WQ0006941_Monitoring - 05-2023_20230628

Monitoring Report Submittal
....................................................
Permit Number#* WQ0006941
Name of Facility:* Stoney Creek Elementary School
Month: * May Year: * 2023
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR Stoney Creek —May 2023.pdf 1.02MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * Jessica. [e-mail]
Name of Submitter: * Jessica Mize
Signature:
je"&A jot
Date of submittal: 6/28/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* W00006941
Is the monitoring report accepted?* Yes NO
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 7/14/2023

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page _1_of_2_
Permit No.: WQ0006941
Facility Name: Stoney Creek Elementary School
County: Caswell
PPI: 001
Flow Measuring Point:
Parameter Monitoring Point:
Parameter Code —►
`, S0050:
00310
50060;
31616
00610
00625
'6662Q
00600
00400
00665
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1
1,216
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3
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0.25
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Month:
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Year: 2023
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) Certified Laboratories
Name: Glenn Price Name: Pace Analytical Services
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ff6mpliant ❑ Mon-Comptiant
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
taKen. Auacn aoomonal sneers Ir 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 Officials Title: Field Services Director ( Pace Analytical )
Has the ORC changed since the previous NDMR? ❑ Yes 2 No
Phone Number: 336-996-2841 Permit Expiration: 8/31/2021
2? Z 7
e:��Z4 -.z
Signature Date
Signatur 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: 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: May
Year: 2023
Did irrigation occur
Field Name:
1
Field Name:
Field Name:
Field Name:
facility?
Area (acres):
3.12
Area (acres):
Area (acres):
Area (acres):
at this
Cover Crop:
P�
Woods
Cover P�
Cover P�
CoverCro P:
- YES
Hourly Rate (in):
0.3
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Annual Rate (in):
18.72
Annual Rate (in):
Annual Rate (in):
Annual Rate (in):
Weather
Freeboard
Field Irrigated?
YES __-1 NO
Field Irrigated?
❑ YES -j NO
Field Irrigated?
YES NO
Field Irrigated?
= YES
R
❑
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Monthly Loading:
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0
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0
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0
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12 Month Floating Total (in):
4.72

FORM: NDAR-1 05-16
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page _2_ of _2_
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?
E CCo/ompliant ❑ Non -Compliant
61C mpliant ❑ Non -Compliant
[}dmpliant ❑ Non -Compliant
Q-Compliant ❑ Non -Compliant
EAmpliant ❑ 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
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 Officials Title: Field Services Director (Pace Analytical Services)
Has the ORC changed since the previous NDAR-1? ❑ Yes ONO
Phone Number: 336-996-2841 Permit Exp.: 8/31/21
` 7
!< ,)�_ V.
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 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

aceAnalytical
www.pacglabs.com
Pace Analytical Services, LLC
1377 South Park Drive
Kemersville, NC 27284
[phone]
Laboratory Report
Caswell County Schools /Jerry
Caswell County Schools
P.O. Box 160
Yanceyville, NC 27379
Project: Stoney Creek Elementary
Pace Project No.: 92669854
Page 1 of 1
Report Date: 06/13/2023
Date Received: 05/31 /2023
Sample: Effluent Lab ID: 92669854001 Collected: 05/31/23 11:32 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 254OD-2015 Total Suspended Solids
34.8
mg/L
10.0
06/01/23 08:38
EPA 353.2 Rev 2.0 1993 Nitrogen, NO2 plus NO3
ND
mg/L
0.040
06/02/23 09:07
EPA 353.2 Rev 2.0 1993 Nitrogen, Nitrate
ND
mg/L
0.040
06/02/23 09:07
SM 521 OB-2016 BOD, 5 day
7.3
mg/L
2.0
06/06/23 09:52 R6
Colilert-18 Fecal Coliforms
ND
MPN/100mL
1.0
06/01/23 10:59 D6
TKN+NO3+NO2 Total Nitrogen
41.0
mg/L
0.040
06/13/23 06:52
Calculation
EPA 350.1 Rev 2.01993 Nitrogen, Ammonia
39.7
mg/L
1.0
06/09/23 13:13
EPA 351.2 Rev 2.0 1993 Nitrogen, Kjeldahl, Total
41.0
mg/L
2.5
06/09/23 07:18
EPA 365.1 Rev 2.0 1993 Phosphorus
4.9
mg/L
0.050
06/08123 15:52
ANALYTE QUALIFIERS
D6 The precision between the sample and sample duplicate exceeded laboratory control limits.
R6 The RPD between valid sample dilutions exceeded 30%.
Reviewed by:
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Asheville
2225 Riverside Drive, Asheville, NC 28804
South Carolina Laboratory ID: 99030
Florida/NELAP Certification #: E87648
South Carolina Certification #: 99030001
North Carolina Drinking Water Certification #: 37712
Virginia/VELAP Certification #: 460222
North Carolina Wastewater Certification #: 40
Pace Analytical Services Eden
205 East Meadow Road Suite A, Eden, NC 27288
North Carolina Wastewater Certification #: 633
North Carolina Drinking Water Certification #: 37738
Virginia/VELAP Certification #: 460025
Page 1 of 3

