WQ0008489_Monitoring - 01-2017_20170217

Permit No.: W00008489
Facliity Name:
NC Prison Facility at Piney Woods
County:
Hyde
Month JAS
Year: .2017
PPI: 002
Flow Measuring Point: 2innuent Offnuert Duo now generated
Parameter Monitoring Point:
Ellnfluent
E]Eftie t DGroundwater Lowering
E]SurfKe Water
Parameter Code
SILS-6rad
00310
W! -1
31616
00625
00400
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'Em
x
N
, pf
-RU
I
TO
1= U5
0
.
U.
0
0
0
2 z
0
0
24 -hr hrs
WT, 00 mL
mgfL
WPM
21
NEI"'
Ao, 'I
goo ""'S
31076D I :g
4
V)rjoo
WOO
6
6106
7
8
9
IMAM
TO 5E-7-100
fl
FIS 010
MOM
71
4C>Sno
6kdd12
6400w
63000-42—MAM
NO"
WWWO
aw M-6
MiUMN
I SO d� 4
VIR
141 1
16 I
01;A J1
00.4m
Amr-WIS
9MRS
MAN
_&W
--A
I
UUM
T q-
17 b -I 00 2
18 403W
19 el -I CIO
To 0-100
21
MWO
MOM
22
T3
0106—
N®RM
Wk
241
26
f)JO()
CUM
Ak _11
T6
moo
27
0-100
SWO
m.
28
E I
29
TO
Ufoo
IWOM_ 1
1
IMP'U
31
Average:
Daily Maximum:
•.
Daily Minimum:
. . . . . . . . .
Sampling Type:
K*fti,
Grab
Grab
Grab
MMON
Grab
NO
Monthly Avg. Limit,
,,�W
RW"W_
Sam
Daily Limit:
Rpm
1 -A WPAKIV V­.•VV al'- I I

FORM: NDMR 03-12 BION -DISCHARGE MONITORING REPORT (NDMR) Page �I of t
Sampling Person(s)
Name: `TOVV\ ISE ASLC Y 80613Y FO 9
Flame: �O CPH P. SADLER
Certified Laboratories
Name:
Name: CA)VIjC0A)MEA)T _—T_ 11VC °
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? OCompliant %Non -Compliant
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.
IELOS Aj)EE ©VEC21 TN -F 12 YA0Tt+ NS -To 7-14 L
Jr I-IEt-05 tA)ERE •ToT19-Lj CompLdAKUT` RECOUEPWJ6 FP1 I-LMOST GikE aF
ZXT2-EPIE RAt IJE� Q_0Pbl (oIUS
Operator in Responsible Charge (ORC) Certification Permittee Certification p
oRc: moose Pt+ F.SWpLEiZ
Permittee: COU11\111-1 Oit �yp� P[NEY WD()0S W0J Tl
- - - -
Certification No.: W U) 15 $ (q SigningOfficial: ZT066PR I'r' SADLEe R
Grade: Phone Number: Q_ 92(o- 12- 2- ti Signing Official's Title: /A iI N A GEk
-Has-the-ORG-changed-since-the-previous_ND.MR? _QYes _NNoPhone Number:C.Sa) 9j& 2-2-2-4 Permit Expiration: n?
—i -
Signature
By this signature, I certify that this report is accurrale and complete to, ihe best of my knowledge.
Date v Signature Date
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.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center

