WQ0028785_Monitoring - 06-2021_20210718

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0029785
Name of Facility:*
Month:* June
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*
QUEENS GRANT WWTP - 1.2MB
NDMR & NDAR - 202106.pdf
PDF 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
7/18/2021
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: 7/27/2021

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Sampling Person(s) Certified Laboratories
Name: Darrell J. Covington Name: Environmental Chemists, Inc. 37729
Name: Name:
Does all monkwftg data and sampling frequencies meet the requirements in Attachment A of your permit? O compliant 0 Non-Cwpliok
If the facility is non -compliant, please explain in the space below the s an(s) the f1cifty was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
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Operator In Responsible Charge (ORC) Certification
Permittee Certification
ORC: Darrell J. Covington
Peffnittee: Queens Grant Rec Association
Certification No.: WW 4: 1002814/ SS: 1005107
Signing Official: Jim Hepner
Grade: 41SS Phone Number: 910 467-5034
Signing Official's Title: President
Has the ORC changed since the pilevilous NDMR? E] Yet JZ No
Phone Number. Permit Expiration: 2/28/2025
Signature Date
Signature Date
By this signature, I certify that this report is accurate AM ownpleft I* the best of my knowledge.
I certify, under penalty of law, that Oft document and all attachments were prepared under my direction or supemision in
accordance with a system designedlo assure that all quallfied personnel property gedwired and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, arlhow persons directly responsible for
gattlering the information. the Information submitted is, to the best of my WxwAedge 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 114—ources,
Information ProciNdIfig Unit
1647 Mail Service Center
Raleigh, North Carolina 27699-1617

Did infiltration occur at
this facility?
❑ YES p no
Weather Freeboard
28
29
30
31
0.41 0.00 *DIV/bl #DIV/01

FORM: NDAR-2 05-16 NON
Did the application rates exceed the limits in
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(
MARGE APPLICATION REPORT (NDAR-2) Page e- of
t B of your permit? Compliant ❑ Non -Compliant
raked? Compliant ❑ Non -Compliant
inding in or runoff from the sites? 2 Compliant Ej Non -Compliant
the berms? E Compliant ❑ Non -Compliant
r source tested and operational? [Z Compliant ❑ Non -Compliant
s) 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
Permittee:
Queens Grant Rec Association
Certification No.: 1009643
Signing Official: Jim Hepner
Grade: SI Phone Number: 9104675034
Signing Official's Title: PRESIDENT
Has the ORC changed since the previous NDAR-2? [I Yes �
to
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