WQ0019665_Monitoring - 10-2016_20170206

(Page 1 of 8
NON DISCHARGE WAST EWA rrER MONITORING REPORT
PERINIT NUMBER: WQ0019M MONTH: October YEAR; 2016
FA61UTY NAME:. Swan Duarte Sanatory ®istnid COUNTY: Hyde
Operator In RespM lble Chem (ORC). Allen Bliven Grade: ^ Si. RIone:.481-52" .
Check Box U ORC Hae Changed: ORC Cergf cation Number 906725
cert and l a (1)e Environment .1 (�):
Peoeomap Caftating Ropes: Alien Bllven
Mail ORIGINAL and TWO COPIES to:
DENR (s*N.ATuRE OF OPERATOR IN RESPONSs i CHARGw
Division of Wer Qeautity IN THIS mmATuRE, I CITIFY THAT This R.E�T 15 ACCURATE
ATTN: Irforrnatlon Procefting Unit AND C I. 'PE YO. THE 131EST OF MY KNOWLEDOE.
DENR FORM NDMR4 (11/2 5)
_.
,I
11117, 711111-11�
©oma
-��
.l � 12M In
NOM
[ , f
Operator In RespM lble Chem (ORC). Allen Bliven Grade: ^ Si. RIone:.481-52" .
Check Box U ORC Hae Changed: ORC Cergf cation Number 906725
cert and l a (1)e Environment .1 (�):
Peoeomap Caftating Ropes: Alien Bllven
Mail ORIGINAL and TWO COPIES to:
DENR (s*N.ATuRE OF OPERATOR IN RESPONSs i CHARGw
Division of Wer Qeautity IN THIS mmATuRE, I CITIFY THAT This R.E�T 15 ACCURATE
ATTN: Irforrnatlon Procefting Unit AND C I. 'PE YO. THE 131EST OF MY KNOWLEDOE.
DENR FORM NDMR4 (11/2 5)

Page I of 8'
1617 Mail Service Center
RALEIGH, XC 2760941617
NON DISCHARGE WASTEWATER MONITORING REPORT
Facility Status:
Please answer the following question:
Compliant (Y.N)
1. Does all monitoring data and sampling frequencies meet permit requirements?
If the facility it non-coMplian
.,t p(ease explain in the space below the reasons) the facility Was not in corn Hance
p .
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 documsht.and all atlachm"eftis Were prepared under my direction
supervision In accordance with a system designed to assure that all qual.1116drt thand
peMorinel properly ga.ered - .. .11
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 In.fOrmaition submitted is., to the best of my
knowledge and belief, true, accurate, and complete. I am aware that there are significant gnificant penolties4br submitting
false Information, including the possibility of tries and Imprisonment fbr knowing violations."
(stnatuva or peirnitteer Date
Wayne UMes, Chairman
PO Box 21
Swan Quarter, NC 27886
(Permfte Address)
Moro
Williarn.G. Freed
(Name Of Sig"Ing Ofpdl&pwOdot or type)
Bj Autho& President, E; rwiro-Tech
(Position or TWO)
252491-5271
(Phone Number) (Permit JEW Date)
Parameter code assistance maybe obtained. by catling the Water Quality -Land AWmation Unit at(919) 7156189.
It signed by 906ttli" the 0IMMM.delegatidn 461319fib" authority must be on III@ with the sto p6r15AMCAC28.06N(bX2X0)..
DEW FORM NDMR-1 (I IMM)

Page 2 of a
FACILITY NAME; Swan .Owrter Sanitary, District COUNTY: Hyde
OpMftri.n RaponaMb Ch" (ORq): Allen BlIven -sl Phonw.
raft. 491-5277
Cho@k Box N Oft Him Cho.... ORO cwuksftn umber. 996725
Coed w Labontwift (2):
Psmw(s) C61IM06
9;rmlm.A.Land TWO 1
Hvkdon of Water Quality
MN.- lnkMmtkm Proigmaing Unit
61.7 Mail service center,
tAl=WK NC 276911-1617
13Y THIS SOMME, I CERTIFY THAT TM REPORT IS ACCURATE
AND CMPLETE TO THE BEST OF MY KNOWLED13L
NON DISCHARGE WASTEWATER MONITORING REPORT
G R
DENR FORM NPMR -1.1 (11/2WS)

Page 2 of 8
Facility -Status:
Please answer the following question:
Gan IMat ,NI
1. Does all monitoring data and sampling frequencies meet permit requirements? F Y
If the facility is nonamoliank 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 inforrnation submitted. Based on my inquiry of the person or persons who manage the system, or
those pentons dtredly responsible for gathering, the information, the information submitted is, to the best of my
knowledge and belief, true, aaxtrate, and complete. I am aware that there are significant penalties for submitting
false information, including the possibility of fines and imprisonment for knowing vlolatibns."
(S onatu ' Q etmittee)" DaW
Wayne Modoes, Chairman
PO Box 21.
Swan Quarter, NC 27885.
(Permittee Address)
Parameter Codes!
Wiiliam.G. Freed
(Names of Stoning Official -Please print or typo)
by Authority, President, Enviro-Tech
-262-491-5277 9=006(Phone Number) (Permit Exp. Dat®)
01002 Anti
31604 Caftm. TOM
00800 NWoodLYaW
00929 sodl =
01022 Bwm
00091.Ca�iriH
00830 N42d1403
00931 sw:'
00310 8006
01042
00820.NO3.
00746 s
01027 Csdnk m
00090' Ors 01m
00556 GFG MO
70293 TaS
00010.Caiidiiin
31616 Fetal Cd term
11x000: PAN AvaiabM '
00010 T
- 00M chladit
01031 Lad
00100 `"
00823 TiQd
60060 Oftt e, Toh!
a.k, aar
00927.'
71900.
32730 Phenols
00845 . TON
00880 TM-
00530 issgsR
01031 Chmn* n
00810 NF430s11
00937 Potasaiuim
00078 T
00340 Coo
01087 NNCW
0064s sewe" mailer
01082 zine.:
Parameter Code asshdance maybe obtained by calNng the Water Quaiitj► land Applicati®n Unft at (919) 715!3189.
The monthly average fbr Fecal Coliform is to be reported as a GEOMETRIC mean. U59 only the units designated in the r®oortia alit„§ permit for
minroug gall,
• It signed by other than the ppm of *VWtary auttwriry Must be on file with file state per 1511 NCAC 2RAM
MNR FORM NCWR -1.1 (1112005)