CHAIN -OF -CUSTODY Analytical Request Document
� � ~W LAB USE ONLY- Affix Workorder/LoginLabelHere orUstPace WorkorderNumber or T
-P CeAnalytical
/ Chain -of -Custody is a LEGAL DOCUMENT T-Complete all relevent fields
' Q
�� ��
SH� IIIIj' �I I'I
ContainerPreservative
D z a i�-'926I69854 ! I
•• Preservative Types: (1) nitric acid, (2) sui...........
(6) methanol, (7) sodium bisulfate, (B) sodium thiosulfate, (9) hexane, (A) ascorbic acid, (B) ammonium sulfate,
(C) ammonium hydroxide, (D) TSP, IU► Unpreserved, (0) Other
Company:
Stoney Creek Elementary
Billing Information:
Address:
ReportTo:
Email To:
Copy To:
Site Collection Info/Address:
Analyses
Lab Profile/Line:
Customer Project Name/Number:
State: County/City: Time Zone Collected:
Lab Sample Receipt Checklist:
/ ( ]PT[ ]MT( ]CT ( ]ET
Z
Y
Custody Seals Present/Intact Y N
Custody Signatures Present 1Ll
Collector Signature Present - N NA
Bottles Intact N NA
Correct Bottles w NA
Phone:
Email:
Site/Facility ID #:
Compliance Monitoring?
( /Yes I ) No
Collect (print):
Purchase Order #:
DW PWS ID #:
Quote #:
DW Location Code:
Z
rj
p
Z
Z
O
0
0-
m
sufficient volume N NA
Samples Received on Ice N N
von - Headspace Acgceptable Y N
USDA Regulated Soils - �N
Samples in Holding Time (lf2i NA
Residual Chlorine Pre nt "�� 6}4A
Cl Strips: 132,
Sample pH Aeceptabl� ` 1 9 � NA
PH Strips: zb ZZSS O
Sulfide Present - Y N t31
Lead Acetate Strips:
Collected By (signature):
Turnaround Date Required:
immediately Packed on Ice:
( ]Yes ( )NO
Sample Disposal:
I I Dispose as appropriate ( ) Return
( 1 Archive:
( (Hold:
Rush:
( J Same Day ( ] Next Day
[ 1 2 Day ( ] 3 Day [ ] 4 Day I ISDay
(Expedite Charges Apply)
Field Filtered (if applicable):
( ] Yes [ ] No
Analysis:
' Matrix Codes (insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Product (P), Soil/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
co
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p
Co IZ
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LAB USE ONLY: -
Lab sample # / Comments:
Customer Sample ID
Matrix •
Comp /
Grab
Collected (or
Composite Start)
Composite End
Res
Cl
# of
Ctns
ate
Time
Date
Time
Effluent
WIN
G
31
r 3
I
I
Customer Remarks / Special Conditions / Possible Hazards:
TYPe of Ice Used: Wet Bfue Ory None
SHORT HOLDS PRESENT (02 hours):
N N/A
Lab Sample Temperature Info:
Caswell County School,"
Temp Blank Received: Y N NA
Therm IDN: t I- r'
Cooler 1 Temp Upon Receipt:2oC
Packing Material Used:
Lab Tracking tt:
Radchem sample(s) screened (c500 cpm): Y N NA
Samples received via:
FEDEX UPS Client Courier Pace Courier
Cooler 1 Therm Corr. Factor: -- / oC
Cooler 1 Corrected Temp: 7 i oC
Comments:
Relinquished by/Co pony: (Signatur _
Da[ i
Rece' by/Company ignature)
Date/Time:
MTJL LA
1 /Z 3 I l f S
Table It:
Acctnum:
Rel4juished by/Company`-(Si ature)
ro
Date/Time:
Rec 1 ed by/Co pa yi ure)
Date/Time:
Template:
Prelogin:
Trip Blank Received: Y N NA
HCL McOH TSP Other
Relir&shed by/Company (Signature)
Date/Time:
Received by/Company: (Signature)
Date/Time:
PM:
Non Conformance(s): Page:
P8:
YES / NO of: ��

Document Name:
Document Issued: November 15, 2021
;aceAnal
Bottle Identification Form (81F)
Page i of 1
Document No.:
Issuing Authority:
lCal
F-CAR-CS-043-Rev.01
Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is
verified and within the acceptance range for preservation
samples.
Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/8015 (water) DOC, LLHg
**Bottom half of box is to list number of bottles
Project #
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pH Adjustment Log for Preserved Samples
Sample ID
Type of Preservative
pH upon receipt
Date preservation adjusted
Time preservation
adjusted
Amount of Preservative
added
Lot 4
Note: wnenever tnere is a ttiscrepancy atreaing Ncrtn Carolina compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office (i.e.
Out of hold, Incorrect preservative, out of temp, incorrect containers.
Page 3 of 3