NON DISCHARGE APPLICATION REPORT Page G- of -_
SPRAT{ IRRIGATION SITE(S)
PERMIT NUMBER: _c�00;;84�?!? TOTAL NUMBER OF FIELDS: �_ MONTH:. j YEAR: a0,%
FACILITY NAME: P� �-p(,v ` M . P CLASS: -� COUNTY:
Formulas
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/Foot)] /.[Area Sprayed (acres) x 43,560 (square feetlacre)]
Maximum Hourly Loading (inches) =Daily Loading (inches) / [Time Irrigated (minutes) / 60 (minutes(hour)) 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)
Average Weekly Loading (inches) = [Monthly Loading (inches/month) /Number of days in the month (days/month)] x7 (days/week)
FIELD NUMBER: Cl 10
FIELD NUMBER: l
AREA SPRAYED (acres):
AREA SPRAYED acres): Y X 1
COVER CROP:
COVER CROP:
Permitted HOURLY Rate (inches): ®,
Permitted HOURLY -Rate (inches): 2y_
WEATHER CONDITIONS Permitted WEEKLY Rate inches): 0.17
Permitted WEEKLY Rata inches): o.
D
A Temp- Storage Maximum
Maximum
T Weather at Precipi- Lagoon Volume- Time Hourly Daily
Volume Time Hourly Daily
E Code* application talion Freeboard A plied Imgated Loading Loading
Applied Irrigated Loading Loading
('F) inches feel gallons minutes inches inchesallons
minutes inches inches
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Monthly Loading (inches)
12 Month Floating Total (inches) ((p
Average 'Weekly Loading (inches) D Q 0
' Weather Codes: S -sunny, PC -partly •cloudy. CI -cloudy, R -rain, Sn-snow, SI -sleet
OPERATOR IN RESPONSIBLE CHARGE (ORC) �p� SAoLerz GRADE _±C PHONE Zz
CHECK BOX IF ORC HAS CHANGED O
Mail ORIGINAL. and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, Nr_ 27626-535
X-- — �—----------
(SIG TURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY T IS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
.AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

FACILITY STATUS -
Please Sndiente (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 (7VA) in the
compliant box-)
nogD-
coni li�ant compliant
1. The application rate(s) did not exceed the limit(s) specified in the permit. El
2: Adequate measures were taken to. prevent wastewater runoff from the site(s)..
3. A suitabld vegetative cover was maintained ort 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 El
lilnit(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. t rovide in your explanon the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
-additional sheets if necessary.
_
7l5pE5 4D 4qf W EPC NDT CooIP14 AOT I N T-tFt= I Z V�tO�Tit
FW AT(N6- �DTALS
"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
(Sf gr(Iture off' Permittee) * (Date).
Po Box SUJ.AN IVC- 27 85 2) 912- 41 g6 1
1201-7
(Permittee Address) - (Phone Number) - (Per it xp. Date)
if ,ipled by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0306 (b) (2) (D).

NON DISCHARGE APPLICATION REPORT Page t- o,;
�SPRAY IRRIGATION SITE(S)
PERMIT NUMBER: U Q (DOQ'Sqg® TOTAL NUMBER OF FIELDS: t2- MONTI-I:3-AW68( YEAR: -1017
FACILITY DAME: lw". U)LJ TP CLASS: COUNTY
:�®�
Formulas
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feettacre)]
Maximum Hourly Loading (inches) =Daily Loading (inches) / [Time Irrigated (minutes)/ 60 (minuresfhour)] Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month F7onting Total (inches) =Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (inches) = [Monthly Loading (inches/month) /Number of days in the month (days/month)] x 7 (days/week)
A@FIELD HUMBER: JF ELD NUMBER: a�
kREASPRAYED (acres)- -. J jjEARFA QPRAVPr)farrnel- q II_
e �vJ
WEATHER CONDITIONS Permitted WEEKLY Rate (inches): 0-17 Permitted WEEKLY Rate inches):
D
A Temp -Storage Maximum
Maximum
7• Weather at Precipi- Lagoon Volume Time Hourly Daily Volume Time Hourly Daily
E Code` ap lication cation Freeboard Applied Irrigated Loading Loading Applied Irrigated Loading Loading
(•) inches feetgallons
mw -
WTI
minutes inches inches .Ilona minutes inches inches
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24
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26
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.,-u. :-:,,.r ,.., ...:,..:,fF r<. ..,L....>:: �>.. �:� : �..., .:.x�n,. ..,.^ .ro. .....r„>h”. .: k<, .<t -.,.:.<. .:?. .�, _.<, ... Y<•T-?2>: i?:yl'<.» :✓:: .'^.?Ss:::,:'3•:t:x. k.:^ <x>l.;c;-<..a..
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-t
28
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...3..z.- c;cz.a:.
f a'.;r.?>:?�Ylr><:...�:�<. ,s:..2a,<aY<Xa..'n '.�z--.<>;. �.:;� ..:£l.=`.<.&.?..':z:�i<:t:F?.3t,a35x-:xsna;.✓,`.>:
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W----
Weather
e<,3..Ias�:::t.�i%�'�;did::.::.�z.k”'�'`.w•?.s£xs•.'<€F:i�w?.a•;rc'.z.s'n.,.'3:>:�;,.::'Sar.:<.
Monthly Loading (inches)
12 Month Floating Total (inches)
Average Weekly Loading (inches) ©� )�
Weather Codes:' S -sunny, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
OPERATOR IN RESPONSIBLE CHARGE (OIRC) nSEP14 F. SAI)L4E2
CHECK BOK IF ORC HAS CHANGED ❑
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL tlt]GT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
GRADE ::� PHONE ZC
X -- --
(S G ATU E OF O ER
(S IN RESPONSIBLE CHARGE)
BY IS. SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO T; IE BEST OF 911Y KMOWLEDGE.

