WQ0019908_Monitoring - 09-2023_20231018

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month: * September
WQ0019908
Country Club of Johnston County
Report Information
Type *
Revised - NDMR, NDAR-1, NDAR-2, NDMLR
Year:* 2023
Upload Document*
NDMR SEPTEMBER 2023.pdf 437.02KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * astephens3241 @gmail.com
Name of Submitter: * andrew stephens
Signature:
olwa%t r 44W.�..,
Date of submittal: 10/18/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* W00019908
Is the monitoring report accepted?* Yes NO
Regional Office* Raleigh
Reviewer: _anonymous
Review Date: 10/19/2023

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page I of L-
Sampling Person(s) Certified Laboratories
Name: NA Name: NA
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Vompliant ❑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
Ld-1.P 111.UUI--JI1.-11,-... —Y.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
oRC: �c� S
Permittee: H Lake Golf & R'fejc. LLC DBA Johnston Co. Country Club
jolt
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Certification No.: NA
Signing Official:C t / ,
Grade: NA Phone Number:
Signing Official's Title: e,, e, ( { f!"r �
Has the ORC change ince the pre ' us NDMR? C7X-
No
Phone Number: / 5 13 q ""- -(d k it Expiration:
ig ture
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 offines and imprisonment for
knowing violations. '
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Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617