WQ0002096_Monitoring - 08-2020_20200930

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Permit No.: W00002096
Facility Name: Pinewood Manor Rest Home
County: Hertford
Month: August
Year: 2020
Did irrigation
Field Name:
Sitel
Field Name:
Site 2
Field Name:
Site 3
Field Name:
Site 4
occur
Area (acres):
1.75
Area (acres):
1.33
Area (acres):
1.35
Area (acres):
1.5
at this facility?
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?
❑ YES ❑ NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YES ❑ NO
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J
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
PC
73
0.41
2
C
72
0.56
1.91
3
C
77
4
R
72
3.5
5
C
75
1.66
6
C
73
7
CL
73
8
PC
70
9
C
1 73
1.93
10
C
72
1.83
24,000
1 240
0.59
0.15
11
C
72
0.02
12
C
72
13
C
78
14
C
77
0.19
1.91
151
CL
73
0.31
16
C
72
0.49
17
CL
70
0.03
37,200
372
0.91
0.15
18
C
72
2
19
C
68
20
C
70
21
C
70
0.17
22
CL
75
0.29
23
C
72
18,000
180
0.49
0.16
24
CL
73
0.02
1.83
25
C
72
0.02
26
C
73
28,800
288
0.79
0.16
271
C
73
2
28
C
75
29
CL
79
30
CL
78
31
C
70
1 0.03
Monthly Loading:
0
0.00
0
0.00
46,800
L28
61,200
1.50
12 Month Floating Total (in):
12.75
15.44
8.44
12.16

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?
❑ 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? Q Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 0 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.
IOperator in Responsible Charge (ORC) Certification 11 Permittee Certification
ORC: Randall Parker
Certification No.: 996843
Grade: SI Phone Number: 252-287-4153
Has the ORC changed since the previous NDAR-1? ❑ Yes No
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee:
Pinewood Manor Rest Home
Signing Official: Paula Armstrong
Signing Official's Title: Administrator
Phone Number: 252-513-8591 Permit Exp.: 4/30/20
-I—
I Signature Date
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.: •111 1•. -
Pinewood Manor Rest Home
• • rd
.nth: August1
1
• irrigation occur
..�
this facility?
Area (acres):;..Area
(acresy.
at
Cover Crop:
Cover Crop:
YES F_ NO
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Annual Rate (iny.
Annual Rate (in�.
Annual Rate (in):
Field Irrigated?
�1111M Mm ZTUN���
Field lrrigated?'���
Field Irrigated?
Month , •
• . 111
^^' ;4,
®'
rim
Month• • • .
°e
�
=

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?
Q 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? Q 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.
IOperator in Responsible Charge (ORC) Certification II Permittee Certification I
ORC: Randall Parker
Certification No.: 996843
Grade: SI Phone Number: 252-287-4153
Has the ORC changed since the previous NDARA? ❑ Yes 7 No
Permittee:
Pinewood Manor Rest Home
Signing Official: Paula Armstrong
Signing Official's Title: Administrator
Phone Number: 252-513-8591 Permit Exp.: 4/30/20
Signature Date V 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: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: WQ0002096
Facility Name: Pinewood Manor Rest Home
County: Hertford
Month: August
•
•
•
©
1: 11---
------_-_-_-

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.
Water meter not working properly. Water Department changed and replaced with new meter. Will Hart was notified.
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 0 No
Phone Number: 252-513-8591 Permit Expiration: 4/30/2020
A2
9 2-Y
Signature
Date
Sign re 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