FACILITY STATUS*
Tease indicate (by c➢aecking the appropriate box) whether the facility has been-coarelsliant or noxa -compliant
%vg -i n the fallowing pernnii require-ments. (Note: 1f a requirement does not apply to your facility put (NA) in the
ce inplIai box.)
non-
compliant compliant
1� 'pile 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).
I A suitable vegetative cover was maintained on the site(s) in accordance with Ifl
the permit.
4. All buffer zones as specified in the permit were maintained during each Mal
application.
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the
limit(s) specified in the permit.
vt
r� 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.
ZC)Ij5 crg* 9c.-14
Com& 6 r tJ " 71+0 IL mole i
-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 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"
CCU" , Y OF LU D E-
ff�r,rrnittee- Please print or typo
(5igUaturdof Permittee)* (.Date)
s�� Q�t� ofN
'Permittee Address) (Phone flu-mben) (Per -it E cp. Date)
6e signed by ocher than the permittee, delegation of signatory authority must be OR file with tine state per 15A NCAC 2B.0506 (b) (2) (D).

BION DISCHAnGE API;"Im CA7iON REPOai7 Page _4� o1 �
. SPRAY IRRIGA73ON SITE(S)
PERMIT NLIMBER:wiTOTAL NUMBER OFIELDS: - �— MONTH: fl_ YEAR:
_it _
FACILITY NAME: �JV�� 1,�00�_��) (.a1 i CLASS: _ �' COUNTY:
Formulas
Daily Loading (inches) ,= [Volume Applied (gallons) x 0.1336 (cubic feeVgallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feet/acre)]
Maximum Hourly Leading (inches) =Daily Loading (inches) / [Time Irrigated (minutes) / 60 (minutes/hour)] 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 Monihly Loadings (inches)
Average Weekly Loading (inches) = (Monthly Loading (inches/month) /Number of days in the month (days/month)] x 1 (days/weA)
Weather Codes: S -sunny, PC -partly cloudy, CI -cloudy, R. -rain, Sn-snow, SI -sleet
OPERATOR IN RESPONSIBLE CHARGE (ORC) MSEPH E S .MEP_ GRADE _�T_ PHONE (72_6- 2_22�
CHECK BOX IF ORC HAS CHANGED ❑
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
(SI ATUR OF OPERATOR 1N RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
FIELD NUMBER: 6 FIELD NUMBER:
AREA SPRAYED (acres): AREA SPRAYED (acres):
p
COVER CROP: INE TEEES COVER CROP: ONES EE=5
Permitted HOURLY Rate (inches): (D , 2� Permitted HOURLY Rate (inches): 0.
WEATHER CONDITIONS
Permitted WEEKLY Rate inches : ®, 2—S Permitted WEEKLY Rate (inches): (9.
6laximum Maximum
D
Temp. Storage
A
Weather at Precipi- Lagoon
Volume Time
Hourly Daily Volume Time Hourly Daily
T
E code* application tation Freeboard
Applied irrigated
Loading Loading Applied Irrigated Leading Loading
CF) inches feel
8311 ons minutes inches- inches allows minutes inches inches
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26
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Vr.:1': �9.'ii ..n, a„�Z X .t ✓.< \J::3.>`.'Z,` e.,
Monthly Loading (inches) S{
12 Month Floating Total (inches)
Average Weekly Loading (inches) ®.
Weather Codes: S -sunny, PC -partly cloudy, CI -cloudy, R. -rain, Sn-snow, SI -sleet
OPERATOR IN RESPONSIBLE CHARGE (ORC) MSEPH E S .MEP_ GRADE _�T_ PHONE (72_6- 2_22�
CHECK BOX IF ORC HAS CHANGED ❑
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
(SI ATUR OF OPERATOR 1N RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

