WQ0024577_Monitoring - 06-2021_20210726

Permit #: * W WO024577
Name of Facility:* Suttons Retirement Center
Month:* June Year:* 2021
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR wg0024577 ndar & ndmr 412.32KB
june.pdf
FCF Cny
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* Kristen Tingen
Signature:*
Submittal Date: 7/26/2021
VW91 be filled out autoneticaly.

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Permit No.: Q11
• Retirement C- -
-
-
1
Did irrigation
occur
at this . •
YES 0 NO
Monthly Loading:
OF
OF
FIF
0/F
12 Month Floating Total
�0FFl.

FORM: NDAR-1 05-16
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page of
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 site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
❑� compliant ❑ Non -compliant
❑� compliant ❑ Non -compliant
❑� compliant ❑ Non -compliant
❑� compliant ❑ Non -compliant
❑� 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: Gary C Sutton
Permittee:
Sutton's Rest Home
Certification No.: 989283
Signing Official: Gary C Sutton
Grade: SI Phone Number: 919-738-2236
Signing Official's Title: Owner
Has the ORC changed since the previous NDAR-1? ❑ yes ❑� No
Phone Number: 919-738-2236 Permit Exp.: 1/1/24
v
v 7/22/21
7/22/21
Signature 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, 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: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: W00024577
Facility Name: Sutton's Retirement Center WWTF
County: Wayne
Month: July
Year: 2021
PPI: 001
Flow Measuring Point: ❑ Influent 0 Effluent ❑ No flow generated
Parameter Monitoring Point: El Influent ❑✓ Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code No
50050
00310
00940
50060
31616
00610
00625
00620
00600
00400
00665
70300
00530
=
a
~�
W
O
co
N-ii
N
W U
E
v
lL O
U
•R
O
s
C
G
tm
weWV)
z
H
te
a-.
z
C W
a
zCO
=
V)
L
Oy
00
a
WE 2
aE
- O
0
'OVa)'a
Y 'aGu)r
F-
24-hr
hrs
GPD
mg/L
mg/L
mg/L
#/100 mL
mg/L
mg/L
mg/L
mg/L
su
mg/L
mg/L
mg/L
1
08:00
1 hr
1,510
2
1,510
3
1,510
4
1,510
5
09:00
1 hr
1,510
61
1,510
7
1,510
8
1,510
9
09:00
1 hr
1,510
10
1,510
11
1,510
121
1,510
13
1,510
14
1,510
15
1,510
16
1,510
17
1,510
18
1,510
19
09:00
1 hr
1,510
20
1,510
21
09:00
1 hr
1,510
22
1,510
23
1,510
24
1,510
25
09:00
1 hr
1,510
26
1,510
27
1,510
281
1,510
29
1,510
30
09:00
1 hr
1,510
31
1
1,510
Average:
1,510
Daily Maximum:
1,510
Daily Minimum:
1,510
Sampling Type:
Estimate
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Monthly Limit:
4,920
Daily Limit:
Sample Frequency:
Monthly
3 X Year
3 X Year
Per Event
3 X Year
3 X Year
3 X Year
3 X Year
3 X Year
Per Event
3 X Year
3 X Year
3 X Year

FORM: NDMR 05-16
NON -DISCHARGE MONITORING REPORT (NDMR)
Page of
Sampling Person(s) Certified Laboratories
Name: Gary C Sutton Name: Environment One
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of 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
Permittee Certification
ORC: Gary C Sutton
Permittee: Sutton's Rest Home
Certification No.: 989283
Signing Official: Gary C Sutton
Grade: SI Phone Number: 919-738-2236
Signing Official's Title: Owner
Has the ORC changed since the previous NDMR? ❑ Yes ❑✓ No
Phone Number: 919-738-2236 Permit Expiration: 1/1/2024
7/22/2021
7/22/2021
Signature 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, 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