily
Loadina
Maximum
Volume Time Hourly
Applied Irrigated Loading
Daily
Loading
CF) a[ACi
fCCI
r1Y1G, -Ms
inch"
ay..w ill nes
nch"
y�ann..g
2
3
4
7
1.'71
(�!
Q:3�
II Jl/
i9
_
b
B
S
544
I. J
000 1—
0,_37jf2_.
SE.��.,^.'...
10
12
13
15
16
10E
T44-
q—q
15
21
M
01
227�
�5
O
�D
2 O. 7
2
23
2'
75w
26
2
--
��
AR
2 NZ
29
a,, �-1
1 qL Q (441
O, Mst
30
31
Monthly Loading (inches)
12 Month Floating Total (inches)
Average Weekly Loading (inches)
�
(3.593-
10,5'1
• Weather Codes: S -sunny, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, 51 -sleet
OPERATOR IN RESPONSIBLE CHARGE (ORC) neEaN E SR DL-Eg
CHECK BOX IF ORC HAS CHANGED ❑
M
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
GRADE J1 - PHONE %�6 -.q
(S ATU E OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

FACILITY STATUS:
Please indicate (by checking the appropriate box) whether the facility has been compliant or non-compliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.)
non-
compliant complian
1. The application rate(s) did not exceed the limit(s) specified in the permit.
❑
119
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.
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 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 imprisonment for knowing violations."
print or type)
of Permittee)* (Date)
r--(z5;;a�QiJb
(Phone Number) (Permit Exp. Date)
" If signed by other than the permittee, delegation orsignatory authority must be on rile with the state per 15A NCAC 2B.0506 (b) (2) (D).

PION DISCHARGE APPLICATION REPORT Page —q— of
SPRAY IRRIGATION SITE(S)
PERMIT NUMBER: l.l�Q 00f�,�T�_ TOTAL NUMBER OF FIELDS: ��� MONTH: AlOVEM86e YEAR: _w!•6
FACILITY NAME: UJ OOD-S��(J WT CLASS: �_ COUNTY: I�LJOE
Formulas
DaUy Loadbeg(Inches) =(Volume Applied (gallons) x 0.1336 (cubic feeugallon)x12(inches/foot))/[Area sprayed (acres) x 43560(squac feet/ace))
Maximum Hourly Lead(ug (inches) =Daily Loading (inches) / [Time Irrigated (minutes)160 (minutaYhour)) hlooddy Loading (Inches) = Sumer Daily Loadings (inches)
12 Month Floating Total (inches) =Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inebu)
Average Weekly Loading (Inches) =[Monthly fading (inches/monds) I Number of days in the month (days)montb)) x 7 (dayslweek)
Weather Codes: S -sunny, PC -partly cloudy, CI -cloudy. R-rain,Sn-ssnow,SSl-steel
OPERATOR IN RESPONSIBLE CHARGE (ORC) MSEed F SS6L) 3—�' GRADE PHONE Q26-22Z'F
CHECK BOX IF ORC HAS CHANGED ❑
ATTN: COMPLIANCE GROUP
DIV, OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
X-��----------
(SI ATUR OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
FIELDNUMBER: C)LO-7 FIELD NUMBER:
AREA SPRAYED aures): 1 C-� • . AREA SPRAYED (acres): O
COVERCROP: FINE COVER CROP:
Permitted HOURLY Rate (inches):Permitted HOURLY Rale (inobes):
WEATHER CONDITIONS
Permitted WEEKLY Raze inches: 0.•2 Permitted WEEKLY Rate inches: 0.
Maximu m
0storage
A
Temp.
T
Lagoon
Weather a Necipi- Lagoon
Volslme
Time Howly Daily Volume Time Hourly Daily
Healy
E
Code* a lieation talion Freeboard
A lied
Irti aced Loading Loading Applied Irrigated Loading Loading
('F) Inchrs feel
allons
mimes inches inches gall.. mi nines inch. inch.
-1
7I o
000 L -q a1z0,37-1
3
c I O
g8000=
56 0. 4 0.3�_
6
B
S %
�a_
i
�Si2--Man
�.,y:..
.':': =u �a i;- y ;3 •.,.j ;p a? T:°`i
10
17
�'<�:+"r:
12-7K
13
zs
f3
16'$°
n:9it
.i•< ..':"��.
20
o
V20! A-11414. x'2.Wn.-1111,"- �;r�' .^
22
24
:25ME
27W
WE
28
7A
mums
30
z,
WWI M5
�ut .a.• f.,v.»
. 3 1 a
Monthly Loading (inches)
12 Month Floating Total (inches)`
Average Weekly Loading (inches)
Weather Codes: S -sunny, PC -partly cloudy, CI -cloudy. R-rain,Sn-ssnow,SSl-steel
OPERATOR IN RESPONSIBLE CHARGE (ORC) MSEed F SS6L) 3—�' GRADE PHONE Q26-22Z'F
CHECK BOX IF ORC HAS CHANGED ❑
ATTN: COMPLIANCE GROUP
DIV, OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
X-��----------
(SI ATUR OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

FACILITY STATUS:
Please indicate (by checking the appropriate box) whether the facility has been c m Tian or non-compliant
with the following permit requirements: (Note: If a requirement does not apply to your facilityput (NA) in the
compliant box.)
non-
compliant compliant
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 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 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 Irnowledge 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 ]mowing violations."
Please Drint or
(Sioturlof Permittee)" '(Datb)
tswmN pTee, 1U. AlW,(),Qgzl�- W11 -
(Permittee Address) (Phone Number) (Permit Exp. Date)
. If signed by other than the permittee, delegation of signatory authority must be on rile with the state per 15A NCAC 2B.0506 (b) (2) (D).

