WQ0000267_Monitoring - 01-2021_20210225

FORM: NDAR-1 05-16
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page � of �{

FORM: NDAR-1 o5-1s 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{ompliant
❑� 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?
Signature
252-287-5957
❑Yes ❑� No
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Perm ittee:
County of Gates
Signing Official: Althea Riddick
Signing Official's Title: Chairman, Board of Commisioners
Phone Number: 252-357-1240
Date �� Signature
Permit Exp.: 6/30/21
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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 05A6
NON=DISCHARGE MONITORING REPORT (NDMR)
Page.n of
Permit No.: WQ0000267 Facility Name: Gates County WWTFs County: Gates Month: January Year: 2021
PPI: 001 Flow Measuring Point: ❑Influent Mj Effluent ❑No flow generated Parameter Monitoring Point: ❑Influent (]Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code 50050 00310 00940� y 50060 "'1616 ;,. � 00610 00625 00620 00611%00 ,,�- 00400 00665.. ;'` 70300
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FORM: NDMR 05A6 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s)
Name: Bobby Fox 11 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? &jCompliant ❑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 corcective
action(s) taken. Attach additional sheets if necessary,
to delayed maintenance due to covid-19, the influent reading is
Operator in Responsible Charge (ORC) Certification
estimated.
Permittee Certification
oRc: Timothy Hedgepeth Permittee: County of Gates
Certification No.: Sk995918 / CS-995758 Signing Official: Althea Riddick
Grade: 1 Phone Number: 252-287-5957 Signing Official's Title: Chairman, Board of Commisioners
Has the ORC changed since the previous NDMR? QYes ❑� No Phone Number: 252-357A240 Permit Expiration: 6/30/2021
�It7
c -
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 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