Pale 3 Of a
NOWDISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE Two Appucmm Fmum MR PAGE. UsE ADDIT10mi. PAGES AS NEEM -
PEWIT NUMUR: W0019665 mom October YEAR: 2016
FACILITY NAME:' swan Quarter ft"Hory.1) kt COUN.Ty... Hyde.
�dY {I) ' l Appy (0) x o:1338 (out 1 x 12 (6xi�airu�jll(Areb Sptuyed Gros) x 43,E (squero tooVaae)) OR
- V*Wm Appkd Wok. =)z"simv d,(")x2T,102W0W4&-4rqhA
ftAmum Hourly Lad!np pncb 2) .00 . a Loolins (►w")
12 Month FWftTota! pnctm)
6 the Mawghnnnihil v 7 Mmshmp&l.
'VMaMW %;CM: G-CWt VU-P&M CMM U14MMi K4W% OUISROWs UPQ�
Spray lmhptiqn Qp0rator In Rpspops!blo Charge (ORC): Allen-BlIven. Phone., 491-5277
ORCCsrdrk.*AonN.umber._ 90725. -Omk Box If ORC Has ChanW:.
Man omGWAL and 7 m' copiEs to:
WENR:
DivisloA of Water Quality
AT TN: Inf6nmfion Processino Unit OF OPERATOR IN RESPONSELE CHAMP
161*7 Mail Sen4ce Center BY THIS SUMATUIM I CERTIFY THAT TIM RSIM 15 ACCURATE APd,0
kALEIGh. k6976M1167 COMM. ETS TO THE SMOFIRYKINI 0MM)W_
NOWDISCHARGE APPLICATION REPORT
DENR FORM Nw.1 V U2005)
yea.
FOMM
DWI OOM.On TM
No,
X
r This
Old Irrigation OM On Fw-
No.
X
7:
AREA SPRAYED. (soft), 2-98
COVER CRAP:
PENETTED HOURLY RATE flEM0.25
FIELD NUMER:
AREA SPRAYED (ORPM:1
COVER CMIM.-
PERRUTTED HOtIRLY RATE
3213
Lkmrm
):I.-
-
T
E?
WEATHER CONDITIONS
Vint! I W,
clwe I..
n
Uven
am ftwwsw
PERMITM
vowme
YEARLY RATE(10c"p): .315
Maxiinuni
baily. Hourly
Time inwated. wwwo uoding.
PERM11711ED YEARLY RATE (ImplIft,
volufflo Th" wiry
4
www" LoadIna
'
40
325.
M*xknum
Ho"
Inthft J"t
W
irn9W_
- i0W_
mkpAn
k0m
inch"
R
81
0.19
0
0
0.00
#DlVJO1
0.
-
2
R
80'
0.39
0
0
O.OD
1=10"I
0
a
.0-00
.0.00
PC
so
0,
0
0
0.00
#DIV/01
0
0
.0.00
#DIV/01 I
4,
R
so
0.611,
0
-0
0.00
*DfV/01
0**
.0
0.00
WDIM
5
R-
so
0.*04 4.6
0
0;
0.00
#DIV101
0
.0
0.00
#DIVVI/00 I
d'
R
79.
0"
0
0
0.00
4DIV101
0:
0.
0.00'
*DIVIO1
'7.
R
79
0.60.
0
0
L0.00
_#DIV101
0.
0
O:OQ_
#DIV101
8
R
79,
1.58
0
0.00.
*DIV10
0
0
0.00
#DIVIOI
9
R
76
0.04
.0
.0
0
-0.0()
I:#WDIV/MOI
.10
PC
78
0 .-0-
.0
#DIV/01
0
0.
00
0.00
#DIV/01
11
PC
1 78
.0
0
_0.'OO
4DIVJO1
0
D
0
0.00
#DIVMI
12
PC
78
0 4.4
0
.0
0.00
Mrviol
0
0
O.00L
E0.0)D,-
#DIV/01'
13
PC
77
a
0
0
.0.00;
#DrVjOt
0
0
0.0
sm/01
14
CL
77
0
0
0
0.00
#DFVJO1
0.,
a.
Is
PC
77
.0
0
0
JOAO
#D I I
OL
.0
0.00
AIDIV/01 I
is
PC
78
0
0
.0
0.00
#DIVY01
0
0
0.00,
4DIVI01
PC A.
70
.0. 1
0
0
0.00
RDW10-1-
10-
0
0.00...
#DIV/01
is
PC
4A
0
'0
0.00_
�60jV101
OL
.0
0:00.
NDIVIOI
116:
PC
76
0
0
0
MOO
[vial
D
0
AM:.
-#DIV101
_iNT10_1
q
C,
75
a
0
0
0.00'
4DIVIL01
.0
0
41
'R
76
0.02
.0 -
.0
0.00
#DNro1
.0
0
0.00
#DNroI
22
PC
76,
0
0
.0
AM101 1
0
.0 1
0.00
#DIV/Of I
as
_C
7.4
0
0
0
_;O.,OO
0.'00
.;#DNI 1
0
0
0:00'
#DIVIO .1
:14
C
'14�
.0
0
0
0.00
#W101
0
0
0.00
Iv/01
48
C..
74
0
0
0.
0.00
#DIV/01
O_
.0
0.00
#DIV/01 I
7- 'G
74
0
0
0
0.00
#DIVJOI
0
0*
0,00
#DIV/O! I
gy
PC
73.
0
0
0
.0.00
.#DIVJOI
0
.0
0.00.
#DNrot I
ft
C
.73.
0
0
.0
0.00
RDIVIOF
`O
0
0.00
#DIV/01
,:w
C.
71
a
0
.0
0.00
#01VIOt.
'0
0
0.00.
ODIVIOI.
.101
M
72
0
V
0
0.00
.#DIVJOI
0.
0
0.00,
#DIV101
.311
PC. 1
.72
0 .4.3
0
0
AGO
0
OL -
0.00
#DIVIOF
ToW GaftwiMon" Loading (Inchm)
.0
0.00
0
6.55 .'77=
12 Mopm Floaft ToW v (bw5R
0.00
0.00
AmWo We" Lo"Ing
_J, ... ....
0
j __1
0
'VMaMW %;CM: G-CWt VU-P&M CMM U14MMi K4W% OUISROWs UPQ�
Spray lmhptiqn Qp0rator In Rpspops!blo Charge (ORC): Allen-BlIven. Phone., 491-5277
ORCCsrdrk.*AonN.umber._ 90725. -Omk Box If ORC Has ChanW:.
Man omGWAL and 7 m' copiEs to:
WENR:
DivisloA of Water Quality
AT TN: Inf6nmfion Processino Unit OF OPERATOR IN RESPONSELE CHAMP
161*7 Mail Sen4ce Center BY THIS SUMATUIM I CERTIFY THAT TIM RSIM 15 ACCURATE APd,0
kALEIGh. k6976M1167 COMM. ETS TO THE SMOFIRYKINI 0MM)W_
NOWDISCHARGE APPLICATION REPORT
DENR FORM Nw.1 V U2005)

SPRAY IRRIGATION SITE(S)
Facility Status:
-Please indicate ( by Inserting Y(es) or N(o) in the aPpropriate box) whether the facility has been c
with the following permit requirements.- (Note. if a requirement does not apply to your fadfity put (NA) in the
compliant box. )
1. The application 11*8) did not exceed the 1knit(s) specified In the permit,.
2' . Adequate nmeums wane 6"n to WMnt wastawaftr runoff from On site(s).
3. A suitable vegebtWe cover was'maintalned on the ske(s) In accordance with the permit.
4. All bufftr zone* 88 sPOC!"d In the penTi.111t were maintained, during each application.
5. The th"bard In the treabnevot and/or storage lagoon(a) was not less than the 1111mit(s)
specified In the permit.
Page 3 of 6
Conjigieft N)
Ir— -
If the facility isA
PleM e*18fil in the space below the reasori(s) the facility was not in compliance with its
permit Provide 16 your explanation the date(s) of the non-cornplianbe and descrbe the corrective action(s) taken. Attach
additional sheets if necessary.
Caft underpetialty Of law, that this dobumefit and all attachments were prepared under my direction or sppervisfim in
accordance with a system designed to assure thatell qualified personnel properly gathered and evaluated the Information
submitted. Wised on my inquiry of p'eirson or persons who Manage the sYstem:or those persons directly responsible
for gathering the information, the information submitted is, to the best bi M- knowledge and t161jef,
/lest -y . true, accurate, and
complete. t am that thiare sjr6 ftnificant penalties for submitting false information, inducting the possibility m
arid imprisonment for knowing vkAafibns." ud y of fine
:2
(sig— Kriwft--e)* Data 7
Wayne HodoesXhainnan
(Permulse-pbase print or typej
PO Box 21, SWan.Quarter. NC 27885
(Permittas Address)
'William d.. Freed
TN—am—o of ft ning Mciall-Please I
-By Authority, President EnOb-Tech
(Position or roe)
252-4911r5277 9/3p/Z006
(Phone Nurnba4 (Pffmit Exp. Date)
64ned by 011mwftn on Wmftg, ftWqatjon of 5WftM RWWft must be On Lite With tbo AMC per 15A WAC 20A N (b)[2)(D),
DENR FORM NDAR-1 (I WWW)

