WQ0022224_Monitoring - 11-2022_20221229

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * November
Report Information
WQ0022224
Sam's Branch WRF
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Year:* 2022
Upload Document*
November NDMR.pdf
PDF Only
2.55M B
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter: * William Simpson
Signature:
Date of submittal: 12/29/2022
This will be filled in automatically
Initial Review
Reviewer: Gerald, Wanda

Is the project number correct?* WQ0022224
Is the monitoring report accepted?* Yes No
Regional Office* Raleigh
Reviewer: _anonymous
Review Date: 1/19/2023

FORM: NDMR 03-12 NON -DISCHARGE NIT ING REPORT (NDMR) Pane of
)0022224 Facility Name: Sam's Branch " aJohnstonMonth: November
PPI: QQ ( Flow Measuring Point: nfluent ,J Effluent No flow generated
Parameter Monitoring Point: Influent u Effluent � Groundwater Lowering ❑ Surface Water
Parameter Code —D, 00310
31616
00610
00530
00076
_
Q
®
O
G
O
crs
E
P in
Cr
Q
_
u 2
0-
L.L o
0
c
6
E
E
0
o n
c
o `Q
N cn
a
g.
24-hr
1
hrs mg/
#/100 mL
mg/L
mg/L
NTU
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31L_
Average:
Daily Maximum:
Daily Minimum:
Sampling Type: Composite
Grab
Composite
Composite
Recorder
Monthly Avg. Limit: 10
14
4
5
Daily Limit: 15
25
6
10
10
Sample Frequency: 2 x Week
rG9onthly
2 x Week
2 x Weak
Continuous

11
FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT () Page of
Little Creek WRF
• #
PPI: 002
Flow Measuring Point: influent Effluent ✓ No flow generated
Parameter Monitoring Point: Influent Effluent Groundwater Lowering El Surface Water
Parameter Code -
WQ01
>
Q _E
0�
0
E
Q
cs
i4
24-hr
1
hrs
gallons
2
3
4
5
6
7
9
0
CD
10
�
11
.L
12
13
14
15
16
E
17
es
18
19
20
s
0
21
22
23
24
25
26
27
28
L30
Average:
Daily Maximum:
Daily Minimum:
SamplingType:l
Estimate
Monthly Avg. Limit:
Daily Limit:
Sample Frequency:
Monthly

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page -3 of
Sampling Person(s) Certified Laboratories
Name: William Simpson, Salvador Valdiviezo, Chad Wallace Name: Environment 1 Inc., Meritech Inc., Cameron Testing,
Name: Michael Ratley, Illona Williams 11 Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? E Compliant --i Non-Complill
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.
No Flow Generated for the Month of November
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: William R Simpson
Permittee: Town of Clayton, Sam's Branch WRF
Certification No.: 1001099
Signing Official: William Simpson
Grade: Boilogical 4 Phone Number: 919-553-1536
Signing Official's Title: WRF Superintendent
Has the ORC changed since the previous NDMR? L7] Yes No
Phone Number: 919-553-1536 Permit Expiration: 10/31/2026
IV
12/29/2022 12/2912022
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 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