WQ0023693_Monitoring - 09-2016_20170103

FORNI: NDAR-1 OS-11 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page 1 of 1
Arwe�-�dzd �Z I�(1(o

FOR(VI: NDAR-1 08-11 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page 1 of 1
Permit No.: WQ0023693 Facility Name: WBR Members Club at St. James Plantation County: Brunswick Month: September Year: 2016
DICI IYI"Iga�1011 OCCUI' a� °Field Name: FNPL (PGM,4} , Field Name: FNPH (PGM 16) Field Name: , FNGL {PGM 17) Field Name: FNGH (PGM 7)
this facility? Area (acresj: " 4,552 '�• Area (acres): 2•85 Area (acres): � �•741 Area (acres): 0.325
Cover Crop: � Cover Crop: � Cover Crop: � Cover Crop: 0
� ves ❑ No � Houri Rafe in): _. �•Z �,_ ' Hourl Rate (in): 0�3 Hourly Rate (in :_ 0•2�' `,"� Hourly Rate (in): 0.3
A�nual Rate (in): 36.4 Annual Rate (in): � 56 Annual Rate (in): 36:4 � Annual Rate (in): 156
Weather Freeboard Field Irrigated? ,❑� ves ❑�No Field Irrigated? ❑� ves ❑ No Field lrrigated? � ves ❑ No Field Irrigated? ❑� ves ❑ rvo
^ � , � � � ,a L' . � v
d °.' � � °' ?' � m �; • :; • P;
O = O � ' Q A C � C 7�T � C � C 7>` � Q � � >>+ ,� Q OI T C � T 67
�a c� � :9 � � c� Q rn >. � � _ � Q rn a, � � = a Q rn >, 'v E � , =c a i - a E 3 'v
� Q 'n >, a m � "° � • o, m a� - '° � 'X o io a� _ aa �y • o m a� _ � �a •X o <a
� � ` y � A �� � � �.,J � = J � � � J � = J � � � J...�..�, � = J � � � J � = J
� F � � v � �~ � ~ � ~ � ~
°F in ft ft al min � in in al min in in ai min in in al min in in
1 CL 73 0 3 0 0 � 0,00 0 0.00 � 0'. 0:00 ' 0 0.00
2 R 72 2.94 3 0 0 0.00 0 0.00 � 0 0.00 0 0.00
3 R 67 0.05 3 0 0' �� 0:00 • 0 0.00 0 0.00 0 0.00
4 C 65 0 3 0 0. 0;00 • 0 0.00 Q O.QO 0 0.00
5 C 62 0 3 0 0 0.00 0 0.00 0 - 0.00" 0 0.00
6 C 72 0 3 0 0 0.00 0 0.00 0 0.00 ' 0 0.00
7 C 72 0 3 0 8;333 83':33 0.07 0.05 2,711 30.12 0.02 0.02 , 22,28g . 234.62 0.18' -0:05 10,241 120.48 0.08 0.04
8 C 77 0 3 0 8,333 83.33 0.07 0:05` 2,711 30.12 0.02 0.02 22,289 234.62 0.18 0.05 10,241 120.48 0.08 0.04
9 CL 77 0 3 0 8,333 83.33 0.07 0.05 2,711 30.12 0.02 0.02 22,289 234.62 0.18 0.05 . 10,241 120.48 0.08 0.04
10 C 77 0 3 0 11,546 115.46 ' 0,09 0,05 3,765 41.83 0.03 0.03 18,574 195.52 0.1,5 0.05 8,534 100.40 0.07 0.04
11 C 79 0 3 0 T1,546 115.46 0:09 ' 0.05 3,765 41.83 0.03 0.03 18,574. 195.52 0.15 0.05. 8,534 100.40 0.07 0.04