Page 4of8
NON -DISCHARGE APPLICATION REPORT
SPRAY 1 T[®N (s)
THERE ARE TIVVO APPLIcaMoN Rkft im riAd . 0N$ AoDmONAL PAGE$ AS WE=.
PERMIT NUMBER: womse$5 MONTH. October YEAR: 201$
FACILITY POW: 30idR g ert it SallNgy i?IstrW COUNTY:, Hyde
Falereeles:
�Y L.adiren dura) g Nd�.d (oeaa!sD x o.1a�s (gff�faed�On) x 1a !(Area (eao,) x �.�o (ate ta®)1 Ore
■ VolunmAppied(Ons)�G(aon�)x27;152i0•m+d+)1
Madmum Hourly LomOng jlnches) _ D* L w&V ( 1 [� boamd irok +Eee±l J80 (nriiiAetulio I) alb t di»0 pnclkq) - Suri 0f D* Loadirtge (Pi =)
i2 MorM Floa*6 To4a1(Gicl) = sum o4 Oia reo s aeanrr i nodrip ( j �d a•,+ �; enmr 's t oedM� (hnaies}
li.�uJl�e Nr�asu� _ l.Jtl,4.1 .-t 'fL-Jr�4Wdl\)LlwJ.�..�•. SA'M•�M1s1Af /MAY VVti�9Yy/MW�1rl�
a\a�•.
. a�aAw
Yes:
r��.•.
.. w.�v r nrww• ��-mal
No: X
a-.�..s.....�..�y.-.
..
Y"d
�.��._. � _ _.._._...._._.
": Oe arr-mn Tt►15 Flatd:
Nod
-. __
X
_
WO WOW".OCwr rM
Yoe:
This Field:
No:' X'
FiEiD.NL BEN:
ARE/CSPRAYED' .__3.433.73
COVE CROP:
Y;tiJ1TE
)%,023'Y
3P'TIEDYEARLY.
WNUMBM ,
OVER CROP:
RA1
.-4
025.WEATHER
E
aVBlarvie
trop
YEARLY RATE
Daily
Tinea I Lel
32:5:
Hourly
Load)
Lng : 32:3:•"ima
volume Minae; oe�lri
L
Applied -1 Load .. ; ....
b+efiis taa!
m
enln
r
t
R
81
0:18..
0.
0.
0:00:
#DNrol
... 0q.0
O.W.
Z
ta:
Bo
0:39
0
0
0:00
-#DIVro1
O.0:00
#DIvro1
a.
1?C..
ao
0
0
0;
0:00:919/10f
0
0:00.
. #DIV101
R
gfl..
o:a1:
o "
d9
0:�
#DIVI01
00:00
#Dlv/o1
6
R.
so
ass �.S.
o
0
0 a0
#l1Nro1
m0:00'
#D1VIOI-
8
R.
7P:
0.20 •
0
.0
0:00
9 i ro!.
®:0.00:.
#DIvl01
R
7e
oss .
0
0
00
a7DIV 1,
0
0
®
IVroI
�sS
0.
0 .
..0:00:
4#I Nrol.
, . 0.
:o .
0:00:..
#DNro1.
s
R
Ts
o ai; :
0'
0
Q 00'
';#I)IVro!
0
0
0:00.
.: #DIV/01
to
°FC `
. 7s ..
o ..
0 .
0
0.00
-a ON1.01.
0 .
0
:0:00
#DIVJO! .
�1
PC.
78
a
O"
0'
.0:00
#.DIVroI
0
0.
0:00'
#DNro1
It
PC
Is..
0.1 4.4
0.
0
Os00
401Vlot
0
0.0,00:#RDNro!
..
13.
PC.
77
0
0
O
0:00.'
#DIV101
0
.0
0:00
WWI
14
Cl .
77
0
0'
0 ..
0:00.
#DIV/01- :
'0'.
- 0 ..
. MOO
#DN101
1s
Pc
n.
0
0
0
AMU
0
0
0:00.
#DN110l:
,s
PC.
'16
®..
0
0
0:00
#D1v101.
0
0.
0:00
I #DNrof
t
PC
7s
0
0'
`0
0:00
11l. 1
0
.0
0:00 .
'DIV/01
tl:
PB
7s
o: 4.4
0
0
0:00,
' #DlV/01
:.
0
0.00
IV101
as
PC.
78
0...
0 .
0:00
IV101
0.
•0
0:00
#DIV101
G
75
0
0..
0
0:00
#D11/101
. , .0
0 .
0:00..
'#DN/OI .
21
it 178
0.02
0
0
0:
.0DIV101
0
-0-6-00
#W/OI
22
PC .
75
Q. ,
0
0 .
MOO
ON101.
0
0
0:00"
#DIV101
29:
PG
74
"0;
0 ..
0
'0.00
#DN:Of.' :
` •0
.. 0
0:00:
#OHIO1
u
c
74
0
0
o
000
#� P 1*
0
..0
:0:00
W, WO
25
C
r4,
0
0.
0
0:00
#DNl01
0"
0
0:00
00/01
28
G
74
0
0
0
0.00
#DIV101.1
:0
0 1
0:00
#DIVrof
27
PC
73
:0:
0
0
0:00
7tDN101.
0 :
0
o:oo .
#DNro!
20
C 1
73 .
.0
0
0
0.00
#DIVIOI
0
0
0:00
.IV/01
go
0 ..
73 7
o°.
0.
'0
0:00
.401V101.
0
"0
.0.00
#DMO)
30
PC.
72
0'
fl
0
:0.00
#DIVrol:
0 .'.' .
-.0
0.00
#D1V/01
31
PC'
72
0 4.3
0
0
0:00
#D1Vrol
:,0
0
0.00
WDNL01
o•ao
: ,r.._:.:.:
0
000.
'
tz IAorine FIS
0.00
0.00
AymnW, Wft* Loading (trachea} ; -.. r.
0.
_
.
T
doudllDkfoudy, tt-m1n, sn-irr0'IND 941eet
Spray lrrWdm 0peirator In R"ponsibb CNarp (ORC)s filen BIIWen Piaojhe, 49"277
oRC Cemwaftn mwnber 9W25 Cheek Dog If ORO Hao Cha
Iftil ORIGINAL OW TWO COPIES Io:
DINR
Dliftl®n ®t water Qua[6
A7'T�I;.Iletorrrlat6�n Pr oce 3e> Its Uelit Q$I13�IAT OF OPERATOR IN B? E CHARM
9017 itserAe:e�. BY THIS si aLA.nm l CEP34t .Y THAT i B ORT I.s ACCUR,ATE AND
RALMWi PIC-*Oig- l I COMPLETE TO THE �$T OF MY KNOWLEDGE.
DENR FORM NDAR-1 (9 112005)

