WQ0034386_Monitoring - 12-2016_20170123

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0034386
MONTH: December YEAR: 2016
FACILITY NAME: Town of LaGrange WWTP COUNTY: Lenoir
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/fool)] I [Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Monthly Hourly Loading (inches) = maximum inches applied over a one hour period for that day
Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
..._ _,.,.. , r:___. _ rn e_-., . __I;_ I,....h....I..,.._, I ni„­he...r .tom in tho m fh /rl­c/m nthll v 7 (rlavc/w k)
Did Irrigation Occur At This Facility:
Yes: No: X
Did Irrigation Occur On This Field:
Yes: No:
Did Irrigation Occur On This Field:
Yes: No:
FIELD NUMBER:
AREA SPRAYED (acres):
COVER CROP:
PERMITTED HOURLY RATE (inches):
FIELD NUMBER:
AREA SPRAYED (acres):
COVER CROP:
PERMITTED HOURLY RATE (inches):
WEATHER CONDITIONS
PERMITTED YEARLY RATE (inches):
PERMITTED YEARLY RATE (inches):
D
TWeather
E
Temper-ature Precipita• Lagoon Storage
Code' at application tion Free -board
Maximum
Volume Time Daily Hourly
Applied Irrigated Loading Loading
Volume Time Daily
Applied Irrigated Loading
Maximum
Hourly
Loading
inches feet
9a I I ons minu es inches inches'
gallons minutes inches
Inc es
1
2
3
4
5
6
7
10
c
1112
A'P i �rui'd3 yd :13;1
13
141
1
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Tota[ Gallons/Monthly Loading (inches)
0 0.00
0 0.00 1_
12 Month Floating Tota[ (inches)
Average Weekly Loading (inches)
0
0
Weather Codes: G -clear, FL; -partly ciouay, la-cioucy, K -ram, on -snow, JI -sleet
Spray Irrigation Operator in Responsible Charge (ORC)
James W Sutton Phone: [phone]
ORC Certification Number: 25209 Check Box if ORC Has Changed:

Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit (SIGNAfURV6F OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SI TURF, I CERTIFY THAT THIS REPORT IS ACCURATE AND
RALEIGH, NC 27699-1617 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 (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. 0
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.
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.
"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. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
// 8 /7
(Sign re of Permittee)* Date
Town of LaGrange
(Permittee -Please print or type)
PO Box 368
John P. Craft
(Name of Signing Official -Please print or type)
Town Manager
(Position or Title)
December 31, 2015
(Phone Number) (Permit Exp. Date)
LaGrange, NC 28551
' (Permittee Address)
* If ped by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 26.0506 (b)(2)(D).