WQ0000267_Monitoring - 09-2020_20201027

FORM: NDAR-1 05-16
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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FORM: NDARA 05A6
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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 speced freeboard heights in your permit?
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Compliant ❑Non -Compliant
❑✓ Compliant ❑Non -Compliant
OCompliant ❑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
action(s) 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: 252-287-5957
Permittee Certification
Permittee:
County of Gates
signing Official: Ray Freeman
Signing Official's Title: Chairman, Board of Commisioners
Has the ORC changed since the previous NDAR-1? ❑Yes ONo II Phone Number: 252-357-1240 Permit Exp.: 6/30/21
Signature "" ry Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Signature
Date
I certfy, 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 property 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699=1617

FORM: NDMR 05-16
NON -DISCHARGE MONITORING REPORT (NDMR)
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FORM: NDMR 05A6 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s)
Name: Bobby Fox
Name: Environment 1, Inc.
Name: Tom Beasley 11 Name:
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Compliant ❑Non -Compliant
If the facility is non -compliant, please explain in the space below the reasons) the facy was not in compliance. Provide in your explanation the dates) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary,
influent meter is still not
Made several calls and emails. Khrone is working on sending a tech out to the site. The readings are estimated. An admendment will be sent as soon as the
Operator in Responsible Charge (ORC) Certification
Permittee Certification
oRC: Timothy Hedgepeth Permittee: County of Gates
Certification No.: Sk995918 / CS-995758 Signing Official: Ray Freeman
Grade: 1 Phone Number: 252-287-5957 Signing Official's Title: Chairman, Board of Commisioners
Has the ORC changed since the previous NDMR? ❑Yes 7No Phone Number: 252-357A 240 Permit Expiration: 6/30/2021
eg
Signature Date Signature Date
By this signature, I certify that this report is accumate 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 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699=1617