WQ0002560_Monitoring - 06-2021_20210802

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month:* June
Report Information
WQ0002560
Town of Bailey WWTP
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
Town of Bailey - Binder.pdf 514.89KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Rebecca Manning
14a 1f W W1�!.?
Reviewer: Zhong, Vivien
8/2/2021
This will be filled in automatically

Is the project number correct?* WQ0002560
Is the monitoring report accepted?* Yes NO
Regional Office* Raleigh
Accepted Date:
12/3/2021

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 1 of 2

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page oft
Did the application rates exceed the limits in Attachment I ' permit?
Were adequate measures taken to prevent effluent pondil��°ri° Knoff from the sites?
compl Non -
Was a suitable vegetative cover maintained on all sites as%�6&ft 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?
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.
Yei] No
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: William Lamm
Permittee:
Town of Bailey l �G���� 17"Lb'2415
/
7 �1
Certification No.: 148134
Signing Official;
Grade: SI Phone Number: 252-235-4900
Signing Official's Title: Mayor
Has the ORC changed since the previous NDAR-1? Yes
Phone Number: 252-235-4977 Permit Exp.: 5/31 /26
�}
7G Iry
Signature Date
Signature Date
By this signature, I rertifythat 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 offines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (N©MR) Page 1 of 2

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 2
Sampling Person(s) Certified Laboratories
Name: D_ Lynn Pope Name: Meritech, Inc.
r❑ Compllant0 Non -Compliant
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
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.
❑ yes ElNo
Estimated flow from influent. Meter is not working properly.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: William Lamm
Permittee: Town of Bailey
Certification No.: 11693
Signing Official: Thomas Richards
Grade: IV Phone Number: 252-235-4900
Signing Official's Title: Mayor
Has the ORC changed since the previous NDMR? Yes
Phone Number: 252-235-4977 Permit Expiration: 5/31/2026
Signature
Date Signature Date
By this signature. I certify that this report is accurrate and complete to the best of my knowledge. I c*". unifier pmairy of taw. that this document anu all ottarhmontx were prepared under my dreclion orscporvision In accordance
to tmt aft personnel property gathafed ane evakwled the tnformaton submdtod, eased on my
wiAt a 6ystem designed assure qua:lred
4equiry 0 the parson or persons who maiage Iho system. or those persons dlfactly responsible for gathering thtr rnrormabon,"
information Submitted is, to the best of my knowledge anf8 Wef, true, accurate- and comnleta. I am aware fhet there are signiflcenl
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
Raleigh, North Carolina 27699-1617