Page a of 6
SPRAY IRRIGATION SITE(S)
FacBlttr Statue:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box) whether the facility has been cmitt:
with the following permit mquirements: (Note. if requirenw t does not apply to your fhcilrty put (NA) in the
compliant box )
��—n�t N)
1. The applidation rates) did not exceed the lknit(s) specified in the permit. L,. I.—
Z Adequate meatsuma wero taken xo prevent wasbwaW mnof .from the sit®(a).
3. A aukable vegetative Cover was'maintained on the altr(a) in accordance with the permlt
4: All buffer zones as specified In the permit Were maintained during. each application.
5. The freeboard in the traibesnt andlor storage lagoon(s) was not less than the "allspecified In the permit
If the facility is nonvoomnliant, please explain in the spade below the reason(s) the fadiiity was not in compliance with its
permit. Provide in your explanation the daWs) of the non-compllanoe and des6rft the cx nective action(s) taken. Attach
additional sheets if hece6sdry.
"1 certify, undSC018 fatty of law, that this documerit and all atfachrnents vrere prepared under rn direction or supervision. in
accordance with a system designed to assure that all qualified personnel properly gathered and eValuated itis information
sut;inilted. Based
an my inquiry of the person or persons who rite age the system, or those persons directly responsit le,
for gathering the information, the information sufinirt d is, to the best of my knowledgd and belief, true, accurate, and
Complete. I bm aware that there are sigWmnt penalties for submitting false Intorawtlon, inducting the possibility of tines
and imprisonment for knowing vioiations."
> 7
(s gnaturs of Perinfaear pate
Wayne Hodges,.Chairman
WenrrWe.. Pfeaa® print or lino) .._
PO Box 221, Swan Quarter, NC. 27US
(Pernifto Addrine)
William f3.. Freed
{Name of Signing efficlaf-Pieces. print or lupe)
�y
By Authofiti. President Enviro=Tech
(Position orrdb)
252-4914277 tir=006
(Phone Number) (Permit Exp. Date)
' If $%nod by ouwr thud the perrnitt @1 delagstim Of signOo Y auwo* prod be On Rif with the SIXW W 15A NCAC 20A50614rit)io)•
DOW FORM NDAR-1(1 i/20)S)

Pepe 6.0f 8
NON -DISCHARGE APPLICATION REPORT
SPRAY IM16016N 4ITE(0)
THERE ARE TWO APPLICATION FM' WS PER PAft USE AWITI AJ. PAGES AS NEEDED.
PERMITNUAiB I: wom96tfi3 MOMM: .October YEAR: 2016.
FACILITY NAME: Swan Quarte' sant& ]Dbbw COUPITY:Hyde
-Formula;
Y OitrKa+..! =Iv6�m d(yrlom)x¢+ase(ou6iefNIl�lot1jx12 1![AOMSpreyad( )x43
M(*1r6%wwWI OR
��MP�d(O�dff f+'vx*SR+�d(iaw) iii �5z (yifiom:FaNnd�}j
Maximuio Hourly Loading pnehai) - b*Lip ) /I� p! d(d*wM!)180 (mh mSMW jf try laa rip (I.fw1Na) a &n of Defy LWA* (9Mw)
12 Month Rcwm w Total (melru) = Sym of go "WO.IN IMdPfiy � adr!o (iP ),fid p►e++law /1 nanHs YaarY Loadn "W)
Avwmom W&@Mv lmd(ne ilnehml - mifi ilr La didkin _aiii n in d marAh Awom md hit m I idi ,Abwd
IN
INNOW
Yea:
OCCUM.
Tm a0 m
No: X
Old InkptlonOcwr,Dn
Yisd
.:--..
.. •
No:
X
Did .RlpalionOcc4rOn Th -. Fitrlll:
Yq: No: x
AREASP1tAYED
COVER titm.
d03.
023.
8PRAYED° 418
:. COVER CROP: .
RATE itrNlis : 023.
pHER
PERMfl
- Y
TE rlChhil
: 325,
YEAItt.YRAI -
3ZS
A
T
rMc.w-w"
I
rt
.ti..,r
CM
spoon
ltori Frobalo d
UPI .. hat.
V61um .
a+mon=
True .1 .
m ....
Daily
M�xiinum
Houft
UmM ..
Volwo Tim®
I
eirnvbs
Defy
Loads'
Ifichng
ANaAttrturtt
. l.as ft
MM
1
R.
81.
os'.-
0
0
Oi00
ODIV101:
- . o:
0
000.
t�vrol.
z.
R
so
0.39:
0
0.
:0.00
_ iV/or
0'
o
0:00.
$#MDIVro1
3.
_Pc
e0.
o: , :.
0
a.,
0:00
#DN/0!
0':
.0
0:00
tBDIV/0f
4
R
80
0.01:
0
0
0:00
#DNro!
0.
0 "
.0:00..
ODNro!
a
R.
so
fi a4. 4:5
0
-0
0:00
#DIVroI .
0
0
000
. S ilVrol
a
R.
79.
o s
0
0.
0;00
#OIV/OP
o,
a
0.00'
dDIV/Ot
7'
A
70
0.'50:
0.....
0.
0:00•
#ON/0!
0'
O ..
0.0a
' #DIVAN
s
R
70
1'.68.
0
0
0'00:.:
iV/0i';
0' :
0 :.
. ' 0:00'
#DIVlO1
R
78
0:04;
"0.
'0.
Oa
: DIV101:
0:.
O
O:OO
#DIV/Of
10
PL
78
c: ,
0
0
a
: #DN101.11
0..
0
0.00
*DIVrof
11
PC.
is
0., :
Q
Q
-0100
-ADIV101.
0.
o
o:
#D1Vro1
12
Pc
.78
o.:. 4.4
0
0
0.00
#DIVrof
a
0
Moo:
#af1/ro1
.13
PC-
77'
o.
:0
0
`0:00
WIM101.
0
0
Obo..
#DIVI01.
14
CL
`77
0
`0
0
0:00 '
WDIV10 .
0
0 .
0:00
DIV/D1.
I
PC.
n
0.''
0
0
:0:00
1 i1Vro1`
O
0
:0:00'
#DIVL01'
1s
PC
7s
0.
D
0
" 'Q00
#DNro!
0
0
0:00:
#DIVro1.
17
PC.
76,
.0:
0
0'
0:00
#DN101"
. a..
0
OAA
#01101
18
PC
70
Q. 74.4
0
0
0.00 '
' =1.0t
0.
0
'0:00
#bN/01
*
'PC .
7s
0
0
0
.0:00
#DIVro1
0
0
0:00
#DN/o!
a
-C
78
':0'
0
0 .
Moo.
ODIVIOI:
0
0.
0:.00:
WDIVW!
3i
R
75
0.02
•0
.0
000
' . #DIVrol:
0
0.
0:00
#DNrot
12.
PC
75
p
0
0
:0.00
#D1Vrol
"0
0
0:00
#DIVro1
J6
PC
74..
o'
0:
O.,
. 061.00
flDIVJ01
0.
0
0:00
�IDIV
24
C
74,
-0:
0
0
;0:00
�IVlol1
-0
0
010Q.
. #DNroI
26.
C
74..
o:
0
0
0.00
ffDIV f
0
0
000
go
c
74
0-
0
0
0:00
:ODIVro! .
.0
0'
0:00
#D1Vro1
27'
. PC
73
0'
0
0
0.00
#DIV/01
-0.
0
000
#019/0! .
n'
C.
73.'
0
0
0
0:00
#DIVIDI
0
0
'O.W.
: 4DIVroI
1:
C: .
'73
0
0'
:0
0:001vrof
'o
.0
'0:00
#DNI01
so
PC.
12
0-
0
0:
0.00
OMYO:::.0
0
0.00
WRIVIo1
31
PC
• 72
.0- .4:3:
0
Q
O:OO
#DIV/01-
0 .
0
0:00.
#nIVroI
Topp► 6141! slM2t V L'
o_
moo
_ �_ w.�
o
�
MOD
Y
1Z Momh FIOaNrrD:TorN (Incheu _c
0.00
0:00
"
AtieeaSi.
Li dihp ) �. tr,
0
k . �
0
EPr,pY Imlgation Opendw In Responsible Cham (ORC): Aril Sliven Phone:. [phone]
ORC Certification Numbm 996725 Check Box If ORC Hiss Changed -
Mau ORIGINAL and MAW CL�PIFS to:
&N* R'
Division of Wetter Quality
A7TN:1MonrletlarL Pr�oceesirry unit (SIGNATURE of OirERATdt p+l �BPoN� u .
1617 f�llail Sen►lCe•Cwlter 61f THIS 31GI44TURE,1 OERTl1-Y IIHAT THIS REPORT IS AMRIATE AND
RALEIGH, N 27$8 I G. 7 C TO THE BEST OPN7 Iv4OWLSIG .
DF,NR FORM NQAR.1(I WOOM