AGILITY STATUS:
Please indicate (by checking the appropriate boi) whether the facility has been compHant or non-compliant
with the foilowing permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.)
non -
Compliant C.O. nrpliant
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 ® �]
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."
OUAIT� OF DE
(ermittee- Please print or type)
. , I , -(S Aatur� of Permittee)* (Date)
PD. ,r4 Q w A e-rE2 ,C . a7 S DEL) )-�-- qA 31 .JOIZ_
(Permittee Address) Konz Number) (Permit Exp. Date)
* 3f signed by other than the permittee, delegation of signatory authority must be on Me with the state per 15A NCAC 2B.0506 (b) (2) (D).

NON DISCHARGE APPLICATION REPORT Page of
SPRAY IRRIGATION SITE(S)
PERMIT NUMBER:- (1)'Q OW?Nggq TOTAL NUMBER OF FIELDS: 12- MONTH: — YEAR:
FACILITY NAME: _P &- V! _Wooj)_5 __w jP_-- — CLASS: _ COUNTY:L---
Formulas
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feet/acre)]
Maximum Hourly Loading (inches) =Daily Loading (inches) / [Tune Irrigated (minutes) / 60 (minutes/hour)] 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)
Average 6dexkly Loading (inches) = [Monthly loading (inches/month) /Number of days in the month (days/month)].- 7 (daystweek)
Weather Codes: S -sunny, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet r I'
OPERATOR IN RESPONSIBLE CHARGE (ORC) Q$ Fluff T . sPr ��2_ GRADE PO�OPIE ��% - z?�4
CHECK BOX IF ORC HAS CHANGED ❑
Mail ORIGINAL and TWO COPIES io:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGA'.
DEHNR
P.O. BOX 29535
RALEIGH, NC 27626-535
)(- ---------------
(S G ATU E OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
TATE
AND COMPLETE TO TIME BEST OF MY KNOWLEDGE.

1!`t'ACIUI Y STATUS:
'lease indicate (by checking the appropriate box) whether the facility has been compliant or non-compliant
w th the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant bo -.0
non-
compliant
9®tll-
com ls�iant compliant
Js . 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). 0
3, A suitable vegetative cover was maintained on the site(s) in accordance with
the permit.
4s All buffer zones as specified in the permit were maintained during each
application.
S. ITte 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.
"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 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."
(permittee -Please print or type),
FA
Address)
�2s�► a 6 of
(Phone Number) (Permit Exp. Date)
fa sigued by other 'than the peiTnittee, delegation of signatory authority must be on rile with the state per 15A NCAC 2B.0506 (b) (2) (D).