12 CL 76 0 3 0 11,546 115.46 0.09 0;05 3,765 41.83 0.03 0.03 18;574 195.52 0.15 0.05 8,534 100.40 0.07 0.04
13 CL 74 0 3 0 11;546 115;46 0:09 0.05 3,765 41.83 0.03 0.03 18,574 195.52 0.15 0:05 8,534 100.40 0.07 0.04
14 CL 73 0.43 3 0 .0 0:00 . 0 0.00 0 0.00` ' '" 0 0.00
15 R 72 0.15 3 0 0 0.00 0 0.00 0 ' 0.00 . 0 0.00
16 CL 71 0 3 0 -0 0:00 0 0.00 0 � 0.00 ,� 0 0.00
17 CL 72 0 3 0 � 0 •` 0:00 0 0.00 18',574 . 195:52 ' 0.15,° -0�05' ' 8,534 100.40 0.07 0.04
18 R 74 0.93 3 0 0 0:00 0 0.00 18,574 195;52 0.15 0.05 8,534 100.40 OA7 0.04
19 R 71 0.19 3 0 0 `0.00 0 0.00 0", . 0.00 0 0.00
20 CL 71 0 3 0 0 '.'. ' 0.00�� ° 0 0.00 . 0 �' 0.00 �;. 0 0.00
21 CL 71 0 3 0 0 0.00 , 0 0.00 0` 0.00 0 0.00
22 R 71 0.49 3 0 0 0:00 0 0.00 0 � 0.00 0 0.00
23 R 72 0.23 3 0 0' 0.00 0 0.00 0 • 0.00:, 0 0.00
24 C 70 0 3 0 0 0.00 0 0.00 0 0.00'' ` 0 0.00
25 CL 69 0 3 0 0 0.00 0 0.00 0. 0.00 0 0.00
26 CL 67 0 3 0 . 0 0.00 0 0.00 18,574- 195.52 ' 0.15 ' 0.05, 8,534 100.40 0.07 0.04
27 CL 71 0 3 0 0 0.00 0 0.00 18,574' 195.52 0.15` "� 0.05 8,534 100.40 0.07 0.04
28 C 68 0 3 0 0 0.00 0 0.00 18,574 195.52 0.15 QA5 8,534 100.40 0.07 0.04
29 C 73 0 3 0 � 0 0.00 0 0.00 0 0.00 0 0.00
30 R 72 0.55 3 0 0 ,"' � 0.00 0 0.00 0` ' `� 0.00 - 0 0.00
31 C 0 0 0 0 0 � 0:00 0 0.00 0 Q.00 0 0.00
Monthl Loading: 71,184 0.58 23,192 0.19 234;032 1.89 107,528 0:87
12 month Floating Total (In): 17.16 ° 7.50` ` 35.35" 17.48_

FORM: NDAR-108-11 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page 1 of 1
Permit No.: WQ0023693 Facility Name: WBR Members Club at St. James Plantation County: Brunswick Month: September Year: 2016
�IC� IP'P'Igat1011 OCCUC at " Field Namei BNTL (PGM 1,3). Field Name: BNTH (PGM 12) , field Name: BNFL {PGM 1) �_ Field Name: BNFH (PGM 10)
? Area acres : 5.2�3 Area acres : �•�2 Area acres : 14;348� �` Area acres : 12.237
this facility . ( ) ( ) ( ( 1
-.
Cover Crop: .' � . Cover Crop: � Cover Crop: >� Cover Crop: �
❑� ves ❑ No Hourly Rate' in): .' x� �•Z� '�,`. ' Hourly Rate (in): ��3 klourly Rate (in); ���2 �'� : Hourly Rate (in): 0.3
Annual Rate (in): 36.4' ' Annual Rate (in): 9$•$ Annual Rate (in): 36.4 _ Annual Rate (in): 156
Weather Freeboard F'ieldlrrigated? � ves ❑ rvo Field Irrigated? ❑� Yes ❑ No Field Irrigated? � ves ❑ No Field Irrigated? 0 ves ❑ rvo
, . .