SPRAY IRRIGATION SITE(S)
FACRW Statue:
Please Indicate ( by Inserting V(es) or N(p) in the aMmpdate box) whether the facility has been ampliata
with the following permit requirements:
(Note, if a ra quimmenit dbes not apply to your facility put (NA) In Me
cimpffant &x. )
1. The appikeom rate(s). did not exceed the limits) specified In the permit,
2. Adequrb njoasunpa were to M to prevent WartgWMW MnW fMM UM
3. A suitable vegetative cover was maintained an the snp(s) in accoMan
Go With the permIL
4. All buftt zones is *WIftd1 In the p4olt weiv nuintil
Ined. during anch 2ppil"Gon.
5- The *69burd 10 00 6686MM snftri MOM218 kgoon(e) was not less than the "s)
specif! Penn
. ;ad In the IL
Page p of 8
If the facility to gga:j2aUgft Please UPS!" in the spoe below the reason the facility was not in compliance with Its
permiL Provide In your e*initon the date(s) of the n*n-c0m01IQnb8 and describe the eMOctive dcWn(t) taken. Attach
additional a" if necessary.
1. C81W, under:Nhafty of low, that this dodUrnefit WW all attachments were prepared Under my direction or syMnlaipp In
aCc;ordanc9'w_M­a's'y`g'bm' designed to assure that all qualified perwnt* pro
pedy gathered and evaluated the Ifform6flon
suibrfifttad Obaed on 'my inquiry designed
person
quiryc the person orpemns whonunap the system, ;orthose persons directly responsible
for the Inbottation subrnMed is to the best of my knowledge and i ' ' true. accurate, rate, and
. r . belief, trus. accu
Cbtv%pkft. 16 aware"that tveo6 are 9190M,ntpenalties for submitting false in%rmation, including the p*60iblloy of fines
and Imprisonment for knowfoo violations."
Wayne Hodges, Chaiterhan
(PannNtae=Please print or hrpe)
PO Box 21, Sltirah.Guarterr hd 27885
(13,1111riFirinioa
William C9.. Freed
=kanw
Sv Authority. President EnvfM-Tech
(Foam" or Title)
. 252-491:4277 . 9=006
(Phone Numb*C- (Pemit Exp. We)
* Ustaw two"Wthan the WM*WQftbqaftn Of awatory IWWftmust be on fgovMh the sbft W 15A NCAC 20A08 (b)(2XD).
DENR FORM NDAR-1 (11=5)

NON -DISCHARGE APPLICATION REPORT
SPRAY
Ay . immmoN drMis)
THERE AM TM APPUCk4Qm'mftPd OiA PAGE U- SE Amofibw PAGES AS NEEDED.
PERMIT NUMBER:
FACILITY tiL4M
*Vbkm
M&dMum k6udy Loading (Whft) a 0.*!4
ii licaM F ftVr4TbftI0ncha) -&oaf,
AWeriaiWMdftLbMfififtNdMM
Page 6 Olt . a.
MONTH: gitober YEAR: .20.18
COUNTY:"Yele
b1 cosi: �a:680 (.quare tirw.n OR
dyLamunow4m) -simbf bwtogew from)
"Mawle �... '��."Wmww ummmw K-MINa"mw 3"W"
Spray In%tion Operator
In Responsible ChaW(ORC): Allen, bliven Pone: A81-5277
ORC Comficifid" Numbom995726 -Chock Box ff'ORC H" ChanW:
NW ORIQKAL and Two COMES to:
DENR
Dh"Ion of WaW Quift
ATTN: Infimmallonc.as
m sing Unit OW -MATURE OF OPERATOR IN RESPONSIBLE WWO-P
161 7 U01146146 Copier BY TW SMATURF, I 09UWY THATTHIS REPORTIS ACCURATE AND
NQ COMPLETE TSO THE BEST OFTINY KNOWLEDGE.
DENR FORM NVAR-1 (I Ir2M)
rnW=
met.
=At 7M
FWJR
K
D101On
Is
lrrlBttlon Occur On Ts FNid,
'
AREAWRAYED-000M,.
02
PEFOAnI 0"tKar 025.
&
SMYWAM
NUMBER.'
t0P
f10URLY.
onth").
T.
.448
_.0Z
A
T
NVMATHIERR CON
HWTIHOMM
PERNH-HE Y�EAMMMY (!rid=).,
Won"
A60WW T(wa hWrMwbWd
5
HauT
L�"Om
Lub)"na
flinhat 325
:r_
4w wtv liouriy
AMIWd 1m&mW LAuding
Sam=
Mum
AWNS
_Zaw
OR MR
COP
st
Q
Q.
#D' 10
IV
'10
-'0
•O"00'
IL 0DIV101
2
0
0
-0.00
�:JV
.-#DIV/DF
.0
OW
I #DIVJO1
3
R.
.0'.
MOD
ADIVIOU
o.
'O.OD.
.1 #DML
4
n
go.,
0.61
.0
'0'
'01.00
#01VAR.
'0
0
0.00
WTV1,01
$
A.
86
0-04 4.6
.0
0
.0.00
WIWI..
'0
.0
.0-01)
'#DIV0Ot
R.
.79
0.20-
.0
O_
0,00
Ox
'0.,
4DIV101,
7
7
ra
R.
76
7
:0
'0'
0
U00
0
0.00'
WDIVIOI
.8
R
79.
1.03
.0
.0'.
0.
-0
'101
#DW
9...
9
R
.7a.
iat
00..
0.
:&OD.-
'*DIV/MOI
46.
=
78
0
0
0
�0.00
w1mmi",
'V.OD
JSVDIVJOI
11
P0
?a
0
0
.0-
0:00
#DIV101
0.
.0
0:00
.. #DIVJOI
12.
PC:
!a*.,
0' 4.4-
.0
0
0.00
1 #01-V/01. -
0
.0
MOD
W101
IWO
Is
PC*
1
"a
.0.00
1 #DIv/Ot 1.
0
0'
."040,
4.01viol
CL
77.
.0.
0
0
010
:1300
A 1
:0
0
'-'0.00:
'WDIVIOI
it,
-Pa
-0-7
0
0..
0.00
_-#DIV
.101..,
Cy
-0
A. -Op
'voliv/01
It
PC
70
1
0
-0'
'0.00,
=
R.
0.-
:0.00.
4DIV/01
017,
P0.
70
'0'
0
a
0.
'00
4DIV
'/Of'
�0
0. .
0.00
;#DLIVIO
i t.L
F r
'M 1
76
'Q A.4
OL
0
.0s,00
I WDIV
0
1
MOW
.19
Fic
P
76
.;0.
0
0
.00
#DW1O
.0
7$,
'0'
"0
0.
0,00
#DIVIO,
- O
0:00
-#DIV/01
- 21
A.
75
0.02
0
.0
1
:0
.0.
4ADIV101
'.92
PC
PC
7s
0,
.0'
#DIV/01 F
-0.
'0.'00
WD
1b:
PC.
74
0
'0
0
...0.00
WON= I
:'D
0
'0.00
#D I
24L
74
0
0
.0;00
#DIVIDI 1
0,
0
:0.00
lei
#DIV)01
95,
25,
0 -
74
0:
0
:.0
0.0.0--
#DIVA01 1'
0
a
�O.'w
10DIV/01
2 0
.0
74
0
0
.0
0.00
#DIvjO1
0�0
To -0
-# ffw-/o I
Pa
73
0
0
a.
:0.00
#DIval -
0
O�*
_-O.W
ADIV/01
.29.
:C,'.
'73
0
0.-
0
'0.00
#DIVWO1
0
0-
OLOD
#DIV1Of
go
J"'tg
:C
73
:.0
..0
0.00.,
.0
0
.0.*00
:#DIVJOI
.
.30
PC :t
12 L
0
0
4.00
#DIVIOf.
'0
0
'0,
-00
WDIV101
.sf­
Og 1 j
4
777174T��
0
0
0.00
#DIVIO - 1
!!vr
1�
.0 .'O.0Q
#DIV/01
wadft.vichm
0
0,00' L
0
.0.00
12;Motft.:Fh*ff" TOW Omdi6m)
..0.00
F
LEI I
a. .
;�� F2 ��.A
O'L"
I
"Mawle �... '��."Wmww ummmw K-MINa"mw 3"W"
Spray In%tion Operator
In Responsible ChaW(ORC): Allen, bliven Pone: A81-5277
ORC Comficifid" Numbom995726 -Chock Box ff'ORC H" ChanW:
NW ORIQKAL and Two COMES to:
DENR
Dh"Ion of WaW Quift
ATTN: Infimmallonc.as
m sing Unit OW -MATURE OF OPERATOR IN RESPONSIBLE WWO-P
161 7 U01146146 Copier BY TW SMATURF, I 09UWY THATTHIS REPORTIS ACCURATE AND
NQ COMPLETE TSO THE BEST OFTINY KNOWLEDGE.
DENR FORM NVAR-1 (I Ir2M)

