WQ0002096_Monitoring - 11-2020_20210311

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: WQ0002096
Facility Name: Pinewood Manor Rest Home
County: Hertford
Month: November
Year: 2020
PPI: 001
Flow Measuring Point: ] Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point: J Influent ❑ Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code -►
50050
00400
00310
31616
00530
00610
00625
00630
00665
-
°
Q E
00
C
0
E ;
0
3
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=
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m
m°
LL o
U
°
M a :o
oa
N
cc_E
°
E
Q
L
�d o°rn
o Z
+y
Z z
N
m rN
_o
r-
a
24-hr
hrs
GPD
su
mg/L
#/100 mL
mg/L
mg/L
mg/L
mg/L
mg/L
1
09:00
0.5
1,410
2
1,410
3
09:30
0.5
1,410
4
1,410
5
15:00
0.5
1,410
6
1,410
7
1,410
8
1,410
9
08:00
1.5
1,410
10
1,410
11
09:00
0.5
1,410
121
09:00
0.5
1,410
13
10:00
0.5
1,410
14
15:00
0.5
1,410
15
09:00
0.5
1,410
16
1,410
17
15:00
0.5
1,410
18
1,410
19
1,410
20
10:00
0.5
1,410
21
1,410
22
1,410
23
1,410
24
09:00
0.5
1,410
25
15:00
0.5
1,410
26
1,410
27
1,410
281
1,410
29
1,410
30
10:00
0.5
1,410
31
Average:
1,410
Daily Maximum:
1,410
Daily Minimum:
1,410
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
E 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? 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.
meter not working properly. Water Department ch
new meter. Will Hart was n
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 th vious NDMR? ❑ Yes E] No
Phone Number: 252-513-8591 Permit Expiration: 4/30/2020
01
< ZO
Signature Date
Signature Date
By this signature, 1 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: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0002096
Facility Name: Pinewood Manor Rest Home
County: Hertford
Month: November
Year: 20k
Did irrigation
Field Name:
Site1
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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0 cc
J=
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K ° O
J
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
CL
52
0.37
1.83
2
3
C
48
60,000
600
1.66
0.17
4
5
C
59
2.16
6
7
8
9
C
60
10
11
CL
65
5
12
CL
67
2
1.75
13
C
61
60,000
600
1.47
0.15
14
C
61
15
PC
57
16
17
C
56
2
18
19
20
C
60
21
22
23
24
C
49
1.91
84,000
840
1.77
0.13
25
PC
52
36,000
360
0.98
0.16
26
27
28
29
30
CL
69
0.6
2.08
31
Monthly Loading:
84,000
i
1.77
60,000
1.66
36,000
0 98
60,000
1.47
12 Month Floating Total (in):
12.50
,
12.13
i %
9.64
8.44

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Di6ihe 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? ❑ Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 0 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? ❑ 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
ORC: Randall Parker
Certification No.: 996843
Grade: SI Phone Number: 252-287-4153
Has the ORC changed since the previousNNDAR-1? ❑ Yes 7 No
Permittee Certification
Permittee:
Pinewood Manor Rest Home
Signing Official: Paula Armstrong
Signing Officials Title: Administrator
Phone Number: 252-513-8591 Permit Exp.: 4/30/20
Signature Date 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, thataignature
ument 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.: 0111 1••■
Pinewood Manor Rest Home
• - rtfo rd
•nth: November1
1
• irrigation occur
this facility'?
Area (acres):
Area (acres):
at
YES•
• Rate
1
r '. -
--
• '.
• '.
Annual Rate®
Annual Rate (in):
Annual Rate (in):
Annual Rate (in):
--r•. r
- • •. -rYES
NO
Field Irrigated?
•
• r.l-r
•
r1111M •. ••
Monthly Loading:
12 M4,nth Floating Total fin)-

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?
❑ 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?
El 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 I Permittee Certification I
ORC: Randall Parker
Certification No.: 996843
Grade: SI Phone Number: 252-287-4153
Has the ORC ch 9 ince the esovieQs NDAR-1? ❑ Yes (] No
Permittee:
Pinewood Manor Rest Home
Signing Official: Paula Armstrong
Signing Officials 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