WQ0028785_Revised Monitoring - 12-2020_20210119

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0029785
Name of Facility:*
Month:* December
Report Information
Queens Grant WWTF
Type *
Revised - NDMR, NDAR-1, NDAR-2,
NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2020
Upload Document*
QG NDMR & NDAR-2 1.22MB
202012.pdf
FDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Jeremy Lemaire
1" T LUA(At
Reviewer: Williams, Kendall
1 /18/2021
This will be filled in automatically

Is the project number correct?* WQ0028785
Is the monitoring report t: Yes r No
accepted?*
Regional Office* Wilmington
Accepted Date: 1/19/2021

FORM: NDAR-2 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page __�_ Of
Permit No.: WQ0028785
Facility Name: QUEENS GRANT WWTP
County: Pender
Month: December
Year: 2020
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Did infiltration III 1 III Icur at
this facility?
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FORM: NDAR-2 45-16 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page Of
Permit No.: WQ0028785
Facility Name: QUEENS GRANT WWTP
County: Pender
Month: December
Year: 2020
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this facility?
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FORM: NDAR-2 05-16
NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Did the application rates exceed the limits in Attachment B of your permit?
If not a basin, were the sites kept free of vegetation and raked?
If not a basin, were there any instances of effluent ponding in or runoff from the sites?
If a basin, were there any instances of breakout from the berms?
Was the onsite automatically activated standby power source tested and operational?
Page —, of
[Z Compliant F-1 Non -Compliant
R Compliant [:] Non -Compliant
F,_,j Compliant F-1 Non -Compliant
[2] Compliant E] Non -Compliant
[21 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
Permittes Certification
ORC: Darrell James Covington
Permfttee: Queens Grant Rec Association
Certification No.: 1009643
Signing Official: Jim Hepner
Grade: Sl Phone Number: 9104675034
Signing Official's Title: PRESIDENT
Has the ORC changed *nce the previous NDAR-2? El Yes 2 No
Phone Number: Permit Ep.: 2/28/25
Signature Date
Signature Date
By this signature, I certify that this report is acGurrate and complete to the best of my knowledge.
I certify, under penalty of taw, 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

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
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Flow Measuring Point: E] Influent 2 Effluent E] No flow generated
Parameter Monitoring
Point: El Influent Effluent Groundwater Lowering surface water
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page — �'of ?,
Sampling Person(s) Certified Laboratories
Name: Darrell J. Covington I Name: Environmental Chemists, Inc. 37729
Name: 11 Name:
—
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 2 Compliant 0 Non-Gompliant
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
with Ammonia and BOD this mnth were caused by a failed
duliviltzi) Ldwil. rNuawl duumul1w wita:ib if
valve in the Nxclear basin. Additional sampling was done while
Valves have been
Operator in Responsible Charge (ORC) Certification Perm Ittee Certification
ORC: Darrell J. Covington Permittee: Queens Grant Rec Association
Certification No.: WW 4:1002814/ SS: 1005107 Signing Official: Jim Hepner
Grade. 41SS Phone Number: 910 467-5034 Signing Official's Title: President
Has the ORC changed since the previous NDMR? El Yes [D No Phone Number: LY;n Permit Expiration: 2/28/2025
Signature Date Signature Date
By this signature, I certify that this report is accurrater 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