d � _ ;, °7 °' d d � °' � � �
� c. � a� E rn a. ,o rn E rn c ,o rn E rn �- m rn E rn
>. O iv iV � Q. U a. � T C 7 �" C O. OI T� � �' C Q- . � >. C � �' C Q- � T C � �' C
io U y -' � � •- �C � -� v E � v a � •� °a E � 'v a � �R � E �''v ' a � •� � E � v
� a`� n .c�i o � a . �" � - � p ��� . R 2. o E a� o o � = o E • � � . =0� o .' � '�� S. �+o � E y � o � = o
� � � � o � . . � �, -� ` � -� � £ � � ,� � � J � � 7 � � � .�
� F- a "' =- � i= j i= j i= , j i=
°F in ft ft gal min in � in gal min in in al min in •- in gal min in in
1 C 73 0 3 0 ` 0• . - 0.00 - �- 0 0.00 0'° 0.00 �� 0 0.00
2 R 72 2.94 3 0 0 0.00 0 0.00 •. 0 ° 0.00 0 0.00
3 R 67 0.05 3 0 0 0.00 0 0.00 0 0.00 0 0.00
4 C 65 0 3 0 =0. 0:00 0 0.00 0 0.00 0 0.00
� __ .
5 C 62 0 3 0 0 '0:00 0 0.00 0 � 0.00 ' 0 0.00
6 C 72 0 3 0 0 � 0,00 0 0.00 0 0.00 0 0.00
7 C 72 0 3 0 24,498 244.98 0:1.7 0_04 7,932 83.49 0.06 0.04 � 35;893 358.93 0.25 0:04 25,502 255.02 0.18 - 0.04
8 C 77 0 3 0 ' 24,498 244.98 0.17 0.04 7,932 83.49 0.06 0.04 35,893 358.93 ' 0.25 0.04 25,502 255A2 0.18 0.04
9 CL 77 0 3 0 24,498 244.98 0.97 0;04 7,932 83.49 0.06 0.04 35,893 358.93 0.25 0.04 25,502 255.02 0.18 0.04
10 C 77 0 3 0 28;112 281:12 0.20 0.04 • 9,036 95.12 0.06 0.04 ,70,481 704.81 - 0.49• 0.04 49,598 495.98 0.35 0.04
11 C 79 0 3 0 28,1'12 281.12 0.20 �0.04' 9,036 95.12 0.06 0.04 70,481 704.81� , 0.49 = 0.04- ' 49,598 495.98 0.35 0.04
12 CL 76 0 3 0 28;112 281.12 0.20 0.04 9,036 95.12 0.06 0.04 70,481 704.81 0.49 0.04 49,598 495.98 0.35 0.04
13 CL 74 0 3 0 28,112 281,12 0.20 0.04 9,036 95.12 0.06 0.04 70,481 704.81 0.49 0.04 49,598 495.98 0.35 0.04
14 R 73 0.43 3 0 •. 0 0.00 0 0.00 - 0 ' 0.00 " • 0 0.00
15 R 72 0.15 3 0 0 0.00 0 0.00 0 0.00 0 0.00
16 CL 71 0 3 0 A 0.00 0 0.00 0 0.00 0 0.00
17 CL 72 0 3 0 �. 0 0.00 � 0 0.00 . 0 0.00 � 0 0.00
18 R 74 0.93 3 0 0 0.00 0 0.00 0 0.00 ' 0 0.00
19 R 71 0.19 3 0 D 0:00 ' � 0 0.00 0 0:00 0 0.00
20 CL 71 0 3 0 0' , 0,00 - 0 0.00 0� OAO 0 0.00
21 CL 71 0 3 0 0 0.00 0 0.00 0 ` 0.00 �° 0 0.00
22 R 71 0.49 3 0 0 0.00 0 0.00 0 0.00 0 0.00
23 R 72 0.23 3 0 •� 0. 0.00 0 0.00 ° 0.. `' 0:00 -'. •- 0 0:00
24 C 70 0 3 0 ° 0 0.00 `. 0 0.00 0°; . 0:00 '� 0 0.00
25 CL 69 0 3 0 0 0.00' 0 0.00 0 0.00 0 0.00
26 CL 67 0 3 0 0 0:00, 0 0.00 0 _ 0.00 : 0 0.00
27 CL 71 0 3 0 0'` � 0.00 ' R 0 0.00 0 0.00 ,` ° `'� 0 0.00
28 C 68 0 3 0 20;883 208.83 0.15 Q:04 6,727 70.81 0.05 0.04 35,893 358.93 0.25 0.04 25,502 255.02 0.18 0.04
29 C 73 0 3 0 0 0.00 0 0.00 0,- O.OQ 0 0.00
30 R 72 0.55 3 0 0 - 0:00 ` 0 0.00 0 ' 0:00 :: `.. 0 0.00
31 C 0 0 0 0 0 0.00 0 0.00 0 0.00 "° � 0 0.00
Monthly Loading: 206,824 1.44 66;666 0.47 425,495 � 2.97 . 300,397 2.10
12 month Floating Total (In): 32.89 ' :14.94 , 66.60 .. . 47.13.

