HomeMy WebLinkAboutWQ0000267_Monitoring - 03-2020_20200422FORM: NDAR-1 05-16
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page of
FORM: NDAR-1 IJ5-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page >�" of �`
Did the application rates exceed the limits 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 listed 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?
(]Compliant ❑Non -Compliant
Compliant ❑Non -Compliant
❑✓ Compliant ❑Non -Compliant
Compliant ❑Non -Compliant
(]Compliant ❑Non -Compliant
If the facility is non -compliant, please explain in the space below the reasons) the facility was not in compliance. Provide in your explanation the dates) of the non-compliance and describe the corrective
actions) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
oRc: Timothy Hedgepeth
Certification No.: SI-995918/CS-995758
Grade: 1
Phone Number:
Has the ORC changed since the previous NDAR-1?
252-287-5957
❑Yes (]No
Permittee Certification
Permittee:
County of Gates
signing official: Ray Freeman
Signing Official's Title: Chairman, Board of Commisioners
Phone Number: 252-357-1240
Permit Exp.: 6/30/21
F� �, ��
Signature Date Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. 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 signifignt
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDMR 05-16
NON -DISCHARGE MONITORING REPORT (NDMR)
Page ���~ of
FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Persons)
Name: Bobby Fox �� Name: Environment 1, Inc.
Name: Tom Beasley �� Name:
Certified Laboratories
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 reasons) the facility was not in compliance. Provide in your explanation the dates) of the non-compliance and describe the corrective
actions) taken. Attach additional sheets if necessary.
Kkrohne tech support andf sent email in reference to influent meter at lift station on 03-09-2020. Received email from Kkrohne 03-12-2020 stating the display screen appears to be
Operator in Responsible Charge (ORC) Certification
oRc: Timothy Hedgepeth
Certification No_: SI-995918 / CS-995758
Grade: 1 Phone Number:
Signature
252-287-5957
❑Yes QNo
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
Date
Permittee Certification
Permittee: County Of Gates
signing official: Ray Freeman
Signing Officials Title: Chairman, Board of Commisioners
Phone Number:
252-357-1240
Signature
Permit Expiration: 6/30/2021
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 qual�ed 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, inGuding the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617