wq0002056_Monitoring - 10-2021_20211116

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * October
Report Information
wg0002056
Patroits Place
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
PP MHP 10-2021.pdf 300.34KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Mikel Seely
Reviewer: Saunders, Erickson G
11 /16/2021
This will be filled in automatically

Is the project number correct?* wg0002056
Is the monitoring report accepted?* Yes No
Regional Office* Wilmington
Accepted Date:
12/2/2021

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.; Q111 156
Facility Name: Patriots Place Mobile Home Park
Countf. Onslow
Measuring Point CLORM Offluent E]No flow generated
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) Certified Laboratories
Name: Mikes Seely Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
Page
❑p Compliant
of
[]Non-t ompWat
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 colrecdve
action(s) taken. Attach additional sheets If necessary.
Operator In Responsible Charge (ORC) Certification Permlttee Certification
ORC: Mikel Seely Penmktes: Michael Smith
Certification No.: 1004691 Signing Official: Michael Smith
Grade: SI Phone Number: 910-330-8011 Signing Official's Title: Park Manager
Has the ORC changed since the previous NDMR? OYes [21No Phone Number. 423-278-2591 Permit Expiration: 6/30/2026
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Signature Date 1 Signature Date
By this signature, I cenffythat this report is aocumata and complete to the best of my imovrWp. I certify, under penalty of law, that this document and all atudments were prepared under my direction or supervision In
accordance with a system designed to assure that as que Pied pemorsei property gadered end evaluated the infometion
submitted. Based on my inquiry of the person or persons who manage the system. orthose persons directly responsble for
gathering the information, the kdonnation submllted is. to the beat of my knowbdge and belief, true, wwrete, and complete. I am
aware that there are significant penalties for sLbmittkV false information. inducting the possibility d fires and imprisonment for
knowing violations.
Mali Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mall Service Center
Raleigh, North Carolina 27699-1617

Facility Name: Patriots Place Mobile Home Park County: Onslow
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR4) Page of
Did the application rates exceed the limits in Attachment B of your permit? Bcomplant ❑N«r-canal�nt
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? I]complant ❑Non-Comptlitrrt
Was a suitable vegetative cover maintained on all sites as specified in your permit? pcompllant ❑NW-Compbnt
Were all setbacks listed in your permit maintained for every application to each permitted site? Ocompmant ❑Nan -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? pcomplaat ❑Noe-comptlant
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
actlonts) wen. muracn auutuwat arntmrs n
Operator In Responsible Charge (ORC) Cerdficadon
ORC: Mikel Seely
Certification No.: 1004691
Grade: SI Phone Number: 910-330-8011
Has the ORC changed since the previous NDAR-14 ❑yo s ❑+ No
'./L-2
Signature Date
By this signature. I certify that this report Is aco crate and complete to the beat of my knowledge.
Permitiee Certification
Permlttee:
Michael Smith
Signing Official: Michael Smith
Signing Ofliclars Tide: Park Manager
Phone Number: 423-278-2591 Permit exp.: 6/30/26
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Signature Date
I certify, under pen* of low, that this document and at attachments were prepared under my direction or supervision in accordanoe
with a system designed to assure that all qualified personnel property gathered end evaluated the IMormadon submitted. Based on my
inquiry of the person or persons who manage the system, or those persons dredy responsible for yethsrkV 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
penallies for submitting false Information, Including the possibility of fines and Imprisonment for knowing vloletkm.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing unit
1617 Mall Service Center
Raleigh, North Carolina 27699-1617