WQ0002096_Monitoring - 07-2020_20200827

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: W00002096
Facility Name: Pinewood Manor Rest Home
County: Hertford
Month: July
Year: 2020
PPI: 001 Tlow
Measuring Point: ❑ Influent ❑ Effluent No flow generated
Parameter Monitoring Point: a Influent '❑ Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code -►
50050
00400
00310
1 31616
00530
00610
00625
00630
00665
7-7—-
Q
@
°i
a E
U F-
O
C
O
2
O
c
LL
o
m
"o
ILL
U
o
a
mc
F- N fn
ri
o
E
Q
@ C
aZ
y m
cM
.,
ZZ
CE
F- y
s
n
24-hr
hrs
GPD
su
mg/L
#1100 mL
mg/L
mg/L
mg/L
mg/L
mg/L
1
2
09:00
0.5
3
4
5
15:00
0.5
6
7
8
08:00
1
9
10
09:00
0.5
11
12
13
09:00
0.5
14
15
16
09:00
0.5
17
'
18
15:00
0.5
19
20
21
22
23
09:00
0.5
24
25
09:00
0.5
26
271
09:00
0.5
28
09:00
0.5
29
30
15:30
0.5
31
Average:
#DIV/01
Daily Maximum:
0
Daily Minimum:
0
Sampling Type:
Estimate
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Monthly Avg. Limit:
7,500
Daily Limit:
Sample Frequency:
Continuous
3/year
3/year
3/year
3/year
3/year
3/year
3/year
3/year

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of -
Sampling Person(s) Certified Laboratories
Name: Randy Parker Name: Environment 1, Inc.
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑� Compliant ❑ 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.
Flow meter used to record daily flow is not working properly. The reading on
was also notified,
were the same. The Hertford County Public Works Department was called to fix or repair
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Randall Parker
Permittee: Pinewood Manor Rest Home
Certification No.: 996843
Signing Official: Paula Armstrong
Grade: SI Phone Number: 252-287-4153
Signing Official's Title: Administrator
Has the ORC changed since the previous NDMR? ❑ Yes No
Phone Number: 252-513-8591 Permit Expiration: 4/30/2020
•
�. 20
Signature Date
Signat 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

.FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0002096
Facility Name: Pinewood Manor Rest Home
County: Hertford
Month: July
Year: 2020
Did irrigation occur
Field Name:
Site1
Field Name:
Site 2
Field Name:
Site 3
Field Name:
Site 4
this facility?
Area (acres):
1.75
Area (acres):
1.33
Area (acres):
1.35
Area (acres):
1.5
at
Cover Crop:Trees
Cover Crop:
p:
Trees
Cover Crop:
p:
Trees/Bermuda
Cover Crop:
p:
Bermuda
❑ YES ❑ NO
Hourly Rate (in):
0.25
Hourly Rate (in):
0.25
Hourly Rate (in):
0.25
Hourly Rate (in):
0.25
Annual Rate (in):
31.5
Annual Rate (in):
31.5
Annual Rate (in):
18
Annual Rate (in):
18
Weather
Freeboard
Field Irrigated?
_I YES `l No
Field Irrigated?
YES ❑ NO
Field Irrigated?
❑ YEs J No
Field Irrigated?
❑ YES (] rvo
A
N
1�0
d
G
�+
d
C
•
iD
_
Q
O
G
O
O
MJ
n'�
.
�
E
J
=i
MJ
�N
G
0
J
3`C
=J J
3
a
R
.
G_C.
E . G>�
o
O OO
JL
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
C
72
2
C
70
0.04
3
C
70
4
C
72
5
C
70
6
1 C
72
7
C
74
8
C
75
9
C
78
0.07
10
C
75
0.23
11
C
76
121
C
73
13
CL
72
14
C
66
0.11
15
C
72
16
C
70
T)w
60,000
600
1.66
0.17
17
C
72
181
C
1 70
19
C
75
0.02
20
C
79
21
C
78
22
C
80
23
C
80
241
CL
1 73
0.2
25
C
75
26
C
76
27
C
75
28
C
77
79,800
798
1.68
0.13
29
C
73
0.01
301
C
73
6�
31
CL
79
0.00
Monthly Loading:
79,800
1.68
60,000
M
1.66
0
0.00
0
12 Month Floating Total (in):
13.57
,�
16.27
8.31
�,
10.66

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of ,
Did the application rates exceed the limits in Attachment B of your permit?
0 Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 0 Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑ Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 2] Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? [E Compliant ❑ 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: Randall Parker
Permittee:
Pinewood Manor Rest Home
Certification No.: 996843
Signing Official: Paula Armstrong
Grade: SI Phone Number: 252-287-4153
Signing Official's Title: Administrator
Has the ORC changed since the previous NDAR-1? ❑ Yes [�] No
Phone Number: 252-513-8591 Permit Exp.: 4/30/20
Sign re 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 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

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.:lIII I••
-wood Manor Rest Home
.unty: Hertford
irrigation
• occurArea
(acres):
Area (acres):
at this facility?
Cover Crop:
Hourly Rate (in
Hourly Rate (in):
Hourly Rate (in):
Annual Rate (in):
Annual '.
Field Irrigated?
Field Irrigated?
i
Monthly Loading:
0 ,.,

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
El Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 0 Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 0 Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 2 Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑ Compliant ❑ 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: Randall Parker Permittee:
Pinewood Manor Rest Home
Certification No.: 996843 Signing Official: Paula Armstrong
Grade: SI Phone Number: 252-287-4153 Signing Officials Title: Administrator
Has the ORC changed since the previous NDARA? ❑ yes 0 No Phone Number: 252-513-8591 Permit Exp.: 4/30/20
L
Signature Date Sig ure 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