WQ0028785_Monitoring - 05-2021_20210707

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0028785
Name of Facility:*
Month:* May
Report Information
Queens Grant WWTP
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
WWTP- NDMR & NDAR - 2.03MB
202105. 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
Reviewer: Saunders, Erickson G
7/7/2021
This w ill be filled in automatically

Is the project number correct?* WQ0028785
Is the monitoring report t: Yes r No
accepted?*
Regional Office* Wilmington
Accepted Date: 7/16/2021

Permit no.: W00028785

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page � Of
Sampling Person(s)
Name: Darrell J. Covington
Name:
Certified Laboratories
Name: Environmental Chemists, Inc. 37729
F, 1=1 7
Does all monkatft data and sampling frequencies meet the requirements in Attachment A of your permit? 2 Compliant 0 NonComplliiirdt
If the facility is non -compliant, please explain in the space below the frrlsh ) the ftwity 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.
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Operator In Responsible Charge (ORC) Certification
Permittee Certification
ORC: Darrell J. Covington
Permittee: Queens Grant Rec Association
Certification No.: WW 4* 1002814/ SS: 1005107
Signing Official: Jim Hepner
Grade. 4/SS Phone Number: 910 467-5034
Signing otficiars Title: President
Has the ORC changed since the previous NDMR? F1 Yes El No
Phone Number: Permit Expiration: 2/28/2025
Signature Date
Signature Date
By this signature, I certify that this report is accurratesid 4otr I I* the best of my knowledge.
I certify, under penalty of low, that this document and all attachments were prepared under my direction or super4hdon in
accordance vwM a system designed 30 assure OW all qualified personnel property gdhwod and evaluated the killurmation
submitted. Based on my incluiry of the person or persons who manage the system, wftw 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 Dud there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
lvxw*v violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

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FORM: NDAR-2 05-16
7e
IISCHARGE APPLICATION REPORT (NDAR-2) Page _t_­of4"
Did the application rates exceed the limits in Attach
If not a basin, were the sites kept free of vegetation
If not a basin, were there any instances of effluent 1
If a basin, were there any instances of breakout froi
Was the onsite automatically activated standby pov
If the facility is non -compliant, please explain in the space below the reas(
ent B of your permit?
Q Compliant
E] Non -Compliant
rid raked?
R1 compliant
E] Non -Compliant
riding in or runoff from the sites?
F, compliant
E] Non -Compliant
the berms?
[2] Compliant
E] Non -Compliant
r source tested and operational?
E Compliant
E] Non -Compliant
;) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and
describe the corrective
tion(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certificatior
Permittee Certification
ORC: Darrell James Covington
Permiftee:
Queens Grant Rec Association
Certification No.: 1009643
Signing Official: Jim Hepner
Grade: SI Phone Number: 9104675034
Signing Official's Title: PRESIDENT
Has the ORC ch ged since the previous NDAR-2? El Yes 2
ll o
Phone Number: Permit Exp.: 2/28/25
Date
Signature
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of m
, 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