WQ0006941_Monitoring - 08-2022_20221003

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * August
Report Information
WQ0006941
Stoney Creek Elementary School
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2022
Upload Document*
Stoney Creek —Aug 22.pdf 558.31 KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Jessica Mize
jwd rA lip
Reviewer: Gerald, Wanda
10/3/2022
This will be filled in automatically

Is the project number correct?* WQ0006941
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 10/4/2022

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _2_ of _2_
Permit No.: WQ0006941
Facility Name:
Stoney Creek Elementary School
County: Caswell
Month:
August
Year:
2022
• irrigation occur
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Field Name:
Field Name
Area (acres.
Area (acres):
Area (acres):
Area (acres):
at this facility?
Cover Crop:
Cover Crop.,
C Over Crop
Cover Crop:
o ■ •
-.
r
-.
-.
-.
SM, rim. I
Annual Rate (iny.
Annual Rate (in):
...
Field .,
o ■ I
Field Irrigated?'■
■ .
.. ..
■ •Field
Irrigated?■
■
-
N
-
-

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
l_r<Mpliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
LTCompliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
5?6mpliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
Incompliant
0 Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
0,el5mpliant
❑ 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 11 Permittee Certification
ORC: Glenn Price Permittee:
Baron Neal McDuffie (Authorized Agent)
Certification No.: 987931/20771 Signing Official: Baron Neal McDuffie
Grade: II Phone Number: 336-996-2741 Signing Official's Title: Field Services Director (Pace Analytical Services)
Has the ORC changed since the previous NDAR-1? ❑ Yes 0 No Phone Number: 336-996-2841 Permit Exp.: 8/31/21
%9/..,v Ii A / "'a 3 - z 3_
Signature Date X nature 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 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) Page _1_ of —2—
Permit
No.: w000.94Stoney --k Elementary School- .2022
11 •. Point:
Parameter ..: rr r rr r rr.r rr. r rr. rr. r rr.rr rr rr rr.. rr r
MEMO
Daily Maximum:
Daily Minimunr
Sampling Type:'
Monthly
° ° -®-

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s)
Name: Glenn Price
Certified laboratories
Name: Pace Analytical Services
Name: II Name:
Does all monitorinci data and samDlina freauencies meet the requirements in Attachment A of your nermit?
❑ Non-compiiant
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
ORC: Glenn Price
Permittee: Baron Neal McDuffie ( Authorized Agent)
Certification No.: 987931/20771
Signing Official: Baron Neal McDuffie
Grade: II Phone Number: 336-996-2841
Signing Official's Title: Field Services Director ( Pace Analytical )
Has the ORC changed since the previous NDMR? ❑ Yes O No
Phone Number: 336-996-2841 Permit Expiration: 8/31/2021
�
Signature Date
R69ature 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