SPRAY IRRIGATION SITE(S)
Facility Status:
Memo indicate, (by in 'ate box) *hether &a Mcility has been SM
1"I'ling Y(es) or M(d) in ft appropriate
with the Wowing permit re -nWnt
CMP&Rt 60ji. ) . quirements. (Nofe., if a mquimment does not apply to (NA) in the
1. The applicalJon rats(s) did not exceed the 11MR(s) specified In the petynk
2. Adequab rneasufes were taken to W9veM waftwaW M"Wfrom the *,Ms)
3. A suitable vegdta" cover Was Maintained on the a
fte(s) In accordance with the perrnlL
4. All Met zoll-901 as ipe6lfled 10 the PiMO WM n1aintitin.9d. duft. "ch.application.
5. The *eeboard In the 6wbneM SwWar sbralp lagoon(*) was notIlm thim the "s)
specified in the pomk
pw3cfe
N the facility Is flamom Ign -
please explain in the spacebelow ft mason(*) the Wifty was not in compliance with its
permit. Provide in your explanation the date(s) of the non -t . onl0flance and describe the c6rrec&6 actions) taken. Mach
additional sh6d1s; if necessary.
"I certify, Under OS0811Y Of IsW, dW this document and 811 attachments were prepared under m
and
direction or supervision in
accordance witli-aiystimn designed to assure that all qualified personnel propertyga"tedimridiivalugtddftlrikrfi:a'go'n
y ixt*.. the wh, Me "ttewor VMS per djre* responsible
Ittad Based
on m n or per;ons . 9 manage I
for gathering the information; the information submitted IS, to the best of M'' k'
confloillift. I bm- ffivare that are all; Y howledge and belief, true. accurate, and
ffiftentpemluesft.reubyWdgngfoWinbmwMon.i uding tho possibility of firm
and iMprisonmOnt for knowing vl6istiorKs.'"' Ind
7
(ekbiat-UMof, e-nWitee)t Date
Wayne Hodges..Chairman
(Pormwee*106"'point or
PO BOX 21. Swan. _Nd. 27aW
(POMOfte Address)
Willis, d.. Freed
of Sliming Id -Please W*g or 6W)
By Authority -President Enviro-Tech
(Posftlon or Title)
—I§L-491-.5277 — 0=006
JPhoft Numb" (PerMll EXP. Date)
'if "Ped by odwftn the pomftw, dMOSIUM of *WUg"y gUft* Mud be an f4evifth the state per 15A NM' 29.O (bX2)(D),
DENR FORM NDAR-1 (I jr2WS)

