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Home My WebLink AboutWQ0024577_Monitoring - 01-2021_20210225Monitoring Report Submittal ............................................................................................................................................. Permit Number #* WWO024577 Name of Facility:* Month:* January Report Information Suttons Retirement Center Type * NDMR, NDAR-1, NDAR-2, NDMLR Confirmation Email Address:* Name of Submitter:* Signature: Date of submittal: Initial Review Year:* 2021 Upload Document* Water reports.pdf 580.32KB FDF only Please upload one PDF containing all applicable monitoring reports (i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59). suttonsresthome@bellsouth.net Kristen Tingen Reviewer: Williams, Kendall 2/24/2021 This will be filled in automatically Is the project number correct? * WQ0024577 Is the monitoring report r Yes r No accepted?* Regional Office * Washington Accepted Date: 2/25/2021 FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page Permit No.: Q11 • Retirement C- - Did irrigation occur at this . • 0 YES El NO FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of 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? ❑ compliant ❑ Non -compliant ❑ compliant ❑ Non -compliant ❑ compliant ❑ Non -compliant ❑ compliant ❑ Non -compliant ❑ 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: Gary C Sutton Permittee: Sutton's Rest Home Certification No.: 989283 Signing Official: Gary C Sutton Grade: SI Phone Number: 919-738-2236 Signing Official's Title: Owner Has the ORC changed since the previous NDAR-1? ❑ Yes ❑ No Phone Number: 919-738-2236 Permit Exp.: 1/1/24 2/24/21 2/24/21 ure 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 FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of Raleigh, North Carolina 27699-1617 FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of Sampling Person(s) Certified Laboratories Name: Gary C Sutton Name: Environment One 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. Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Gary C Sutton Permittee: Sutton's Rest Home Certification No.: 989283 Signing Official: Gary C Sutton Grade: SI Phone Number: 919-738-2236 Signing Official's Title: Owner Has the ORC changed since the previous NDMR? ❑ Yes ❑ No Phone Number: 919-738-2236 Permit Expiration: 1/1/2024 2/24/2021 A 2/24/2021 V IX Signature Date I ture 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 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of Permit No.: Q11 •n's Retirement C- - . - . Flow Measuring Point: El Influent El Effluent [:1 No flow generated Parameter Monitoring Point: LJ Influent Effluent Groundwater Lowering El surface water Parameter Code I. • •