FORM: NDAR-1 08-11 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page 1 of 1
Permit No.: WQ0023693 Facility Name: WBR Members Club at St. James Plantation County: Brunswick Month: September Year: 2016
DIC� ICClgatl011 OCCUt' �t Field Name: BNPL (PGM,6) Field Name: BNPH (PGM 5) Field Name¢ � BNGL{PGM 3) , Field Name: BNGH (PGM 8)
tIIIS faClllt)/? Area (acres): 3•952 ' y Area (acres): 0.486 Area (acres): 1':637 ` Area (acres): 0.204
Cover Cro : � Cover Crop: � Cover Crop: 0 Cover Crop: �
_. . _,
� ves ❑ rvo Hourl Rate in): 0•2 '. ' Hourl Rate (in): 0•3 Hourly Rate (in :- `' ��`2 Hourl Rate (in): 0.3
Annual Rate (in): 36.4 Annual Rate (in): 156 AnnuaP Rate (in): �, 36.4 - Annual Rate (in): 156
Weather Freeboard Field�lrrigated? � Y?s ❑�No Field Irrigated? �❑ Yes ❑ rvo Field Irrigated? � ves, ❑ No Field Irrigated? ❑� Yes ❑ rvo
d �' o �, °' ��°-' m ° d ��°-' � ° d
7. � ia ia � Q. V C. � 7+ c 7?�- � Q p) >, c � �^ C n �p) " � C 7 �' = Q � >. � j T�
m t� � .. � � ._ Q � r� 'v E 3, 'v a ; •� -o E � 'v Q ` •� 'a E � 'v a � •�-y v E � 'v
T O_ � d � 10 ' N C7 = N ' f0 Of , � R� • �6 N - � ' N
� L � •� o ia n. 8 .m ' � � � = o E a� � � � x� � E . a� o o � � = o � d o o � = o
� � y p m � � � � � � E � � J � E J': � J � � � � .�
� � a � � > F. - � F. � i=, j F
°F in ft ft ai min in in al min in in al � min in . in al min in in
1 C 73 0 3 0 - 0' 0;00 0 0.00 0 0.00 0 0.00
2 R 72 2.94 3 0 0 O:OD 0 0.00 0 0.00 0 0.00
3 R 67 0.05 3 0 .0 0,00 0 0.00 0 0.00 0 0.00
4 C 65 0 3 0 :- 0. Q:00 0 0.00 0. -0:00 ' 0 0.00
5 C 62 0 3 0 0 0.00 0 0.00 � 0- 0.00 0 0.00
6 C 72 0 3 0 0 0.00 0 0.00 0 0.00 � 0 0.00
7 C 72 0 3 0 7,831 85.'12 0.07 . 0.05 2,359 25.65 0.02 0.02 17,269 172.69 . 0,16 ." . 0.06 6,024 60.24 0.06 0.06
8 C 77 0 3 0 7,831 85.12 Q'.07 0.05 2,359 25.65 0.02 0.02 17,269`' 172.69` 0.16 0:06� 6,024 60.24 0.06 0.06
9 CL 77 0 3 0 7,831 85.12 0:07 ' 0.05 2,359 25.65 0.02 0.02 17,269 172.69 0.16 0.06 6,024 60.24 0.06 0.06
10 C 77 0 3 0 10,793 117.32 0;10 0.05 3,263 35.47 0.03 0.03 13,353 133.53 -0.12 0.06 1,506 15.06 0.01 0.01
11 C 79 0 3 0 10,793 117.32 0.10 0.05 3,263 35.47 0.03 0.03 14,357 143.57 0:13 0.06 - 5,020 50.20 0.05 0.05