WN USCHARGE APPUCATION REF -'ORT Page
SPRAY IRI slGAMN SITE(S)
PERMIT NUMBER: t=,Q& QQC') : 45Z!2 TOTAL NUMBER OF FIELDS:�;� MONTH T A1GPAk YEAR: 01
FACILITY NAME: _ �J � � a — _( --_-- CLASS: _ COUNTY: --
Formulas .
Daily Loading (inches) - = [Volume Applied (gallons) x 0.1336 (cubic reet/gallon) x 12 (inches/fool)) / [Area Sprayed (acres):, 43,560 (square feetlacre)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / [Time Irrigated (minutes) / 60 (minutes/hour)) 1.1on1hly Loading (ircb-s) =Sum of Daily Loadings (inches)
12 Munth Floating Total (Inches) =Sum of this months tslonthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (Inches) = [Monthly Loading (inches/month) / Number of days in the month (days/month)) x 7 (days/week)
Weather Codes: S -sunny, PC -partly cloudy, CI -cloudy, R-rain,
,SSn--[snow, SI -sleet
T
OPERATOR IN RESPONS113LE CHARGE (ORC) gJ F � � r LEP, C,RADE � PHO,13S )4-2-22-
CHECK
4A2-2?CHECK BOX IF ORC HAS CHANGED 0
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
(SIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. SON 29A35
RALEIGH, HC 27626-535
NDAR-1 (7/94)
(SI TUBE F OPERATOR IN RESPONSIBLE CHARGE)
BY IS SIGNATURE I CERTIFY TH AT •HIS ?REPORT IS ACCURATE
ANIS COMPLETE TO THE BEST OF MY It:NOINI-EDGE.
FIELD NUMBER:
FIELD NUMBER: ap
AREA SPRA YEDacres):�e
ARE,. SPRAYED acres C
pA
COVER CR F7 �
IN
COVER CROP: = _5
Permitted HOURLY Rate (inches): o. 2 -S
Permitted HOURLY Rate (inches): -
WEATHER CONDITIONS
Permitted WEEKLY Rate(inches): 0 .
Permitted WEEKLY Rate inches):
MaximumMalimum
P
Temp. Storage
A
T Weather at Precipi- Lagoon
Volume Time Hourly Daily
Volume Time Hourly Daily
,
E Code^ application talion Freeboard
r`,p lied Irrigated Loading Loading
Applied Irrigated Loading . Loading
('F) inches
feet
gallons minutes incites inches
gallons minutes inches inches
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28
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s
a d -fY 3i.._Yte•CsE it `C<h:.,,j3s¢t:£ '/yce
5 o0. +y3R t! +'f $�. 3t jxSf`+>.
:`:..,x,`T�Y�•4
Wn
301
Monthly Loading (inches)
'11q
44
12 Month Floating Total (inches)
L)
O' 1 -1 1
Averane 1Weekiv Loadino (inches)
Weather Codes: S -sunny, PC -partly cloudy, CI -cloudy, R-rain,
,SSn--[snow, SI -sleet
T
OPERATOR IN RESPONS113LE CHARGE (ORC) gJ F � � r LEP, C,RADE � PHO,13S )4-2-22-
CHECK
4A2-2?CHECK BOX IF ORC HAS CHANGED 0
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
(SIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. SON 29A35
RALEIGH, HC 27626-535
NDAR-1 (7/94)
(SI TUBE F OPERATOR IN RESPONSIBLE CHARGE)
BY IS SIGNATURE I CERTIFY TH AT •HIS ?REPORT IS ACCURATE
ANIS COMPLETE TO THE BEST OF MY It:NOINI-EDGE.

FACMITY STATUS.
pine ase indleate (ley cheeking the appropriate box) whether the facility has been r:d M-011ant Or f OYI-con'plia"t
<,'Bei2 the fo lowirig perfri t reit lliremiants: (Note: If a require)nent does not i1,p' )'toYoicr f7cilitvPur (NA) in the
c.;IVIia it box- ncre-
somplinnd eons 1Qai3t
, '1 he application rate(s) did not exceed the limit(s) specified in the pernniA.
r�de�ua measures were taken to prevent wastewater runoff from the site(s).
I �Aj suitable vegetative cover was maintained on the site(s) in accordance with
the. permit.
4. AI! 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.
iirnit(s) specified in the pernnit.
11f the facility is non-compliant, please explain in the space below the reason(s) the, facility was not in compliance with its
par indt. Provide in your explanation the date(s) of the noncompliance and describe the corrective action(s) taken_ Attach
additional sheets if necessary.
-SEs o03 ooy u)ERe WDIUCOMPU01' 1 10 TOE ►Z VAD Elf FLPATiN&
`=1 rtify, under penalty of law, that this document and all attachments were;repared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information
submitted. Based oil 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
e
corl-iplete. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
CduN i I 6)F a -�h r
(Permittee- Please print or type.)
of Permittee)*
13laolI
(Date)
D 6�X (oto �W�ry QUA TE2 /U'e• (9,7/3t/400
(Perrrditee Address) (iee,Yae Ne.ra1)r:u) (PerinitExp. Date)
^` H signed by odiel- tBan5 the permittee, delegation of signatory authority must be on Me ;wiih the sstaite per 15A i CAC 2B.0506 (i)) (2) (D).