Page 7 of 8
NOM -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGL USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: YYQ0019685 . MONTH: October YEAR: 2016
FACILITY NAME: Swan Quarkw Sinilary Dit#6 M COUNTY: Hyde
Fonnulesi
!► is1 • NoUimRi Afipi®tl (peaoin) is 0.133Q (pdi)efisVyeMorQ x tz (iehesJioalp)1(�vea Spreyed.(eaea)z 13.reo (eq�a fe®uaoi�)1 OR
• Voir+leAq�ped (pNor►s)llAroa SpraysU j�aes)x2i 152{�forWade•iiKhj]
Maximum Hwufy Lb10r!g QMIW) D* Waft WW) iUkM krip* Cmc) 18D by wwing linden) • ti0 orD* L08d rips (meg)
12 MOMh F1oWr4 TOW 0ww) ■ Sun wmb rnantlP� Loeayfp (iidiee) aid a 11 mo a �Nantliiy Logo", (atm)
A"roo We" L00019 610" it�Iaahhr iosstinri eaM�o ) iNisnberaadws b aie mangy c )i x r
Spray Irrigation Operator In Responsible Charge (DRC): Alien Bliven Phone; 491-5277
ORC.Certificotion kwber. 995725 Check Box UORC Has Changed -
Mill ..motNA - told i`WO COPIES to:
pENR FORM NDAR-1 (11/2005)
Yore
Na: X
Yom:
Pr Q"T#4 . ..
_
.,:
Ila::.
X
Yisi.
Murow.
No:
X
>
'"
-
BER: 9.
AREA SPRAYED'. eerrs ' .4.93
CQIIER'CROPa
PERMITTED HOURLY RATE (iticl s : 0.25.
NUMB
SPRAYED � :
ITOVER CRS•
, RA "
10.
6.08
(f .. . 0.25. ;
D
A
T
E
WEATHER CON DffiON$
Timp•r. ti9ofap•
waow ap a Pie . Lapocn
...
CON' ifon arra board
Inions tint
PERNRtEDYEARLY* RI17E. inehbs: 52.5
Mrvifnium
Vol* Daily Hourly
: irla* ! . " .. ,
Ions m
0YEARLY RAI E bcMak
Volum Tired Da'y
ied - , :<.
inlnutts'
..32.5'
Mi1X1111Um
Holter.
Lmslllig
1
R
:er.
; .0:19'
O'..
0:
0:00
.. _.fxDi1/i !.;
0::
0
0:00.
#DIV/0!
Z:
'R
80
'09
0
0.
0:0:0
#DtV/0! .
O_
0 .
0:00.
#DMO!
3
PC7'10
80
0.
0
0'
000
#DIVIOI
0
0
.0:00.
4
R
8o
0;01
0 .
0
0.00
#DI ' 1 ..
0
0.
0:00'...
#DIV/01
a
R
80
0.04; 4.5.
0
.0
-0:00,
#DIVIOl;
0
.0
0:00'
#DIVI01
e
R.
79
o:2s:.
0
0
0:00
Ivrot:.
0
0
0:00
#Dl ' 101
T
R
79
' O.W.
tl ..
0#D11I10l;
0
0
0:00
#DIV/oa
e
R
79
o
Q.
0:00
�IVIOI
0
0
0:00
#IOIV/O!.
V
R.'
78
O.Oe
0
0
0.00:
#DN/Ol".
0.
0
0.00 '
#DIVIOl:.
10
PC
70
0
0
0.
OAO
DIV/01.
0 • .
..0"
0:00
.#DIV/0!
11
PC.
78.
0
0
:000 0'
#DIV/01` ;;
..0.
0
0:00
#DIVIOL
12.
. pC:..
:78..
..0. 4:4
0
0..
0:00:
4OIVI01:
0 .
0
::0:00...
#DIV/01
19
PC
77
0:
0...
0
0:00
;i1Dl.V/01
0
0
0.
ODIV/Of.
14
G.
n
o
OOo
#DIV/Oi;
0
0 ,
0:00.
is
PC
71
0
0
0
0:00.
�#DIV/O!
0.
0
0.00
.#DIV/O!
1d.
PC
'76
0
0
0
0:00.
#DIVIO
0.
o.
0:00
#Dl.,.
17
PC
76
0
0
0:
0.00
#DMot
0
0
OAO
#DIV/Ot
1S
PC
76..
0. 4.4
0
0:'
0:00
#DIVI01
.0
0
MOO'#01V/0!_:
18'
PC •
7s
�0
0
0
0.00.
# Wel
..0.
o
0:00
#a (viol
20.
C
75
0.
0
0
0:00::..:#DIVro[
0
0
0:00
;y€DIVlo1.
z1
R
75
4.02:
0.
0.:
..0:ii011N0!
0
0
0:00
SIV/o!
r1
PC
75
0
0
.0
0.00
#DIVroI
0..
0
::0:00
aIfDIV/01
22.
PC
74
0
0 .
. ` Q.
0:00
#DIV/OC
0
0
0.00
#DIV/01
24
C
74
0:
0
.0
0.00
#DIV/Ot.
0
0.
0.00
MIMI
25
.G'
7.4
a
0
0. ..
MOO...
�IV/01.:
0
0.
oA0
#DLVIO!
2a"
C
74
0
0:
0.
0:00.
#DIVIOt
o
0
0:00
#DMO!
v
PC
.73
0
:0
0
0:00
#DIV/01 _
0
0 ...0:00..
#DIV/01.
tis.
c
.73
0
0
0
O:QO
#DIV/01
0
0
0.00
#DIV10!
�.
c:
"73.
0
0
0
0.00:
#DIM
0
0
0.00
# Iva
20
PC
72..
0
0.
0
0.00
`#DIV/0!
0
0.
0:00
#DIV/OI,.
31.
P-0
72.:
'0 . 4 3: 1
0-
0
0.00 '
VDN/OI
0-
0
0.00
#DNIol
TOM W11 SlYgnfAthtR4ad6A9.{incllos)
0
0
0:00
12.Mone FbofinBToW.Oo
.:,�.. t .r :.. ..... r
0 .
s..:. ..;r._�. ;:..:.:•;
AVO .Iincheal __ -
- 0
-0
3
0" f
Spray Irrigation Operator In Responsible Charge (DRC): Alien Bliven Phone; 491-5277
ORC.Certificotion kwber. 995725 Check Box UORC Has Changed -
Mill ..motNA - told i`WO COPIES to:
pENR FORM NDAR-1 (11/2005)

SPRAY IRRIGATION SITE(S)
Familft
Please Indioete (by lmwrdngV(es) or N(d) in the aPPrq=t8 box) WheMer the facility has been cognplIgUl
with the Wowing permit requirements:N
(Note. if a requirement does not apply to your md1ity p6t (NA) In the
1. The application rale(:) did not exceed the 111MR(s) specified In the pernalk
Z "Ulb nie"d M.'e' wane tam" 116 OMWW4 W"Ievmw, nutoNfrom, the on
3. A sultable, vegetative obvet was'maintalned on the. sites) In accords.nce with Ow penalt
4. All bufkt zones is isiftd In the pinpo were nmlrft
P06 Ined. durinfl. each applkqdon.
5. The ftoboard in the ftaftnent andlor storage kg000(s) was not Ins than the UrnitIs)
specilled In ft pevrnIL .
PV9 3 Of 6
fl9k9MN)
If the facility is ML1211121ft please a he facility was not in compliance with No
-Wain in ft Wade below ft reasoin(s) t
Permit Pmvide in your e*planaoon the dab*) or the non-cmpli8fte and describe the c6ne+�ive action(A) taken. mach
additional sheets if 6e,ce asa ry'.
car*. underpOnally of 18 w. that this document and all attachments Were prepared under my direction or supeniWon In
accordance with a system designed to assure that*all qualified pergonrWI pr6pedy gathered and evaluated the Informagon
subinnEed. Based on my Irrcju�y of the person or pereons wild manage the system,;or those pentons: diiaedly respongltlefor gathering the information, the infonrttadon su6gnitted is, to the tient of my knowledge and belief; tole, accurate, and
• I am aware that iiieie ani significant penalties for submiifiing false iMom►edon, including the possibility of fines
and imprisonment for knowing violations
7
(8119naturs7of Pbmdfter Date
12ayne Hodaw. Cheignen
(Permittee -Please print or
PO Box 21, Swan Ouarter, NC 27885
(Peraddee Address)
VVIlhain G. Freed
Name W $hLnlft Official -Please... rkK or tw)
LB Auihorb, President Enviro-Tech
(Posithm OrTitle)
252-491m5277 moos
(Phone Numb" (P;m—It Exp. On%)
It signed by ~ ftn ft per, demgnftn of gWefty 04gWili, mud be on ft with ths sty per ISA NC= 213MM (6)(W(
MR FORM NBAR-i o ir=5)

