WQ0035784_Monitoring - 02-2021_20210331

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0035784
Name of Facility:* Cottages of Boone
Month:* February
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
WQ0035784.pdf 10.7MB
FDF Cnly
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
[e-mail]
Kimber Reese
Reviewer: Williams, Kendall
3/31 /2021
This will be filled in automatically

Is the project number correct? * WQ0035784
Is the monitoring report r Yes r No
accepted?*
Regional Office * Winston-Salem
Accepted Date: 3/31/2021

FORM: NDA -1 08-11 NON -DISCHARGE APPLICATION REPORT (-1) Page 3 of
Did the applicationrates C the limits in Attachment B of your it? O Compliant ❑ Non -Compliant
measuresWere adequate taken to prevent effluent ponding in or runoff fromthe sites? 2 Compliant ❑ Non -Compliant
Was a suitable vegetative cover i t i on all sites specified in your permit? 9 Compliant ❑ Non -Compliant -
Were all setbacks listed your permit maintained for every application to each per itt site? [7 Compliant ❑ Non -Compliant
Were all freeboards maintainedin accordance withthe specifiedr i in your permit? M Compliant ❑ 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.
Operator in Responsible Charge (RC) Certification Permittee Certification
RC: Dale Holman Permittee:
Boone cottages
Certification No,: Sl 1003141 Signing Official:, Robert Barr
Grade: SI Phone Number: 328-251-1900 Signing Official's Title: Signatory
Has the ORC changed since the previous NDAR-1? 0 yes o Phone Number: 323-251-1900 Permit Exp.: 4/30/22
00.�-aA A�W-1 als { ­�_-2,
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 Quality
Information Processing Chit
117 Mail Service Center
Raleigh: North Carolina 27699-1617

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT () rage 5 of
Sampling Person(s) Certified Laboratories
Blame: Dale HolmanName: Water Tech Labs, Inc.
Name: Robert Barr Name:
Does all monitoring dataand samplingcis meet the requirements in Attachmenter i ? o compliant ❑ 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.
Operator in Responsible Charge (ORC) Certification Permittee Certification
O C: Dale Holman Permittee: Boone Cottages
Certification No.: SI1003141 Signing Official: Robert Barr
Grade: SI Phone Number, 523-251-1900 signing Official's Title: Signatory
Has the O C changed since the previous NDMR? ❑ Yes O No Phone Number: 32 -2 1-1900 Permit Expiration: 4/30/2022
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 Quality
Information Processing Unit
117 Mail Service Center
Raleigh, North Carolina 27699-1617