NON DISCHARGE APPLICATION REPORT Page l of (-L
SPRAY IRRIGATION SITE(S)
PERMIt NUMBER: (4 -TOTAL NUMBER OF FIELDS: _ LZ. MONTH:.JA00fty TEAR: (7
FACILITY NAME:' Wootivz,_ [RiWTe CLASS: COUNTY:
Formulas
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] /(Area Sprayed (acres) x 43,560 (square feetlacre)] .
Maximum Hourly Loading (inches) =Daily Loading (inches) / [Time Irrigated (minutes) / 60 (minutes/hour)] Monthly Loading (itches) =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)
Average Weekly Loading (inches) = [Monthly Loading (inches/month) I Number of days in the month (dayslmonth)] x 7 (days/week)
FIELD NUMBER: Q ®� FIELD NUMBER:
AREA SPRAYED acres : , Z AREA SPRAYED (acres): (�
COVER CROP: PINE S COVER CROP:
Permitted HOURLY Rate (inches): Permitted HOURLY Rate (inches): �-
WEATHER CONDITIONS
Permitted WEEKLY Rate (inches): 01 Permitted WEEKLY Rate (inches): eL.29
D
A
Temp_ Storage
Maximum Maximum
T
Weather at Precipi- Lagoon
Volume Time Hourly Daily Volume Time Hourly Daily
g
Code' application talion Freeboard
Applied Irrigated Loading Loading Applied Irrigated Loading Loading
inches feet
gallons minute¢ inches inches gallons minutes inches inches
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Monthly Loading* (inches) 3 t
12 Month Floating Total (inches) b 14
Average Weekly Loading (inches) QZ..
c Weather Codes: S -sunny, PC -partly, cloudy, Cf -cloudy, R-rain,
,SSn-snow, SI -sleet
OPERATOR IN RESPONSIBLE CHARGE (ORC) V EPH SADIZ
9 GRADE jl� PIIO[tIE qZ6— Z?Z'
CHECK BOX IF ORC HAS CHANGED .(]
Mail ORIGINAL and TWO COPIES to:
ATTN: COMPLIANCE GROUP
DIV. OF ENVIRONMENTAL MGT.
DEHNR
P.O. BOX 29535
RALEIGH, NO 27626-535
X- --- �� -- --
(Sl ATUR OF OPERATOR IRRESPONSIBLE CHARGE)
B IS 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.
-Ath the following permit Yequire xaentse (Note: If a requirement does not apply to your facility put (NSI) in the
Compliant box.)
non-
compliant compliant
�. 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 suifable 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 El
application.
�o
The freeboard in the treatment and/or storage lagoons) was not less than the
limits) specified in the permit.
If the facility is non-compliant, please explain in the space below the reasons) the facility was not in compliance with its
permit. "Provide in your dxplana-tion the date(s) of the noncompliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
,QALlj 12 ►moofff FL-oATJ �G ToTWL n nl ZOVE Cot WA -5 tuo T
(owinuAVJT w1T4 Ll MIT:
"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."
Couti v © 14�bF
�(P- Please ,print or type)
,oe1A�. & �� OiJ131.7017
(816haturC of Permittee)* (Date)
P.O. OX(__ (ab f�N u �A R`r�J2 ,AI, C. 7�g�s - [
(Peryr�ittee ddress) { l orae Number) (Permit Exp. Date)
if signed by other than the perinittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b) (d) (D).