WQ0000948_Monitoring - 12-2020_20210122

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 of
k Permit No.: WQ0000948
Facility Name: Town of Jackson WWTF
County; Northampton ;i�
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Measuring Point: Elirfluent EZEftluent ___Aa flow perierated
'Parameter Monitoring
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FORM: HDIVIR 03-12 NOM-D1SCf<-1ARf3r IVItr9Pd11'CDRiNG REPOiTF (NDMR) Page 1 of 1
Sampling Person(s) Certified Laboratories
Mama: Johnny Young Monte: Dnvirormmt 1, Inc. Greenville, N C
Flame: Flame:
Does 7qQ cknvn and e,~Imp6iIno iliac r,'L��tln�f'radb��t��� 8Gt s'!�°a���GtB�a�Ht ®a y09Ai' Ca@G'ovtR? ❑ Compliant Amon-compliont
if the facility is non -compliant, please explain in tile 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) iallen. Attach additional sheets if necessary. _
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operator In Respotnsible Charge (011C) Certification Permittes Cert-Ifieation
ORC: Johnny Young Permittee: Town of Jackson
Certification No.: 2-3129 Signing ofGicial: Jason S. Morris
Grade: 1 Collection Phoile Mumber: 252-53!+ 3811 Signing official's Title: Mayor
Has the ORC changed since the previous NDNIR? ❑ Yes kANo Phone number: 252-534-3811 Permit Expiration.
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Date Signature . Date
13y Nis signelure, I cargo Unit Oft roped Is accurrale and complete to ilia bast of my hnowledgo. I Ify, under penally of lawn, that this document and all atloclunonls were prepared under my dlracllon or supervision in
accordance with a system designed to ensure nioi all quallned personnel propoily gathered and evaluated Ilia Information
subailllod, eased on my Inquiry of the person or persons who monago ilia syotam, or iliona persona directly responsible for
galhoring Ilia infonnanon, ilia Information submitted In, to the beat of my Ienoedodga and ballot, Imo, accurate, and aomplalo. i am
avraro that there are significant penalties for submitting false information, including Ilia possibility of lines and Imprisonment far
Ino{ving violations,
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Mail Original and 7vuo Copies to:
Division of Water Quality
InVarmation Processing Unit
>16'17 Mail Service Center
Raleigh, Morth Carolina 27699.1617

fORM: NDAR-1 05-18 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _, of ,�_
Permit No.: Q011 •4i.'
Facility Name: Town of Jacksony:
Northampton
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Did irrigation occurl
at this facility?
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FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 2 of .1,
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FORM: NDAR-1 09-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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 rite?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
Page
1 of 1
O Compliant
❑ Non -Compliant
WJ Compllant
❑ Non-l:ompfiant
e Compliant
❑ Non -Compliant
e Compliant
❑ Non -Compliant
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: Johnny G. Young �
Permlttee: Town of Jackson
Certification No.: 2 312 9
Signing Official: Jason S. Morris
Grade:1 collection Phone Number: 2 5 2- 5 3 4- 3 811
Signing Official's Title: Mayor
Has the ORC changed since the previous NDAR-1? ❑ Yes IN No
Phone Number: 2 5 2 - 5 3 4 - 3811 Permit Exp.: 12-31—*V
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i Date
CSignature Date
By this signature, I certify that this report Is aceurrate and complete to fire best of my knowledge.
1 certify, under penally of low, that this document and all attachments were prepared under my direction or supervision In accordance
w(lh a system designed to assure that all qualified personnel properly gathered and evaluated the Information submitted. Based on my
Inquiry of the.parson 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 Informalion, including the possibility of fines and Imprisonment for knowing violations,
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617