12 CL 76 0 3 0 10,793 117:32 0.10 OA5 3,263 35.47 0.03 0.03 14,357' 143:57 0.13 � 0.06 5,020 50.20 0.05 0.05
13 CL 74 0 3 0 � 10,793 117:32 0,10 0.05 3,263 35.47 0.03 0.03 14,357 ' 143.57 0.13 0.06 5,020 50.20 0.05 0.05
14 R 73 0.43 3 0 0 0.00 ` 0 0.00 1,004; 16.04' 0:01 0.01 ' 3,514 35.14 0.03 0.03
15 R 72 0.15 3 0 0 0.00 0 0.00 0 0.00 0 0.00
16 CL 71 0 3 0 , 0 0.00. 0 0.00 0 � 0.00 � 0 0.00
17 CL ' 72 0 3 0 � 0 0.00 " 0 0.00 1,4,357 ' 143;57 ' 0.13 ` 0.06: , 5,020 50.20 0.05 0.05
18 R 74 0.93 3 0 0 0.00 0 0.00 14,357 143.57 ; -0.13 0.06 5,020 50.20 0.05 0.05
19 R 71 0.19 3 0 0- 0:00. 0 0.00 D 0.00 0 0.00
20 CL 71 0 3 0 ` 0' '` '0:00 0 0.00 - 0, < 0.00�' •�` 0 0.00
21 CL 71 0 3 0 0 0.00 0 0.00 0� ' 0.00 • 0 0.00
22 R 71 0.49 3 0 D 0.00 0 0.00 0 0.00 0 0.00
23 R 72 0.23 3 0 0 0.00 . 0 0.00 0° ` 0.00, . 0 0.00
24 C 70 0 3 0 0 0.00 0 0.00 0 0.00 0 0.00
25 CL 69 0 3 0 0 O:DO = 0 0.00 0 0.00.., 0 0.00
26 CL 67 0 3 0 = D 0.00 0 0.00 14,3.57 143:57 : 0.13.a , 0,06 5,020 50.20 0.05 0.05
27 CL 71 0 3 0 . 0 0.00 0 0.00 14,357 143:57 0.13 ' 0.06 5,020 50.20 0.05 0.05
28 C 68 0 3 0 0 0.00 0 0.00 14,357 143.57 0.13 -0(06 5,020 50.20 0.05 0.05
29 C 73 0 3 0 0 Q�00 0 0.00 0�, 0:00 ,. �- 0 0.00
30 R 72 0.55 3 0 0 0.00 ' p 0.00 0' � 0:00 - 0 0.00
31 C 0 0 0 0 0 0.00 0 0.00 0 0.00 0 0.00
Monthl Loadin : 66;666 0:62 20,130 0.19 181,021 1'.69 '63,252 0:59 �
12 month Floating Total (In): 20:98 � 7.96 - 29.03" 19,64

FORM: NDAR-108-11 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page 1 of 1
Permit No.: WQ0023693 Facility Name: WBR Members Club at St. James Plantation County: Brunswick Month: September Year: 2016
DICI II'ClgatlOfl OCCUP at '- field Name: RH (PGM,15) Field Name: BL (PGM 18) Field Name: � ��: . `="= Field Name: �
this facility? Area acres): 6�69� Area acres): 10.564 Area(acres): • � Area(acres): �
Cover Crog: • ` �. Cover Crop: � Cover Crop: -_ _, ^�` .• :: Cover Crop: �
❑✓ Yes ❑ No Hourl Rate (in ;'. � �'•2 Hourl Rate (in : 0•3 Hourl Rate (in �- �_: Hourly Rate (in): �
Annual Rate (in): 36.4 Annual Rate (in): 156 Annual Rate (in): .= 0, � Annual Rate (in): �
Weather Freeboard ' Field Irrigated? �fi ves ❑ No Field Irrigated? ❑ Yes � No Field Irrigated? '❑ ver. � No . Field Irrigated? ❑� Yes � rvo
u, �' o ;, °' ° d �°�-' � �°�-' v ` ° �
O � � O_ R � Ll � C 7 �` � O- N C = T fA Q. 10 C. � T� Q t0 � � T 61
T i` � �C C7 �� T.� C O7 T._ �, � � T G 01 T._ C
0 � Q �Q- O �, o. a� � 'p�...0� De ' o� m a� = O o x � m a! ' � o� x p. tc� a� _ � o x p�v
L N ` � p � � ` : � � J � � _ ��J 7 � J � = J 7� � . � . .. �. . J ... �. i ��. � � -� � = J
N F- a 'n ��`-„� ?�. F j F ? F � 1--.
�
°F in ft ft al min in . in al min in in al min in in al min in in
1 C 73 0 3 0 � 0 ` 0:00' 0 0.00 ` 0 ' - 0.00 ;` 0 0.00
2 R 72 2.94 3 0 0 0.00 0 0.00 0 0.00 ` 0 0.00
3 R 67 0.05 3 0 .0 0.00 , 0 0.00 0 0.00 0 0.00
4 C 65 0 3 0 u� 0�� 0`.00 �� 0 0.00 0� -' � r 0.00 -�, �� �� 0 0.00
5 C 62 0 3 0 � 0 0.00 0 0.00 0 0.00 0 0.00
6 C 72 0 3 0 0 0.00 0 0.00 0 0.00 , 0 0.00
7 C 72 0 3 0 32,128 324:53 0,98 0:03 0 0.00 D ° 0.00, , 0 0.00
8 C 77 0 3 0 32,128 324.53 ' 0;18 0.03 0 0.00 0 0.00 ' ' 0 0.00
9 CL 77 0 3 0 32,128 324:53 Q.18 0.03 0 0.00 0. 0.00 • 0 0.00
10 C 77 0 3 0 32,128 324.53 0:18 0;03 0 0.00 0",_ -. • 0.00 , ., 0 0.00
11 C 79 0 3 0 32,128 324.53 0:18 0.03 0 0.00 0 0.00' • 0 0.00
12 CL 76 0 3 0 32,128 324.53 0.18 0.03 0 0.00 0 0.00 0 0.00
13 CL 74 0 3 0 32,128. 324.53 0.18 0:03 0 0.00 0. 0.00 0 0.00
14 R 73 0.43 3 0 `_. 0 ' 0.'00 ` 0 0.00 0' � •= 0:00 =` 0 0.00
15 R 72 0.15 3 0 0 0.00 � 0 0.00 0 0.00 .,- 0 0.00
16 CL 71 0 3 0 0 0:00 - 0 0.00 � 0 0:00 0 0.00
17 CL 72 0 3 0 0 0,00 ., 0 0.00 0„`: � 0.00 .`- ,. 0 0.00
18 R 74 0.93 3 0 0 0.00 0 0.00 0 . 0.00; , 0 0.00
19 R 71 0.19 3 0 0 - 0.00 � 0 0.00 0 0.00 :' 0 0.00
20 CL 71 0- 3 0 0� 0.00 '.• ; 0 0.00 0� .° � 0:00 ,' .. :.' ': 0 0.00
21 CL 71 0 3 0 0 0.00 0 0.00 0 � 0.00' 0 0.00
22 R 71 0.49 3 0 -0. 0:00 0 0.00 0� 0.00 0 0.00
23 R 72 0.23 3 0 0 O;OQ ; 0 0.00 0 ,.`. 0.00� .' ` 0 0,00
24 C 70 0 3 0 0 0;00 0 0.00 0 '�' 0.00 • 0 0.00
25 CL 69 0 3 0 0 0.00 0 0.00 0 0.00:. 0 0.00
26 CL 67 0 3 0 . 0 0.00. 0 0.00 � 0• 0.00;. 0 0.00
,. . . , _.-
27 CL 71 0 3 0 0 ` . 0:00 ` 0 0.00 0 � 0.00 `.' : 0 0.00
28 C 68 0 3 0 24,196 244.41 0.13 0.03 0 0.00 0 0.00 ' 0 0.00
29 C 73 0 3 0 0 � 0:00 0 0.00 0 .. 0.00 , 0 0.00