NON DISCHARGE APPLICATION REPORT Page of
SPRAY IRRIGATION SITE(S)
PERMIT NUMBER:�v00O3TOTAL NUMBER OF FIELDS: 12 MONTH: 41006^36*- YEAR: ZtOlb
_IA
FACILITY NAME: LY _ 1 t.l)iA.�%P CLASS: T COUNTY: liyb�
Formulas
Daily Loadiog (inches) = [Volume Applied (gallons) x 0.1336 (cubic feeVgallon) x 12 (inches/foot)] / [Area Sprayed (ayes) x 43,560 (square feeVacre)]
Max(anam Hourly Luading(luelm)=DaOyloading(inches)/LTuneirigaw(mint)/60(min.,sn.ur)] MonLMILoading((oches) = Sum of Daily Loadings (inches)
12 Mouth FIm1i.g TotsI (loches) =Sum of this month's Monody Loading (inches) and previous 11 montes Monthly Loadings (inches)
Average Weekly Loading (Inches) = (Monthly loading (inches/monlh) / Number of days in the month (dayshnmth)] x 7 (days/week)
Weather Codes: S -sunny, PC -partly cloudy, C -cloudy, R -rain, Sn-snow, Sksleet
OPERATOR IN RESPONSIBLE CHARGE (ORC) TOSC F F SADL,e GRADE _QF, PHONE .2
CHECK BOX IF ORC HAS CHANGED ❑
Mal ORIGINAL and TWO COPIES
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
(S TU E OF O BATOR IN RESPONSIBLE CHAAGE)
B IS SIGNATURE,1 CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

,ti
Please indicate (by checking the appropriate box) whether the facility has been complian or non-compliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.) non-
compliant
on-
com Ip iant compliant
1. The application rate(s) did not exceed the limits) 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 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 noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
• . , ♦ •ITEMATNim
_r -
• ' r� li • ' ACT
- ten. • 1 t u .
" 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 imprisonment for knowing violations."
jig nOp42 SWAN P�[1 t N,C. 2y88� CaS2i q2_6- glgL
0261 1�017
(Permittee Address) (Phone Number) (Per it E p. Date)
" if signed by other than the permittee, delegation of signatory authority must be on rile with the state per 15A NCAC 211.0506 W (2) M.

NON DISCHARGE APPLICATION REPORT PageAa—
of
SPRAY IRRIGATION SITE(S)
PERMIT NUMBER: TOTAL NUUM-BER OF FIELDS: 11 MONTH: e&96—A&9-YEAR. Aab
1
FACILITY NAME: avo U � (�f� P CLASS: Z COUNTY: �YD�
Formulas
DaOy Loadiag (hnches) = [Volume Applied (gallons) x 0.1336 (cubic feedgallon) x 12 (inches/foot)) f [Area Sprayed (acres) a 43.560 (squaw feetlacre)]
Maximum Hourly Loading (inches) =Daily Loading(inches)![Timelrrigated(minutes)/60(minus/hour)) Monthly Loading(inches) =Sum of Daily Loadings (inches)
12 Month Floating Total (inches) =Sum of this month's Monthly Loading (inches) and previous I I month's Monthly Loadings (inches)
Average Weekly Loading(inches) =[Monthly Loading(inches/month)/Number of days in the month(daysfmonth)) a I(daysl ek)
Weather Codes S -sandy, PC-Parltytloudy, Ckhrudy, R -rain, Sn-snow, SI -sleet
916-227
OPERATOR IN RESPONSIBLE CHARGE (ORC) '�Se f44 F Sl�� GRADE -tC PHONE
CHECK BOX IF ORC HAS CHANGED ❑
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
P.O. BOX 29535
RALEIGH, NC 27626.535
(SIG TURECFOPEAATORINRESPONSIBLECHAAGE)
BY IS SIGNATURE,1 CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

FACILITY STATUS:
Please indicate (by checking the appropriate box) whether the facility has been compliant or non-compliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box-) non-
compliant compliant
1. The application rate(s) did not exceed the limit(s) specified in the permit. ❑ 50
d. 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 m ❑
the permit
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 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 imprisonment for knowing violations."
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(Sibialude of Permittee)" (Date)
PD BOX Me SWAN OWAOU-� AIC. 77985' A2) j26- 4186 12 _
(Permittee Address) (Phone Number) (Per it kfxp. Date)
z if signed by other than the permittee, delegation of signatory authority must be on rde with the state per 15A NCAC 211.0506 (b) (2) (D).