WQ0002096_Monitoring - 01-2021_20210305

FARM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: W00002096
Facility Name: Pinewood Manor Rest Home
County: Hertford
Month: January
Year: 2021
PPI: 001
Flow Measuring Point: ❑ Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point: ❑ Influent ❑ Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code - 0
50050
00400
00310
31616
00530
00610
00625
00630
00665
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Z Z
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F- O
L
a
24-hr
hrs
GPD
su
mg/L
#/100 mL
mg/L
mg/L
mg/L
mg/L
mg/L
1
10:00
0.5
1,565
2
09:00
0.5
1,565
3
09:00
0.5
1,565
4
1,565
5
09:00
0.5
1,565
6
14:00
0.5
1,565
7
15:00
0.5
1,565
8
1,565
9
1,565
10
1,565
11
1,565
12
1,565
13
1,565
I
14
1,565
15
15:00
0.5
1,565
16
1,565
17
15:00
0.5
1,565
18
15:00
0.5
1,565
19
1,565
201
15:00
0.5
j 1,565
21
1,565
22
15:00
0.5
1,565
23
1,565
24
1,565
25
1,565
26
1,565
27
1,565
28
1,565
29
15:00
0.5
1,565
30
1,565
311
10:00
0.5
1,565
Average:
1,565
Daily Maximum:
1,565
Daily Minimum:
1,565
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? 2 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 NDMR? ❑ yes Q No
Phone Number: 252-513-8591 Permit Expiration: 4/30/2020
rpajll�o_
ig ature 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, th is 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.: W00002096
Facility Name: Pinewood Manor Rest Home
County: Hertford
Month: January
Year: 2021
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?
❑ YES r NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YES ❑ NO
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°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
R
47
1.1
2
PC
65
0.9
1.75
3
R
49
0.6
4
5
C
36
1.66
42,000
1 420
1.15
0,16
6
C
43
1.91
7
C
45
2.08
42,000
420
1.03
0.15
8
9
10
11
12
13
14
15
R
41
0.3
1.75
16
17
C
46
1.66
54,000
540
1.50
0.17
18
C
44
19
20
C
42
21
22
C
44
2.16
54,000
540
1.14
0.13
23
24
25
26
27
28
29
C
33
1.75
30
31
R
40
1.6
Monthly Loading:
54,000
1.14
54,000
1.50
42,000
1.15
42,000
1.03
12 Month Floating Total (in):
11.66
12.61
10.59
10.36

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?
E Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑ Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? E] Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ❑ Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? [Z 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 II Permittee Certification I
ORC: Randall Parker
Certification No.: 996843
Grade: SI Phone Number: 252-287-4153
Has the ORC ch999d since the previous NDAR-1? ❑ yes 2 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 Officials Title: Administrator
Phone Number: 252-513-8591 Permit Exp.: 4/30/20
a�
oignatre 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.: 11111 1••
••• Manor Rest•
• • •
• y
1
• irrigation occur
at this facilit
..
Area (acres):,
Area (acres):
YES•
• '.
1
• '.
• '.
• '.
I
Monthly•.• •
�.,.
1 ••
111
c F.9�,
1 •1
�����
111

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? ❑ Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 21 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? 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.
Operator in Responsible Charge (ORC) Certification I Permittee Certification I
ORC: Randall Parker
Certification No.: 996843
Grade: SI Phone Number: 252-287-4153
Has the ORC changed since the previous NDAR-1? ❑ Yes 7 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
r
r
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