page e s
NON -DISCHARGE APPLICATION. REPORT'SPRAY IRRII:GAIT­I0N­-8'ff*'E(3)
THERE ARE rvvqAPPucAmoNFIELDS PER PAGE USE AwnqmALPAGES M NEEDED.'
PERMIT NUMBER: W00019w MONTH. October YEAR: .2018
FACILITY NAME:
9: Swan Quarter. Sanitary District COUNTY: flyoe.
F*MuIM-
OftLM"(WM) -rMxMAR*sd(Rebft)xQ-t3X OR
KaxImnM,NwdyLA&dh*0nc'hw) =s"db*LNOW010w)
12 Maim Ftwdng TOW One: ) = Sun ormmw . eftUmftL=*V"M . )"FWAMII . MMY& UMM Laa*w (900)
Av&MwWm0ftLwW=flnchmI
DWW9IU"QvWA;MF'*MIy.
Nd.- x
DW IM 900"Becur
Olt This Fw.
.
X
101d r"Gron M`Sb
YAS:
Raid;
NL9ABMI-
AREA l~ Im. -
covek'
POVAITTED HOUKV
T -I ow"r.
4.
025
0-25
ELD:
SPRAYED B "009
COVER CR
HOURLY RATE
12-
F43
.0.25.
Q.25.
D
A
E
VJIFAT IER
Cod's20kom
COND[TKM
aww
am ifiWv4b�vW
PERUMnEDV�TEAARLY
ADOW
0411k.
Tinn In UUMUM
.315
Nasdmunr
H
H
AG"no
YEARLY
Volume Tim:
A00W IM MW
(Indws).
DAY
LWOM"
Kuhhum,
Feouily
rm" fm
am""
low
&OW
PEW-
nftuwl
j
R
$1 01"
0
0.*W'
I #10XV101
'a
0
0.
0.00
#DIV/01
.2
R.
00 0.30
0
0
1 0
'0.00
1 -
.0
J, 0
0.0a
MIMI.
PC
80
0
0
0.w
0
..0.
.0.100
.
-�L-
-4
R
be 0.01:
0*
:0.
A00
0
0
AM
#DIV101 1
.5
A
00., 0-04 4.5
0
0
-0.*00
#0101
0
0
ADD'
OD
6
.0
79 0.26.
0
MOD
#DIV/01'
V
0
-7
670(-).
7
R
79 a.ss.!
0
.0,
0-00.
vDIV101 1
...0
0
- MOD.*
#DIV/01
AI
R'
is -7-58
0
0
-01100,
#DMOL'I:
:0
0.,
S.00-
0DIV101
'9
:R
78 0.'04
0
4
`040*
J #DIV
"/Dt I
D
.0
OW
MV1.01
jo.
M
78. 0
0
0
0.00
1 #DIVIDI - I.
-mo
0.
-crbo
SDIVIDI
,11
PC'
76
0
.0
O.W.
1, #DIV101 1,
.0
.0*
VbD
12
PC
78, 'a'
0
0
OM
OD 1
0
0
0.100
#DIVIDU
A3
77 .0
0
0.-
0..00
, 1�
0
0.00
#DIVIO
14
CL
77
'0'
-0.
On
#DIV101
0.
0'..
0:00
-FF
77 0. 1
0
O.w
0
D
0.00f
1.
is
PC'.
76 0..
0
0.00
#DIVJDI
:-0
0
0.w
1V/0!
ADI -V/Q -1
Pd.
'.76 0.
"0
0
AM-
#DIVIOI
A
0
VIOI.
IS.-
P.C. -
78 0'. AA
0
0.
.. 0.00"
0 1
D.X,
VDIVY01 'I
A9.1
PC' 1
.70-
.0
0
:0-00
1 ADIVIM I
* 0
0 1
0.06
#DN101
'C
is 0
0
a
4DIV101 1
-0,
0.
0:00
#DIVIDI
11
R
is, -.0-02, 1
.0
0
Qi
'00
VDIV/01 1
.0
.0
75.55
wD 1
22
PC-
76- 0' 1
.0
0
0.00
0DIV101 1
0
0.
m'OA)o
as
PC
14 :0
-0
0.
0.00,
IcNlOI1
0
0,
0.00
#DIV/01
c
74. 0
.0
0.
'0.00
0DIV101 1
.0
0.'..
ADIV)DI
. 2
C. 1"
.74 0
-01
0
0-00
4DIV/01 1
0-
0
.00
'V/JO
#DII
C
74 0
0
0
AM.
VDIV101 1
0
-0
0
0.00
#DI-VJ0I
27:
PC
73 .0
0
-0.00-
#DIV/01 1
.0
A:
0.00
#DIV/01
.0
C
73. .0
0
0
0.00:
#DIV/01
0
0
'0.00
'.#DIV/01 I
129
C
.73-A 4.
L4
0
0.00'.
1 =V101
:0
0-
-0.00
#DIV/01
tb
C'
P - -
72- 1 0
16
0
*b.00-7
MV101
0
al.
PLC I
0.- -7-
1 0., 3
D
0.
0.00-
#DIVIOI
-0
IDIV/01
12 Month F100 ft Tota!O.OD
0
0
Spray krIMMonOperator In Responslifle Char" (ORC)-- Allen BlIveh Phone: A01-5277
One Gertlficntion wumb.Qr*- 99M5 Ctwk.. Box If ORO No Changed:
Mall 0.RIG#M god TWO COPIP'ta.
DENR ...........
0141slon of Water Quality
ATTN: inform stiou Ing unit Y1JRE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail SeTW"-C.enter
OY THI$M41lTIRiE,. I CERTIFY REPORT LSACCURATE AND
COMPLETE TO THE 8W OF MY MMOME,
PENR FORM NOM -1 (I 1=0)

SPRAY IRRIGATION SITE(S)
Facility Status:
PlOase indicate ( by Inserting Y(es) pr N(c) in the appropriate box) whether the cility has been r MWDI
pn wheM o fs &M
With the folldWing permit Mquiniments: (Note: ff's requireawnt does not apply io your /achy put (KW In the
compliant 1ioi )
1. The appikodon MOB) did not exceed the Ilmit(0) specified In the permit.
2. Adequaft W"urss wm taken to PmveM wwWwaW nmWfnxn the sue(s).
-3. A suitable W90Wthe cover was nialatilned on the site(s) In accordance with the permit,
4. All buffer zones as s0ecilled In the POMIt Won) Inaliftined durlh# each applicadon.
5. The ftebo&M in 60 tm2bvwft 8n&6T j001`898 NO&NO) was not less than 616 "s)
specifiled In the pemk
F%ip 3 o18
If thefadift
. . wis *m explain in the space beloW the reason(s) ft facility 'was not In compliance with He
permit PiWde In your explanation the date(s) of the non-compliance and describe the correcWe action(s) taken. Attach
additional sheets if necessary.
"I car*, underpshally, of law that this docurrieM and all iiftchmirdsWetepreoared udder
aocordanp6wrlth a system designed to y direction or supervision In
assure OW all qualified personnel pri�pejjy ga#wred and evaluated dj�6 lnf�majon
sutkhftd Based a'" my inquiry of the person On or j)jism" v" rnn'age ttie By rn, or
ftft penpons djM* resporwible
lcr gaiite* the information,. the Information suOrnflfed is, to the best of
my knowledge and b6114i tr66, accurate, and
domtafete. I am aware thiftme are ilgiffmnt penettles'for skibWonq false Information, including OV powiblifty, of tin esimprisonment for MoMng vWaff-06S."'
7
(Branaturvior-06mmaef DOW
Wayne Hodges, Chairman
PO BOX 21,Swan Quarter, NC 27M
(Permittee Addlese)
William -d- Freest
Lkanw of MI-00*0111161al-pbose j�R-r&
91 &M_OA President EnWo-Tech
(po$Won orTft)
252=.491.5277 930/2006
(phone Numb" (Permit Exp. Data)
It signed by Qdw than the PwMftW, delegation or signatory *Uft* Mud be an ft wM the stift
W IdA WCAC 20A06 &X2)(D),
DENR FORM NDAR-1 (I IMDDM