30 R 72 0.55 3 0 0 0.00 0 0.00 ° 0 0.00 0 0.00
31 C 0 0 0 0 0 0.00 0 0.00 . 0 - 0.00 :- 0 0.00
Monthl Loading: 249;092 1:37 0 0,00 0, 0:00 � �'0 0:00, .
12 month Floating Total (In): 28.56 0.00 ° 0.00 . � 0.00 ..•

�FOara: NDAR-1 os-11 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page _of
Did the application rates exceed the Iimits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks Iisted in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
❑� CvnDllaM ❑ Non{anpllaM
QQ CanpllaiK ❑ NomCanpllaM
Q CCmpIWM ❑ Nm{dnpllaM
❑� CanpllaM ❑ Nm{anpllaM
❑� CanPIlarR ❑ Nm-CompllaM
If the facility is noncompliant, please explain in the space below the reason(s) the fadlity was not In compliance. Provide in your e�lanatlon Me date(s) of Me non-compliance and descnbe the correcUve action(s)
. . ... . . .... . . . ..
name
Operetor In Raspansible Charge (ORC) CeAMcatlon Permfltee Certlflqtlon
ortc: Grayson B. Grainger Pam+iaea:
Brunswick County
Certlficatlon No.: 993152 Slgning OiflGal: Jerry W. Pierce
G�ade: SI vhone Number: [phone] Signinp OmGai�s ntle: Public Utilities Director
Has tM ORC ehanped slnce !he preNous NDAR•1? � ves ❑� No Phone Numbar: [phone] PermM Exp.: 9/30/17
" i / � Z-Z�-'�
Signature Dete i ature Date
8y t�is signeNre, I ceNfy ihet �hia report is eccunate anE comple0e ro Me bent c( my knowleABe. I certNy, urMer penelly of lew, Mat Nb tlocumerrt entl ell attechments were Oropeietl unCer my tlirection or supervaion in eccordance
wXh e syntem tlesgnetl ro eaeure Me[ all pualMed pereannel property getheretl entl evaluetetl ihe informeGon suEmit[ed. Banetl on my
inquiry c1 [he person ar persons who menepe the eye[em, or those perwns directly re9ponsible for gettiering Ma IMortnalion. the
IMomietion euMnitletl is, to the bert of my knwAetlqe entl bellef, true, eccurete, enC comd�� I am aweie that Mere are elpnlficerrt
penetties for aubmiMng febe in/ormetion, includinp the posaiCiliy oi Bnee end imprisonment (or knowing vbletiona.
Mail Orlginal and Two Coples to:
Dlvision of Water Qualily
infortnatlon Processing Unit
1817 Mall Servlee Center
Ralelgh, NoAh Carolina 27 899-1 8 7 7